Borderline Personality Disorder patients are impulsive, unstable and destructive, hurting themselves and those around them, including those who seek to help them. This has resulted in a widespread reluctance to treat them and a pessimism about treatment. In the experience of the authors this pessimism is unjustified, because for many patients a relatively brief intervention can be effective in cost-benefit terms as well as human terms. The interventions illustrated here have been used to treat outpatients for 15 years. The results indicate that treatments can achieve clinically significant changes in the course of 16-24 sessions, in a substantial proportion of patients. While CAT shares some ideas and methods with other approaches, it introduces many new features and is uniquely integrated at both the theoretical and practical level. The early joint reformulation of patients' problems serves to contain destructiveness and to create a working alliance. Also, the use of reformulation to teach self-reflection and avoid collusive responses from the therapist, throughout the therapy, represents a powerful new technique. The book offers a critical appraisal of current ideas and practices, contrasting with these the ways in which CAT mobilizes the patient's own resources. The authors argue that CAT should have a place in any service seeking to help these difficult patients.
Table of Contents:
Diagnosis Course and Prevalence of Borderline Personality Disorder.
The Evolution of Cognitive Analytic Therapy.
The Multiple Self States Model of Borderline Personality Disorder.
A Critical Account of Current Theories of Borderline Pathology and their Clinical Implications.
An Outline of Practice and Two Case Illustrations.
Understanding the Treatment Relationship in Work with Borderline Patients.
Referral, Assessment, Contracts and Containment.
The Early Sessions.
From Reformulation to Termination.
Borderline Personality and Substance Abuse Problems.
CAT of an Offender with Borderline Personality Disorder.
CAT in Context.