Reformulation letters in cognitive analytic therapy: The practitioner's experience

Erlend Slettevold (Lead Author), Paul Fisher, Adrian Leddy

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Objectives: The aim of this study was to explore (1) cognitive analytic therapy (CAT) practitioners' experiences of receiving their own reformulation letter as part of their training and (2) CAT practitioners' perceptions about how receiving their own reformulation letter altered their clinical practice.
Design: Semi-structured interviews were used to elicit participants' (N= 9) experiences of having received their personal CAT, with a particular focus on the reformulation letter, and their perceptions of its impact on them as clinicians and their clinical practice.
Methods: Inductive “bottom up” thematic analysis was used to analyse the interview transcripts and extract overarching themes and subthemes across all participants.
Results: Four overarching themes emerged from the data: the power of the reformulation letter; inhabiting the client's role; absorbing thinking as a CAT practitioner; and evolving the therapist's technique.
Conclusions: Cognitive analytic therapy practitioners report experiences of the reformulation letter that indicate a positive impact on their self-awareness, learning about CAT and consciousness about how their own clients experience therapy. This was also the case when the reformulation letter did not resonate with them to the desired extent as learning from their therapist's limitations was experienced as having an impact on their learning and subsequent practice.
Original languageEnglish
Pages (from-to)308-316
Number of pages9
JournalCounselling and Psychotherapy Research
Issue number1
Early online date5 Jun 2023
Publication statusPublished - Mar 2024


  • cognitive analytic therapy
  • personal therapy
  • practitioner training
  • reformulation
  • therapeutic letters

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