It is not clear from the literature whether successful outcomes can be obtained with CBT in chronic, drug refractory patients who require admission to hospital and whose problems date back to childhood. Anecdotal evidence suggests that they can be treated with CBT (e.g. Beck and Freeman, 1990; Young, 1990). However, no detailed reports of successful treatment in this group have been published. The present report will describe the treatment and outcome of one patient, Alison, who was suffering from depression and who was treated with CBT. She had failed to respond to medication and required admission to hospital. She had chronic difficulties that dated back to childhood and had most of the features described by Scott (1992). Her treatment illustrates how the many different aspects of her complex problems could be examined and treated using CBT techniques as these provided a simple way of understanding and dealing with the difficulties she faced.