ABSTRACT
A key feature of those with borderline personality disorder and narcissistic personality disorder is a pattern of unstable mood states and chaotic interpersonal relationship patterns, and these patterns will inevitably present within the therapeutic relationship. Some clients can present with complex difficulties that impact on the delivery of Cognitive Analytic Therapy (CAT) and necessitate particular attention. Drawing out these different self states with their associated mood and reciprocal role procedures in the form of self state sequential diagrammatic reformulation offered a different way of understanding and working with these clients. A client who had pattern of self-harming every time her key worker in the Community Mental Health Team went on annual leave was helped early on in her CAT therapy to understand this behaviour. In understanding personality disorder in terms of personality fragmentation, as indicated by dissociation and state shifts, CAT makes integration an explicit aim of therapy through direct methods, which encourage the development of greater self-awareness and control.
