Conflictual Relationship Theme Method Research Articles

Applying relationship anecdotes paradigm interviews to study client–therapist relationship narratives: Core conflictual relationship theme analyses

Objective: We describe client–therapist relational narratives collected in relationship anecdotes paradigm (RAP) interviews during psychotherapy and the application of the core conflictual relationship theme (CCRT) method. Changes in clients’ and therapists’ CCRT in relation to each other are examined and associations between their CCRTs and self-reported ruptures and repairs are explored. Method: Sixty-seven clients and 27 therapists underwent RAP interviews and completed self-report rupture and repair items at early, middle, and late psychodynamic psychotherapy. Client–therapist relationship narratives were rated on the CCRT and the relational interplay within dyads was explored qualitatively. Results: CCRT changes from early to late therapy showed that with time clients perceived the therapist (RO) and the self (RS) more positively, and the therapist perceived the self (RS) less negatively. Some associations were found between tension in the session and clients’ and therapists’ negative RO and RS. Therapists’ reports of alliance repairs were associated with positive RO and RS. Conclusions: Relational narratives that clients and therapists tell in RAP interviews about meaningful interactions between them, enhance our understanding of clients’ and therapists’ inner experiences during interpersonal dances in the therapeutic relationship. Limitations and directions for future research are discussed, and implications for training are suggested.

Relationship representations and change in adolescents and emerging adults during psychodynamic psychotherapy

Objective: Two groups of clients at sequential developmental stages, adolescents and emerging adults, were compared regarding their presenting problems, psychological distress, and relationship representations over one year of psychotherapy. Method: Thirty adolescents aged 14–18 years and 30 emerging adults aged 22–28 years, with similar demographic background, completed outcome measures and interviews according to the Core Conflictual Relationship Theme (CCRT) method. Results: The groups differed significantly in the presenting problems but did not differ in their initial levels of distress; their symptoms improved to a similar extent after one year of psychotherapy; differences between the groups in the representations of others were consistent with age-specific developmental challenges; levels of representations were associated with levels of symptoms at the end-point of treatment. Conclusion: Clinicians need to be attuned to the specific difficulties and challenges of these continuous yet distinct developmental stages.

Pragmatic Psychodynamic Psychotherapy—Bridging Contemporary Psychoanalytic Clinical Practice and Evidence-Based Psychodynamic Practice

Pragmatic psychodynamic psychotherapy (PPP; Summers & Barber, 2009) describes the therapeutic principles and approaches found in many forms of manualized psychodynamic psychotherapies, which are being used in research studies with the aim of building an evidence-based psychodynamic practice. This article focuses on one such treatment, Supportive-expressive psychotherapy (SEP; Luborsky 1984), which employs the Core Conflictual Relationship Theme (CCRT) method to formulate core interpersonal problems and treatment goals and identify therapeutic interventions. To illustrate SEP, we describe the 40-session treatment of a patient who met diagnostic criteria for several personality disorders. The case illustrates how complex ego-syntonic character pathology is expressed in CCRT terms and worked through in the transference, gradually becoming ego-dystonic and amenable to modification. In this case, the patient became more aware of his interpersonal wishes and vulnerability. Although his anxiety increased somewhat, he had an improvement in psychosocial functioning.

The core conflictual relationship theme (CCRT) method: testing with adult offenders who have intellectual and developmental disabilities

Purpose – The aim of this paper is to investigate the feasibility of using the core conflictual relationship theme (CCRT) method, used to assess relationship patterns and interpersonal schemas, within a small group of men who had intellectual and developmental disabilities (IDD). The relationship anecdote paradigm interview, with minor adaptation, was used to collect material from participants necessary to generate a CCRT. CCRTs formulated in the study are described and consideration is given to the potential clinical application of CCRT method in this patient group. Design/methodology/approach – A small sample of four men with IDD was taken from a medium-low secure forensic service. Initial interviews, necessary to elicit narrative anecdotes for CCRT formulation, were conducted at the start of a psychotherapeutic treatment study. Trained judges completed a CCRT formulation for each participant. Findings – Participants in the study were able to provide personal information necessary to formulate a CCRT. Unexpected common themes were shared in participants who had committed contact sexual offences, this differed from a participant with autistic spectrum disorder who had committed a non-contact sexual offence. The CCRT method can be feasibly used in a mild IDD population. The CCRT method is clinically relevant and provides an opportunity for the exploration of clinical micro-theories related to interpersonal schemas found in offenders who have IDD. Originality/value – This is the first study, to our knowledge, reporting results of the CCRT method with adults who have mild intellectual disabilities.

