The Multiple Self States model of CAT was developed in response to practical difficulties encountered in understanding and reformulating patients with Borderline Personality Disorder (BPD).

The impact of 40 sessions of CAT on a woman at the mild end of the borderline spectrum.

A 46-year-old woman, presented with panic attacks and somatization. She was feeling lonely, worried and stressed, had difficulties in engaging in relationships, and needed to be loved. Moreover, she was incapable of coping with real life, afraid to work and used fantasy to avoid real world. CAT was the mainly psychotherapeutic treatment.

Early history revealed emotional deprivation. At first, two self states were identified, labeled “Victim” and “forms of Idealization". Later, a third self state was added labeled “ I am Bad". The use and constant enrichment of the Sequential Diagrammatic Reformulation (SDR) throughout the therapy was very effective in the progress of the therapeutic process, concerning the recognition and revision of the reciprocal roles and the target problems procedures. Once the patient understood the idea of separate partly dissociated self-states she was capable of identifying and characterizing them on the SDR. After session 20 her symptoms almost disappeared, she started to deal with her anger and with her fear to cope with real world.

The use and constant enrichment of SDR throughout the therapy with partly dissociated self states enables a better capacity for self reflection and integration. It seems that a long term CAT for BPD patients is more beneficial.