Treatment of obsessive morbid jealousy with cognitive analytic therapy: An adjudicated hermeneutic single-case efficacy design evaluation

Psychol Psychother. 2018 Mar;91(1):95-116. doi: 10.1111/papt.12151. Epub 2017 Oct 9.


Objective: The evidence base for the treatment of morbid jealousy with integrative therapies is thin. This study explored the efficacy of cognitive analytic therapy (CAT).

Design: An adjudicated hermeneutic single-case efficacy design evaluated the cognitive analytic treatment of a patient meeting diagnostic criteria for obsessive morbid jealousy.

Method: A rich case record was developed using a matrix of nomothetic and ideographic quantitative and qualitative outcomes. This record was then debated by sceptic and affirmative research teams. Experienced psychotherapy researchers acted as judges, assessed the original case record, and heard the affirmative-versus-sceptic debate. Judges pronounced an opinion regarding the efficacy of the therapy.

Results: The efficacy of CAT was supported by all three judges. Each ruled that change had occurred due to the action of the therapy, beyond any level of reasonable doubt.

Conclusions: This research demonstrates the potential usefulness of CAT in treating morbid jealousy and suggests that CAT is conceptually well suited. Suggestions for future clinical and research directions are provided.

Practitioner points: The relational approach of CAT makes it a suitable therapy for morbid jealousy. The narrative reformulation component of CAT appears to facilitate early change in chronic jealousy patterns. It is helpful for therapists during sessions to use CAT theory to diagrammatically spell out the patterns maintaining jealousy.

Keywords: cognitive analytic therapy; hermeneutic; morbid jealousy; outcome.

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Delusions / psychology
  • Delusions / therapy*
  • Female
  • Hermeneutics
  • Humans
  • Jealousy*
  • Obsessive Behavior / psychology
  • Obsessive Behavior / therapy*