Repetition or Reparation?

This exploratory study examined the relationship patterns of child abusers in treatment by comparing interactions involving the therapist with those involving a parent. Twenty participants were included in the study. The participants' relationship patterns were assessed using the core conflictual relationship theme (CCRT) method. Core schemas were found in interactions involving the therapist and a parent. The two CCRTs found in interactions with parents were often motivated by a desire for closeness or intimacy, to which the parent reacted with rejection or domination. The participants then felt disappointed, depressed, and unreceptive. In relationship episodes involving the therapist, a similar desire for closeness was answered with help and cooperation from the therapist, hence leading the participants to feel self-controlled and self-confident. Furthermore, the therapist's criticism and opposition was often experienced as an indication of care and acceptance.

An exploratory study of child molesters' relationship patterns using the core conflictual relationship theme method.

This study examined the relationship patterns of N = 20 child molesters (CM) using the Core Conflictual Relationship Theme (CCRT) method. The relationship patterns of the CMs were compared with those of a control group of N = 20 subjects from an out patient counseling service. Results showed that CMs had significantly less wish to be controlled, hurt, and not responsible than the control group. No significant difference was found between both groups for the CCRT response of other component (RO). For the response of self (RS) component, results indicated that CMs reported more relationship episodes in which they felt respected and accepted and self-controlled and self-confident. The authors suggest that these interactions could be indicators of the CMs'attempts to attribute blame to others and present themselves as victims. It is also suggested that CMs may have core issues involving autonomy and control.

Relationships between God and People in the Bible, Part II: The New Testament, with Comparisons with the Torah

In an earlier study on the first five books of the Bible, the Torah or Pentateuch, relationships between God and people were assessed with the use of a clinical-quantitative method, the core conflictual relationship theme (CCRT) method. Here, the study is extended to God or Jesus's relationships with people in the New Testament, to obtain the first description of those relationships based on an established measure of relationships. In the New Testament, many different kinds of relationship themes were observed, with benevolent and positive themes as the most frequent. Other results included that: (a) relationships in the New Testament often appeared more positive than in the Torah; (b) New Testament relationships between Jesus and people were less positive than between God and people; and (c) God's relationship with Jesus was more positive than God's relationship with Moses. Relationships with Paul, Peter, and women were also assessed. Relationship patterns were considered within the context of attachment theory, and biblical CCRT patterns were consistent with depiction of both secure and anxious attachments. Biblical relationships portray a variety of models for interpersonal relationships, ranging from the very positive to the very negative.

Relationships Between God and People in the Bible: A Core Conflictual Relationship Theme Study of the Pentateuch/Torah

The most widely known images of God are from the Bible. An important characteristic of these images is their portrayal of God's interactions with people. Although there have been many religious and literary discussions of God's relationships with people in the Bible, no systematic psychological assessment has been reported. Therefore, the aim of this study was an innovation: to identify patterns of relationship between God and people portrayed in the first five books of the Bible, the Pentateuch or Torah, by using the core conflictual relationship theme (CCRT) method, a widely used scoring system for the assessment of interpersonal relationships. Reliability for the application of the CCRT method to relationship episode narratives in the Pentateuch/Torah was assessed and found to be very good. Results show that the most frequent theme in relationship episode narratives about God and people is that God is helpful. Two less frequent but also highly repetitive themes are that God controls or hurts the other person. Many differences were found between relationship themes defined by the type of person with whom God interacted: patriarch, Moses, woman, non-Israelite, or not a non-Israelite. Thus, the CCRT results identify several different patterns of relationship between God and people.

