ABSTRACT
In this chapter I will consider the application of CAT principles to working with older people with personality-based problems, both as an individual and couple therapy as well as a theoretical model to inform discussion in a case conference setting – what I will call ‘Systemic CAT’. The older people who may benefit from these approaches have problems stemming from their earlier lives, often as a result of emotionally depriving or abusive relationships in their childhoods, and have symptoms and behaviours that appear in the DSM IV definition of borderline personality disorder (APA 1994). This is not to say that these people have had long psychiatric careers with frequent admissions and self-harm; many seem to have coped through their middle years only to ‘regress’ back to more primitive ways of coping when faced with cumulative loss in later life. The distress for these people is often severe and destructive. Those who work in mental health services for older people will quickly recall people who fall into this group and how challenging, emotionally draining and resource-consuming is the support that they need. It is my hope that this chapter will at least draw together some common themes of working with this group of older people and provide an understandable theoretical base for this challenging work.
