CAT Identification — MRCPsych Paper B MCQ

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HardPsychotherapyCAT IdentificationMRCPsych Paper B

In a time-limited individual psychotherapy, the therapist and patient collaboratively produce written and diagrammatic reformulations of recurrent reciprocal role procedures. Target problem procedures are classified as traps, dilemmas or snags; these are first recognised and then revised by developing alternative “exits”. Which psychotherapy is being described?

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Correct answer: C — Cognitive analytic therapy

The answer is **cognitive analytic therapy (CAT)**. Its distinctive features include collaborative narrative and sequential diagrammatic reformulation, mapping of reciprocal role procedures, and identification of target problem procedures as traps, dilemmas and snags. Treatment moves through reformulation, recognition and revision, with healthier alternatives described as “exits”. CBT commonly uses cognitive restructuring and behavioural experiments but not this terminology. DBT is organised around behavioural targets and skills modules such as mindfulness and distress tolerance. MBT focuses on restoring mentalising during interpersonal and emotional arousal. Schema therapy works with early maladaptive schemas, modes and limited reparenting. Although these therapies may all examine recurrent patterns, the combined use of reciprocal roles, traps, dilemmas, snags and exits specifically identifies CAT.

Reference: Gaskell C, Taylor P, Airnes Z, Kellett S. Change to the recognition and revision of target problems and target problem procedures during eight-session cognitive analytic therapy for self-harm. British Journal of Clinical Psychology. 2026. https://pubmed.ncbi.nlm.nih.gov/42500839/