Reformulation of the Core Conflictual Relationship Theme (CCRT) Categories: The CCRT-LU Category System

The Core Conflictual Relationship Theme (CCRT) method, developed by Lester Luborsky, is regarded as an established technique for assessing central relationship patterns in psychotherapy research. Numerous studies have investigated associated research areas and clinical applications. Many of these studies have reported problems with the CCRT method attributable to the underlying construct of the CCRT categories. This study describes the development of alternative German CCRT categories, the CCRT-LU categories, in which LU stands for the place of development (Leipzig/Ulm) and for the ‘logically unified’ aspect of the system. For the 1st time, the CCRT-LU categories are assigned to a sample of clinical intake interviews with 32 female patients.

Consistency in Interpersonal Themes in Narratives About Relationships

The current study investigates the hypothesis that psychiatric patients display consistent interpersonal themes in narratives across different important interpersonal relationships. In response to a revised Relationship Anecdote Paradigm interview, 93 patients with a diagnosable disorder, based on Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) criteria, were asked to give 5 narratives about each of the following significant people in their lives: mother, father, same-sex best friend, and romantic partner. From the transcribed interview material, independent judges reliably rated the intensity of wishes, responses of others, and responses from self associated with a modified Core Conflictual Relationship Theme (CCRT) method (Luborsky & Crits-Christoph, 1990). Consistency of specific relational themes was assessed across multiple interactions with the same person and across different relationships. Although only 1% to 3% of the variance was explained by an individual's consistency, there was substantial variability in specific interpersonal themes across narratives, both across and within relationships (explaining 27% to 30% of the variance). The discussion addresses methodological issues that may have contributed to the current findings and the implications of these findings for the CCRT method, psychodynamic theory and practice in general, and the psychodynamic concept of transference in particular.

The Core Conflictual Relationship Theme of Psychotic, Borderline, and Neurotic Personality Organizations

Kernberg's (1984) model of personality describes 3 personality organizations (POs)-psychotic, borderline, and neurotic-each of which has specific characteristics in terms of relationship schemas, defense mechanisms, identity diffusion, and reality testing. The Core Conflictual Relationship Theme (CCRT) method (Luborsky, 1998a) is a measure of central relationship schemas as revealed by relationship narratives. It identifies 3 components: the patient's wishes (Ws), the responses from others (ROs), and the responses of self (RSs). The goals of this study were to compare 2 methods for scoring ROs and RSs and to examine whether different POs vary in terms of their relationship schemas as measured by the CCRT. Eighty-one participants were included in this study. A PO diagnosis was made with the Personality Organization Diagnostic Form (Diguer & Normandin, 1997). Results showed that both scoring methods were equivalent in all dimensions. We found more similarities than differences between the 3 PO groups with respect to Ws, ROs, and RSs. The psychotic PO group presented the flattest CCRT profiles, the least negative responses, and the lowest narrative complexity. These results are discussed in relation to Kernberg's model and the development of the CCRT method.

The core conflictual relationship theme (CCRT) and psychopathology in patients selected for dynamic psychotherapy

