Abstract
Research concerning the influence of core interpersonal patterns related to childhood trauma on the therapeutic process is scarce. We investigated interpersonal patterns at the start of treatment, changes in interpersonal patterns as treatment progressed, and the change process in a mixed-methods single case study of a supportive-expressive psychodynamic psychotherapy with a 33-year-old female with a history of childhood trauma. The patient showed a pervasive inability to open up towards others throughout the entire treatment, which is closely associated with others’ actual or anticipated rejection, disrespect and disinterest. Excessive use of expressive interventions, which target interpersonal change, initially led to a worsening of the patient’s condition. Via supportive and general interventions, symptom stabilization was achieved. The findings of this study suggest a thorough understanding of dominant interpersonal patterns is necessary to recognize their influence on the therapy process.
Highlights
Van Nieuwenhove et al: The Influence of Interpersonal Patterns on the Therapy Process in a Case of Childhood Trauma (Wadsworth, 2004) and the Core Conflictual Relationship Theme (CCRT) in psychodynamic psychotherapy (Luborsky, 1984)
Following the clinical predicament of the therapeutic relationship being marked by a fundamental distrust, several researchers propose a stabilization phase in the treatment of complex trauma, in which the focus primarily lies on the formation of a safe therapeutic relationship (e.g., Cloitre et al, 2012; Herman, 1992)
We found that Pam experienced a strong inability to open up, which could be traced back to the relationship with her parents, whom were always very critical towards her
Summary
Van Nieuwenhove et al: The Influence of Interpersonal Patterns on the Therapy Process in a Case of Childhood Trauma (Wadsworth, 2004) and the Core Conflictual Relationship Theme (CCRT) in psychodynamic psychotherapy (Luborsky, 1984). Previous studies, using the CCRT paradigm, have found that complex trauma is associated with the perception that others are rejecting, opposing, controlling, and – overall – bad (Chance, Bakeman, Kaslow, Farber, & Burge-Callaway, 2000; Drapeau & Perry, 2009) This interpersonal pattern, comprising a fundamental distrust toward others, is translated to a variety of interpersonal relations later in life, including the relationship with a therapist (Gleiser et al, 2008; Pearlman & Courtois, 2005). To arrive at a more comprehensive understanding, it is necessary to study some of the core assumptions underlying the need for initial stabilization Certain questions such as if and how interpersonal patterns influence the therapeutic relationship, how therapeutic interventions can foster or hamper the establishment of a safe working alliance, and which therapeutic techniques are necessary to accomplish therapeutic change, remain unanswered. The relationship is safe enough to tolerate expressiveness, more expressive interventions can be introduced
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