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This article describes ways the theory and practice of cognitive analytic therapy (CAT) can contribute to the treatment and management of patients with borderline personality disorder (BPD). CAT, as its name suggests, was derived initially from an integration of conventionally opposed models. From the beginning, it was delivered within a limited timeframe, usually of 16 weekly sessions, extended to 24 in the case of more disturbed patients. Over time, on the basis of clinical experience, conceptual debate, and research, it has evolved into a general theory and has demonstrated itself to be of value over a wide range of conditions and contexts. The evolution of the basic theory and practice of CAT over the past 25 years is summarized, followed by a description of the theoretical developments concerned specifically with BPD. The techniques used in the individual psychotherapy of borderline patients are described in detail and illustrated with case material. The application of methods and understandings derived from individual therapy to staff supervision and the treatment and management of patients in day hospitals, therapeutic communities, and community mental health centers is then considered. A final section describes research contributions to the development and evaluation of CAT with borderline patients.
THE EVOLUTION AND THE BASIC FEATURES OF COGNITIVE ANALYTIC THERAPY: ORIGINS IN OUTCOME RESEARCH
Cognitive analytic therapy (CAT) originated 25 years ago as a by-product of research aiming to develop ways of formulating the goals of dynamic therapy for the purposes of outcome research. Although behavior therapy can define its aims in terms of observable, easily measurable phenomena and cognitive therapy seeks to change relatively accessible beliefs, psychodynamic therapies seek more complex changes concerned with both the content and structure of the mind as manifest in experience and in how lives are lived. I had many reservations about the theoretical constructions of the various psychoanalytic schools and doubts about the effectiveness of the long-term therapies based on their theories but I believed that the wider aims and sometimes the achievements of dynamic therapies were correctly concerned with the existential realities and complex difficulties of human life and I regretted the paucity of research into its effectiveness. Such research was, and to an extent still is, hampered by the conceptual contradictions and confusions found within the...