The present naturalistic study examined the relation between core interpersonal patterns measured by the Core Conflictual Relationship Theme (CCRT) method and psychopathology in 55 patients selected for long-term dynamic psychotherapy. Psychopathology was assessed by the DSM-III-R, symptom self-report, and the Karolinska Psychodynamic Profile (KAPP). Patients with different DSM-III-R diagnoses did not differ in their CCRTs abstracted from the Relationship Anecdote Paradigm interview. Furthermore, lack of flexibility (pervasiveness) in the use of different CCRT components was not associated with psychiatric symptoms. Only one significant correlation between character pathology and the CCRT was found: problems concerning the patients' experience of social significance were associated with more negative responses of other. Limitations of the CCRT method and the sample used are discussed. Die vorliegende naturalistische Studie prüfte den Zusammenhang zwischen interpesonalen Mustern - gemessen mit der ZBKT-Methode - und der Psychopathologie bei 55 Patienten, die für eine psychodynamische Langzeittherapie indiziert waren. Psychopathologie wurde mit dem DSM-III-R, Selbstbeschreibungen und dem Karolinska Psychodynamic Profile (KAPP) untersucht. Patienten mit verschiedenen DSM-III-R Diagnosen unterschieden sich nicht im Hinblick auf ihre ZBKT in einem Beziehungsinterview. Mangel an Flexibiltät bezüglich unterschiedlicher ZBKT-Komponenten stand nicht in Beziehung zu psychiatrischen Symptomen. Nur eine signifikante Korrelation zwischen Charakterpathologie und ZBKT lie ß sich nachweisen: Probleme der Patienten mit ihrer sozialen bedeutung standen in Beziehung zu negativeren Reaktionen von Objekten. Bergrenzungen der ZBKT-Methode und der Stichprobe werden diskutiert. Cette étude naturaliste examine la relation entre des patterns interpersonnels de base mesurés par la méthode du Thème Relationnel Conflictuel Central (CCRT) et la psychopathologie chez 55 patients sélectionnés pour une psychothérapie psychodynamique de longue durée. La psychopathologie a été évaluée selon DSM-III-R, par un auto-questionnaire de symptômes et par le Karolinska Profile Psychodynamique (KAPP). Les patients avec des diagnostics DSM-II-R différents n'ont pas montré de différence dans leur CCRT obtenu sur la base d'interviews RAP (Paradigme d'Anecdotes Relationnelles). Par ailleurs, le manque de flexibilité ('pervasiveness') dans l'emploi des différentes composantes du CCRT n'a pas été associé à des symptômes psychiatriques. Une seule corrélation significative entre pathologie de catarctèe et CCRT aété trouvée; une expérience de position sociale problématique a été associée à des réponses de l'autre plus négatives. Nous discutons des limitations de la méhode du CCRT et de l'échantillon. El presente estudio naturalístico examina la relación entre el núleo de pautas interpersonales medida por el método del Tema Nuclear Relacional Conflictivo (CCRT) y la psicopatología en cincuenta y cinco pacientes seleccionados para psicoterapia dinámica a largo plazo. La psicopatología se evaluó según el DSM-III-R, el informe auto-administrado de sintomas y el Perfil Psicodinámico de Karolinska (KAPP). Pacientes con diferentes diagnósticos según el DSM-III-R no difirieron en el CCRT abstraído de la entrevista Paradigma Anecdótico Relacional (Relationship Anecdote Paradigm). Más aun, la falta de flexibilidad ['pregnancia' ('pervasiveness')] en el uso de diferentes components del CCRT no estuvo asociada con síntomas psiquiátricos. Solo se encontró una correlación significativa entre la caracteropatía y el CCRT; los probelmas relacionados con la experiencia de significatividad social de los pacientes estuvo asociada con respuestas más negativas del otro. Se discuten las limitaciones del método del CCRT y de la muestra usada.

Different Reliabilities at the Episode Level and that of the Final CCRT—A Rejoinder to Luborsky and Diguer

The Core Conflictual Relationship Theme (CCRT) method is one of the most thoroughly elaborated instruments in the field of quantifying relationship diagnosis. Its development not only fills a gap for clinicians and researchers, but it also represents an important innovative process for putting psychodynamic formulations into operation (cf. Schauenburg & Cierpka, 1994). The purpose of our two studies has been to contribute toward promoting the use of the CCRT method by simplifying the preparation of the material (video rating).

A Novel CCRT Reliability Study: Reply to Zander et al.

A new study of the reliability of the Core Conflictual Relationship Theme (CCRT) method should be welcome. But this one's welcome is reduced by its limited generalizability, for several reasons.

The Meanings of Narratives Told During Psychotherapy: The Fruits of a New Observational Unit

It is the new definition of relationship narratives in psychotherapy that has led to the 14 observations about them in our review and to recognition of their meaning for the process of psychotherapy. Among the most significant externally descriptive observations about relationship narratives were, their identifiability by trained judges, their frequency in almost all sessions and their focus on recent events in intimate relationships. Internal observations came from the Core Conflictual Relationship Theme (CCRT) method applied to the narratives, including: a high frequency of wishes for closeness as well as for independence, a high frequency of negative expectations of responses from others and self, a high pervasiveness of wishes both early and late in therapy, and an increase in positive responses from others and of self as patients improved in psychotherapy.

Locating transference paradigms in psychotherapy transcripts: Reliability of relationship episode location in the core conflictual relationship theme (CCRT) method.

Locating transference paradigms in psychotherapy transcripts: Reliability of relationship episode location in the core conflictual relationship theme (CCRT) method.