Core Conflictual Relationship Theme Research Articles

Changes in countertransference and changes in patient working alliance and outcome: An empirical study.

The American Psychological Association task force on empirically supported therapy relationships defined countertransference (CT) management (i.e., awareness of CT) as a "promising" element in psychotherapy research. The present study aimed to examine how changes in therapist CT and awareness of CT relate to therapy process and outcome. The data analysis was based on 41 treatments and used the core conflictual relationship theme to measure CT. We found that changes in therapists' Wishes from the relationship with the patient at the beginning of therapy were related to patients' working alliance and symptom changes at the end of treatment. Changes in therapist awareness of CT moderated the relationship between therapists' wishes from the therapy and patients' symptom changes during therapy. Last, we present a case study and discuss how awareness of CT can help the therapist handle the challenges that arise from it. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Virtual reality roleplays for patients with depression: A user experience evaluation

BackgroundVirtual reality (VR) has been used successfully and effectively in psychotherapy for a variety of disorders. In the field of depression, there are only a few VR interventions and approaches. Although simple social interactions have been successfully modeled in VR for several mental disorders, there has been no transfer to the field of depression therapy. VR may be employed for psychodynamic psychotherapy to work on interpersonal conflict patterns. In this study, we developed and evaluated a VR intervention for the simulation of roleplay situations in the context of supportive-expressive therapy. MethodsWe conducted a clinical user experience (UX) study at a psychotherapeutic clinic in Düsseldorf, Germany. Eight inpatients with depression and four therapists were included. Semi-structured interviews and qualitative content analysis were used to identify UX issues of the developed VR intervention. Usability questionnaires and technical usage data were also considered. The VR intervention consisted of two therapist-controlled roleplay scenarios designed to support work on the core conflictual relationship theme by allowing patients to interact in typical problematic social situations. Recorded VR roleplays allow for therapeutic debriefing with a change of perspective. Therapists were given the option of using the roleplay in multiple sessions. ResultsAll therapists conducted one session per patient with the VR intervention. From the patient interviews, 26 UX issues were extracted, of which one technical malfunction and two unclarities in the interaction with the VR agent were rated as major problems. From the therapist interviews, 14 UX issues were extracted, of which five were rated as major problems related to the interface in the dialog control or the complex system setup. ConclusionThe main problem was designing a dialog structure that allows both complex conversational flows and a clear control interface. In principle, VR roleplays could be integrated well and safely into therapy. The VR intervention shows promise for providing an emotional experience of interpersonal conflict patterns in the context of psychotherapy. Additionally, other roleplay situations involving various social problem areas must be created and evaluated in terms of the fit to the patients' core conflictual relationship themes.

Identifying the origins of countertransference using the core conflictual relationship theme method: A multiple case study approach

ABSTRACT Objective Measurement of countertransference (CT) has proven challenging throughout the history of studying this construct. We sought to determine the potential value of using a common measure of transference, the Core Conflictual Relationship Theme (CCRT) method, as a means of studying CT. Method The Relationship Anecdote Paradigm and the CCRT method were used to examine CT in two studies. In Study 1, we examined the correspondence between a therapist’s wishes with significant people in her life (i.e., her parents and husband) and three long-term patients. In Study 2, we identified the interpersonal wishes of a different therapist and examined 14 of her sessions with 3 patients for evidence of how these wishes and needs were displayed in her clinical work. Results Analyses revealed that specific wishes in therapists’ personal lives could be detected from projective interviews and these wishes were similar, but not necessarily identical, to wishes in therapists’ descriptions of, and actual work with, their patients. Evidence of both chronic wishes and patient-specific wishes was revealed. Conclusions These findings support the idea that the origins of CT reside in therapists’ interpersonal wishes and that the CCRT may be a promising means of identifying CT in research, practice, and supervision.

Changes in clients' relational patterns with parents and therapist during psychodynamic psychotherapy: Their association and relation to treatment outcome.

The study aimed to explore how changes in clients' relational patterns during psychodynamic psychotherapy relate to treatment outcomes and therapy effectiveness. Seventy clients receiving psychodynamic psychotherapy in a university counseling center were interviewed three times and filled out the OQ-45 questionnaire five times during therapy. We used the Core Conflictual Relationship Theme (CCRT) to study clients' relational patterns. Mixed models were used to assess the interaction between clients' CCRT intensity toward their parents and toward their therapists, treatment effectiveness, and treatment outcome. First, we found that clients' relational patterns with their parents correlated with relational patterns with their therapists across several time points in therapy. Then, we found significant interactions, indicating that treatment effectiveness moderates the relationship between clients' CCRT intensity and treatment outcomes. The findings suggest that the transference phenomenon is related to therapy outcomes differently in effective and less-effective therapies, depending on the transference intensity. Further research is needed to expand knowledge about the intensity of transference and its possible impact on treatment choice and management.

