Exploring the Impact of Interventions in Cognitive Analytic Therapy

  • Stephen Bradley

Student thesis: Doctor of Clinical Psychology


The aim of this thesis was to understand more about the potential impact of interventions in Cognitive Analytic Therapy (CAT). The thesis is presented in three separate papers. Paper one is a systematic review of quantitative and qualitative literature exploring the impact of reformulation in CAT. Following a standardised approach, four databases were searched and a sample of 20 papers were identified. Results suggest there is a real lack of consistency between quantitative and qualitative studies. Across a series of small-scale non-controlled studies evidence of symptom change following reformulation was mixed. In the only controlled study identified in the area, the inclusion of narrative reformulation within CAT was not associated with any treatment benefit. Positive features of reformulation were reported in qualitative studies. These included how it helped guide perceived change, provided clarity and understanding for clients and supported the therapeutic relationship. Paper Two is an empirical investigation examining the feasibility and acceptability of CATCH (Cognitive Analytic Therapy Containment of Self-Harm) as a brief intervention for people with non-suicidal self-injury (NSSI) and as a preliminary evaluation regarding the efficacy of the approach on depression, self-compassion and urges to self-injure. A two arm (CATCH plus Treatment as Usual (TAU) and TAU alone) open feasibility randomised controlled trial (RCT) with 14 participants was conducted. Results suggest CATCH is feasible and safe for use with people with NSSI. Clinical outcomes suggest evidence of improvements in depression for participants in CATCH plus TAU and deterioration for participants in TAU. There was evidence of improvement in urges to self-injure for both groups. This reduction was more marked for the CATCH group. There was a small and similar improvement in self-compassion for both group. Finally, Paper Three is a critical reflection of the process involved in conducting the project. It includes reflections on methodological approaches used, strengths, limitations and implications of the findings for research and clinical practice. The paper concludes with personal reflections on the endeavour of completing this thesis.
Date of Award31 Dec 2021
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorPeter Taylor (Supervisor)


  • Self-harm
  • Cognitive Analytic Therapy
  • Non-suicidal self-injury
  • Brief therapy

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