If you’ve been looking for therapy, you’ve probably met both acronyms — CBT and CAT — without much that explains the difference in plain terms. Here’s how I’d put it.

The short version

CBT (Cognitive Behavioural Therapy) works the present-tense loop: the cycle of thoughts, feelings, and behaviour keeping a problem going now. CAT (Cognitive Analytic Therapy) works the pattern underneath: the way of relating to yourself and others, usually learned early, that keeps reasserting itself. Both are evidence-based and time-limited. They’re not rivals — they suit different shapes of problem.

What CBT does best

CBT is the most direct route when the problem is specific and current — panic, a phobia, generalised worry, a recent low patch, OCD. It’s practical and testable: we map the loop, run behavioural experiments to check what fear predicts against what happens, use exposure to loosen avoidance, and examine the thoughts that don’t hold up. It’s the talking therapy NICE recommends first for anxiety and depression, and you can usually feel it working within a handful of sessions.

Its honest limit: when the real issue is an old, repeating pattern rather than a present-day cycle, CBT can feel like it’s working on the surface while the deeper thing stays put.

What CAT does best

CAT is built for the I keep ending up here problems — the same kind of relationship, the same dead end, difficulty bound up with how you treat yourself. It names those patterns as reciprocal roles, and early on I write you a reformulation letter setting out how they formed and what keeps them going. From there we map them and work out the exits.

Its honest limit: for a single, discrete, present-day problem, CAT can be more than you need — CBT will often get you there more directly.

How to tell which fits

A rough guide:

A specific, current problem held in place by a present-tense cycle → usually CBT.
A pattern that repeats across relationships and time, or tied to how you see yourself → usually CAT.
Trauma or PTSD → often EMDR or trauma-focused CBT (see Trauma & PTSD).
Plenty of people need a bit of both, and that’s fine.

You don’t have to work this out alone

Choosing the right approach is part of the job, not a test you pass first. In a free 15-minute call, or the first session, we look at what you’re actually bringing and decide together — and I’ll tell you plainly which I think fits, and why. More on how I work.