Countertransference awareness and treatment outcome.

Countertransference (CT) is considered a central component in the therapy process. Research has shown that CT management does not reduce the number of CT manifestations in therapy, but it leads to better therapy outcomes. In this study, we examined therapists' awareness of their CT using a structured interview. Our hypotheses were (a) treatments in which therapists were more aware of their CT would have a better outcome and (b) different definitions of CT would be related to different therapy outcomes. Twenty-nine patients were treated by 19 therapists in 16 sessions of short-term psychodynamic therapy. We used the core conflictual relationship theme to measure CT, a special interview was developed to study CT awareness. Results show that awareness of CT defined as the relationship with the patient moderated 10 outcome measures and awareness of CT defined as the relationship with the patient that repeats therapist conflicts with significant others moderated three outcome measures We present examples from dyads in this study and discuss how awareness can help the therapist talk to and handle patient challenges. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Object Relations and Core Conflictual Relationship Theme in Patients With Major Depression and Normal Individuals

Objective: The present study aims to evaluate the object relations and core conflictual relationship theme in depressed patients while comparing them with normal individuals. Methods: Thirty people with major depressive disorder and thirty normal individuals were selected using the convenience sampling method via structured clinical interviews (SCID-I & SCID-II) and the psychiatric symptoms checklist (SCL-90-R) based on inclusion and exclusion criteria. Bell Object Relations Inventory (BORI) and Central Relationship Questionnaire (CRQ) were used to investigate the study variables. The data were analyzed by multivariate variance analysis. Results: The multivariate analysis of variance showed a significant difference between the depressed and the normal groups in the four subscales of object relationships (egocentricity, insecure attachment, social incompetence, and alienation). Findings of the Central Relationship Questionnaire (CRQ) indicate that depressed patients in all three components of wishes (higher tendency toward aggression and reluctance to intimacy), the response from the other (RO) (perception of significant others being annoying and not receiving love from them) and the Response of Self (RS) (distance and a lack of sense of independence and success) had a significant difference and a higher mean compared to the normal group. Conclusion: The findings of this study indicated that the style of object relationships and some core conflictual relationship themes in depressed patients is pathological, and these patients can be treated by identifying these styles and themes in therapeutic interventions.

Helping patients master core conflictual relationship themes in psychotherapy.

An important component of case formulation is to understand the patient's difficulties in the context of their relationships. The Core Conflictual Relationship Theme (CCRT) method provides a clinical guide for understanding the narratives of relationship conflicts told during therapy. We follow the case of Barbara, a 60 year old with a long history of chronic shyness. Her narratives follow a common CCRT: she wishes to feel safe, but fears that others are out to get her, which makes her withdraw. These patterns have pervasively repeated themselves in the past, present, and across different relationships (self, family, partners, colleagues). The therapist responds carefully by creating safety, tolerating her fears, and working to overcome these CCRT patterns, thus reducing her impulse to withdraw from treatment. Psychotherapists from many theoretical orientations can learn how patients mastering these repetitive negative CCRTs can lead to more adaptive relationship patterns that improve their mental health.

Living with pathological narcissism: core conflictual relational themes within intimate relationships

BackgroundPathological narcissism is a severe mental health condition that includes disturbances in interpersonal functioning. Interpersonal difficulties by those affected include aggressive, domineering, cold and coercive behaviours which often result in strong negative reactions from others. We sought to examine the moment-to-moment patterns that emerge within close relationships between intimate partners and family members.MethodsParticipants (N = 15) were romantic partners (73.3%) and family members (26.6%) in a close and long-term relationship (+ 10 years) with an individual with pathological narcissism. Participants told verbatim relationship narratives involving five narrative interactions with their relative with pathological narcissism and five narrative interactions with others. Transcripts were coded using the using Core Conflictual Relationship Theme method. Participants also completed three versions of the Relationship Questionnaire, reporting on 1. their relationship style ‘in general’, 2. their relationship style ‘with their relative’ and 3. the relationship style of their relative.ResultsA total of 133 relationship episodes were analysed, comprising 783 components (wishes, responses of others and responses of self). While the identified wishes (e.g., for love, for support) were consistent between relative and non-relative narratives, there was significantly higher disharmony and lower harmony in narratives involving relatives with pathological narcissism. Described disharmony in these relationships involved the relative’s rejecting, subjugating and attacking behaviours, and participants rejecting and withdrawing behaviours. There was a prominent deactivation of participants attachment system when interacting with their relative with pathological narcissism, endorsing predominately dismissing relationship styles. Individuals with pathological narcissism were similarly rated as predominately dismissing.ConclusionsTogether, these results reflect the cycles of interpersonal dysfunction for individuals with pathological narcissism and their partners and family members. Treatment implications point to the risk of therapists withdrawing and dismissing a patient with high pathological narcissism in the countertransference. Strategies to monitor and manage these core relational themes in treatment remain a challenge.

