Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method

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. From a review of Cognitive Analytic Therapy: Developments in Theory and Practice (Anthony Ryle (Editor), 1995): "Ryle is surely the most original, productive and interesting writer in psychotherapy in Britain today, and CAT is a remarkable systematizing achievement which deserves to be better known on the other side of the Atlantic This book documenting CAT s recent theoretical and practical developments is a must for anyone interested in CAT itself and in integrative approaches, for those interested in brief, psychodynamically informed therapy, or indeed for those interested in developments in psychology generally." Robert Rentoul, British Journal of Medical Psychology