The author outlines 6 years of once-weekly therapy with the patient. Cognitive-behavioral techniques were used to provide a concrete, external structure to increase the patient's sense of self-control, self-efficacy, and self-confidence. Working in this way allows some of the expertise in the therapist to be directly handed over to the patient in the form of specific techniques and educational reading materials. When working with complex cases, however, the author's experience suggests that cognitive- behavioral approaches must be underpinned by a working knowledge of psychodynamic theory, particularly that relating to object relations and to transference and counter-transference phenomena. Without this, patients often fail to engage in treatment, or, if they do, may fail to benefit, or may even experience therapy as further abuse. An overly rigid, inflexible approach can also result in denigrating the patient. Work with such patients requires that the therapist be able to stay with very difficult experiences and material and struggle to foster an understanding of complex damaged aspects of the personality. It also requires an ability to maintain a dialog with those who may have lost any belief that they can be understood or that their lives can be different. In the case presented in this paper, treatment ended as designed after 18 months. Although there continued to be occasional periods of acting-out in the form of drinking relapses, these were brief and far less destructive than previously.