The Functional Psychotherapy Approach: A Process-Outcome Multiple Case Study.

Objective: The present work aims to conduct the first naturalistic empirical investigation of the process and outcome assessment of functional psychotherapy (FP) treatment. The FP model of psychotherapy is rooted in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes.Method: The study sample included ten patients recruited on a voluntary basis and treated by clinicians in their private practices. Each patient received FP with an average duration of 40 h (min 35 and max 42). Therapies had weekly sessions, were audio-recorded with the patient’s written consent, and lasted for an average of 10 months (min 9 and max 12). Outcome and process tools included the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Luborsky’s the Core Conflictual Relationship Theme (CCRT), used to assess therapeutic benefit, and the Metacognition Assessment Scale (MAS) and the Italian Discourse Attributes Analysis Program (IDAAP) system, used to evaluate therapeutic benefit and process. The MMPI-2 was used also in the follow-up assessment.Results: Results show that FP had a positive therapeutic outcome on the patients assessed in this study, and that the therapeutic benefits were maintained over time. Some specific features of the FP approach were found to contribute more than others to the observed therapeutic benefits.Conclusion: The current investigation constitutes a first step toward assessment of the therapeutic effectiveness of FP. Future developments should apply the methodology to a larger sample, possibly introducing different methodologies to enable detection of specific bodily oriented processes and techniques.

Freud’s Rule of Abstinence: Implications for Brief Therapy: A Case Report

Abstinence was defined by Freud as the analyst’s abstinence in gratifying patients’ infantile needs. The writer noticed a controversy regarding abstinence among long-term therapists and that it has disappeared from the literature in short-term therapy. Both literature reviews are summarized. The writer wondered if abstinence has a place in brief therapy. His patient was a severely disturbed 23-year-old man with a history of being scolded and strictly controlled by his mother. A summary of the patient’s therapy sessions is provided, which was based on Luborsky’s Core Conflictual Relationship Theme approach for brief therapy. The therapy revealed that rather than feeling the expected deprivation, this patient felt gratified by the abstinence. The implications of this finding for long-term and brief therapy are discussed. The writer suggests that careful and flexible use of abstinence, even in brief therapy, is beneficial in exploring the patient’s need and ability to tolerate a caring relationship.

Lessening of the pervasiveness of interpersonal patterns in borderline personality disorder explains symptom decrease after treatment: A process analysis.

BackgroundProblematic interpersonal patterns, as defined by the core conflictual relationship theme (CCRT) method, are part of the clinical presentation of clients with borderline personality disorder (BPD). So far, we do not know whether the pervasiveness of interpersonal patterns changes and if this change explains therapy outcome.MethodsIn a secondary analysis of a randomized controlled trial on a brief version of psychiatric treatment for BPD, a treatment with a psychodynamic focus, the present study included N = 39 clients. One early session and one late session of the treatment were transcribed and analyzed using the CCRT method.ResultsIt appeared that pervasiveness of the predominant CCRT decreased over the course of the brief treatment; this effect was robust across treatment conditions. Change in pervasiveness in any CCRT component explained a small portion of variance of the decrease in borderline symptoms observed at the end of treatment.DiscussionLessening of pervasiveness of problematic in‐session interpersonal patterns may be hypothesized as potential mechanism of effective treatment for BPD which should be tested in controlled designs.

Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder.

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

"We can work it out": Working through termination ruptures.

Supportive-expressive (SE) psychodynamic treatment is based on the identification of and working through the patient's signature core conflictual relationship theme. According to the SE framework, when termination is anticipated, separation conflict arises, and the actualization of the patient's interpersonal wish in the relationship with the therapist is no longer possible. The disactualization of the patient's wish in the relationship with the therapist may cause patients to regress to their maladaptive prototype responses (Nof, Leibovich, & Zilcha-Mano, 2017), which may manifest as a rupture in the therapeutic alliance. The present work integrates constructs based on the SE framework, specifically the disactualization of the patient's wish at the end of treatment, with the framework of alliance ruptures and their resolution (Safran & Muran, 2000). We propose a conceptual clinical model to guide therapists in the successful resolution of alliance ruptures, which are the result of the disactualization of the patient's interpersonal wish. We propose a two-stage process to achieve successful resolution of termination ruptures: (a) identification of termination ruptures and (b) addressing and resolving termination ruptures. For each stage, we propose practice-based guidelines and steps to follow. We demonstrate the proposed guidelines based on the case study of a patient with major depressive disorder. We used three sources of information from the case study: verbal transcripts of the therapy sessions, questionnaires, and semistructured posttreatment interviews. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

