The Contribution of Cognitive Analytic Therapy to the Treatment of Borderline Personality Disorder

Abstract

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.

Dismissing and preoccupied insecure attachment and procedures in CAT: Some implications for CAT practice

“…Ryle's commentary on Holmes' reappraisal of AT (Holmes, 1994;Ryle, 1995b) criticized AT for its failure to acknowledge fully the central importance of such jointly created signs in human development, drawing on Leiman's (1992) reworking of ideas from Winnicott, Vygotsky and Bakhtin (see also Ryle, 1997b). Ryle's (1995b) paper also contrasted AT unfavourably with recent developmental psychology research into 'intersubjectivity', (e.g.…”

“…The current Guy's Hospital borderline protocol (Ryle, 1997b) involves four follow-up sessions extended over 6 months, after an initial 16-24 weekly sessions. Perhaps, with some of the most damaged patients, a model not unlike that described by Byng-Hall (1999) could be employed.…”

Effectiveness of an emotion regulation group training for adolescents—a randomized controlled pilot study

“…To our knowledge, there are only two interventions thus far studied in borderline youth. Cognitive analytic therapy (CAT) (Ryle, 2004) was developed for the treatment of adults with BPD. CAT consists of 16-24 weekly individual sessions and uses elements of psychoanalytic object relations theory and cognitive psychology.…”

Primhe: Primary Care Mental Health and Education

“…16 The psychological therapies with some evidence to demonstrate their effectiveness include: dialectical behaviour therapy; 6,17 therapeutic communities; 18 psychodynamic psychotherapies; 19 mentalisationbased therapy; 5 cognitive analytic therapy; 20 and cognitive behavioural therapy. 21 Studies on the effectiveness of these treatments have reported improvements in terms of reduced suicide attempts and selfharm behaviours, reduced use of a range of health services and reduced readmission rates to psychiatric wards.…”