THE EFFECTIVENESS OF DIARY WRITING IN IMPROVING UNIVERSITY STUDENTS’ ASSERTIVE ATTITUDES

This study aimed to apply diary writing as a therapy for low-assertive students. This study employed the Core Conflictual Relationship Theme (CCRT) method developed by Lester Luborsky. The data were collected using diary as an elicitation medium and analyzed using the Garnefski Emotion-Cognitive Regulation Questionnaire (CER). The results showed that(1) student low assertiveness could be improved through expressive writing therapy using a diary as the medium; (2) diary as a therapeutic medium was effective in improving student low assertiveness because diary writing tasks can be distinguished based on CCRT and CER; (3) there was a difference between male and female assertiveness patterns; (4) subjects in the category were easier to change towards normal assertiveness with diary writing therapy compared to subjects in the LSE category.

Repairing alliance ruptures using supportive techniques in telepsychotherapy during the COVID-19 pandemic

ABSTRACT The COVID-19 pandemic shifted many traditional face-to-face treatments to telepsychotherapy, forcing many therapists worldwide to adapt effective techniques developed in face-to-face treatment to telepsychotherapy. These include supportive techniques that may be particularly important at a time of rising anxiety, loneliness, helplessness, and depression. The present paper provides detailed guidelines for therapists on how supportive techniques developed in traditional face-to-face treatment can be effectively used in telepsychotherapy to resolve alliance ruptures. To this end, we used the conceptual framework of the core conflictual relationship theme (CCRT) formulation, making adjustments for identifying and resolving ruptures in the therapeutic alliance in telepsychotherapy. We demonstrated the proposed techniques for identifying and repairing ruptures with a case study of a patient participating in an ongoing RCT, whose treatment shifted in mid-therapy to telepsychotherapy because of the COVID-19 pandemic. The techniques presented and illustrated in this article may be used in the transition to remote therapy for a range of reasons, including patient or therapist relocation and more.

Core conflictual relationship theme: the reliability of a simplified scoring procedure

BackgroundCreating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient’s interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns.The CCRT method is based on the assumption that humans display a central relationship theme, which is shown in most relationships as well as in the patient-therapist relation. The CCRT scoring is based on how the patient describes interactions with others, in therapy sessions or in a specific interview. These descriptions are transcribed. Raters then score the identified relational episodes by choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. The method has shown high validity and reliability. Inter rater reliability is generally good: Cohen’s kappa ranging from 0.55 to 0.70.To decide CCRT pattern from transcribed material is time consuming and labour intensive This study investigates a labour- and timesaving version of the method.MethodsThis study aimed to investigate rater agreement in a simplified method of scoring the CCRT, based directly on live semi-structured dynamic interviews without transcribing the material.Fifty-two patients referred for psychotherapy in a clinical trial, were scored for CCRT pattern. Based on information that came forth during the two-hour interview, raters scored the patients choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. More than one category in each component could be chosen without ranking. Five raters compared two by two were investigated. Inter rater reliability was measured by Cohen’s kappa.ResultsMean kappa for Wishes, Response from Others and Response from Self was .33, .41 and .45 respectively. Mean kappa for CCRT in total was .41 among 5 raters.ConclusionIn this simplified method to score the CCRT based on oral dynamic interviews, fair to moderate IRR was obtained.Trial registrationFirst Experimental Study of Transference-interpretations (FEST307/95).Registration number: ClinicalTrials.gov Identifier: NCT00423462.

Working through childhood trauma-related interpersonal patterns in psychodynamic treatment: An evidence-based case study.

Adult interpersonal difficulties are considered 1 of the core consequences of childhood trauma exposure. However, research concerning the nature of interpersonal patterns associated with childhood trauma is scarce. The aim of this case study of a supportive-expressive psychodynamic therapy with a woman with a traumatic background, is to provide a detailed understanding of the nature of interpersonal patterns at the beginning and throughout therapy, and to provide an in-depth investigation of the therapeutic process. The Core Conflictual Relationship Theme method (Luborsky & Crits-Christoph, 1998) and the Penn Adherence/Competence Scale for Supportive Expressive Dynamic Psychotherapy (Barber & Critis-Christoph, 1996) were applied to study dominant interpersonal patterns and therapeutic interventions, respectively. At the beginning of therapy, the patient was unable to safely express herself because others were perceived as critical and rejecting. This relationship pattern originated in her primary (traumatic) childhood relationships and was repeated in her adult relationships. As treatment progresses, the patient aspired more proactively to assert herself and felt more self-confident in interactions, although she consistently perceived the reactions of others in a negative way. The neutral, acknowledging and empowering attitude of the therapist created a new relational experience, through which change (on the interpersonal level) appears to be achieved. We conclude that to adequately address interpersonal difficulties in therapy, it is fundamental to recognize dominant interpersonal patterns and to apprehend their dynamics within the broader context of the case. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Dialogue analysis of a filmed Gestalt therapy session: an introduction to a method

"Abstract: Psychotherapy process research takes us beyond answering the question, ‘does psychotherapy work?’ This area of research aims to study the hows and whats that happen within the psychotherapeutic session that potentiate change. The psychotherapeutic dialogue is an important source of data for psychotherapy process research. Micro- analyses of dialogical turns within the therapeutic session support the understanding of the therapeutic method. This paper introduces the Helbig Method of Dialogue Analysis. This method is founded upon four pillars: 1) that dialogue is implicit action between persons that is supported by explicit verbally uttered content; 2) that the individual’s mode of interaction within the dialogical dyad reflects the person’s relationship patterns; 3) that dialogue is an intersubjective process that leads to the development of new intersubjective configurations; and 4) that the observer-researcher’s phenomenological involvement plays a part in the analytical process. In this study, Bob Resnick’s video-recorded Gestalt therapy session entitled ‘A Rose on the Grave of my Family’ was selected. The transcription of the session was coded using the instrument, the Core Conflictual Relationship Theme – Leipzig/Ulm. Results obtained from this study are quantified graphical representations of the developing relationship between therapist and client. Simple to operate, scalable and practical, this method is designed for use by therapists and researchers who are interested in tracking, comparing and/or contrasting the developing psychotherapeutic alliance in a single or in multiple psychotherapy sessions. Keywords: psychotherapy process research, dialogue analysis, psychotherapeutic alliance, Gestalt therapy."

Group psychotherapy with young adults: Exploring change using the Core Conflictual Relationship Theme method

In this exploratory study, the Core Conflictual Relationship Theme method was used to assess changes in interpersonal relationship patterns in a scenetherapy group based on dramatization and improvisation to facilitate the processing of conflicts. Four young adults with difficulties in interpersonal relationships participated in 32 scenetherapy sessions. Relationship episodes observed in the first eight and the last eight treatment sessions were compared using the CCRT-LU (Spanish version), a variant of the method with a logically unified category system to code patterns found in relational narratives. Outcomes indicate that scenetherapy contributes to modifying both the relationship patterns in sessions and reflections on the staged stories by individuals. Disharmonious interactions decreased and harmonious interactions increased, promoting a more positive vision among participants of themselves and others. Clinical implications, study limitations and further lines of research are also discussed.

Levels of personality organization and internal relational patterns

BackgroundThis study aimed to determine whether level of personality organization is associated with a relational pattern present in an autobiographical narrative about an important interpersonal relationship. The main goals were to explore whether and how the components of the internal relationship pattern, and whether and how the configurations of the components, are related to personality organization, when integrated personality organization (IPO) is taken into account.Participants and procedureAssessment of the relational patterns was based on the Core Conflictual Relationship Theme (CCRT) – wishes (WS), responses from others (RO), and responses of the self (RS) – as identified from participants’ self-narratives about important relationships (N = 90).ResultsOne-way analysis of variance revealed significant differences between groups with different levels of personality organization, according to one wish of self (WS2 To oppose, hurt, control), five responses of others (RO4 Bad; RO5 Rejecting; RO6 Helpful; RO7 Likes me; RO8 Understanding), and three responses of self (RS1 Helpful; RS4 Oppose and hurt others; RS8 Anxious). Considering the configurations of WS + RO + RS, the results indicate that in the borderline personality organization (BPO) group, the WS Libidinal + RO Frustrating + RS Negative pattern is most prevalent, while in the neurotic personality organization (NPO) and IPO groups, the WS Libidinal + RO Fulfilling + RS Negative and the WS Libidinal + RO Fulfilling + RS Positive configurations are most frequent.ConclusionsThe study supports the thesis that component relationship patterns and their configurations might be related to personality organization. The main differences were found between BPO and IPO with NPO placed between them, in a way congruent with Kernberg’s theory.