Introducing the Aesthetic Turn in the field of Psychotherapy

Aesthetic knowledge (also known as tacit knowledge) attained through our lived and sensory experiences. Interest in aesthetics in psychotherapy practice and research is borne out of the search for an alternate method of knowing and knowledge processing. The transmission of aesthetic knowledge has created interest in the qualitative research field for art-based research methodologies like Autoethnography, which I have adapted for the inquiry into the psychotherapeutic process. The turn towards aesthetic knowledge helps us fill in knowledge gaps left behind by decades of positivistic thinking that had dominated research and, inadvertently, training. Postmodernists are more interested in conveying knowledge and overcoming problems of representation and form or the poetics of knowledge-making. Aesthetic inquiry finds value in all field-based, cultural and sociological research, including psychotherapy and organisational development. Aesthetics relates to the study and attunement of the researcher to the atmosphere of the environment, images and perceptions, artefacts, ideas, symbols and culture of the investigated field.

Descartes believed in the power of detached intellectual thinking, but Vico (1744/1948) and Baumgarten (1750/1936) disagreed. They argued that knowledge is more about feelings than cognitions. Vico believed that we create meaning through our senses, and called this “poetic wisdom.” Baumgarten believed that logic studies intellectual knowledge, while aesthetics studies sensory knowledge. This type of knowledge is directly experienced through our five senses. Nietzsche and other philosophers later agreed that aesthetic knowledge is not only a separate way of knowing, but that other forms of knowledge depend on it. Aesthetic knowledge offers new insights and awareness, even though it can’t always be put into words. It’s an embodied, sensory knowing that is often contrasted with intellectual knowing.

The word aesthetics is derived from Greek aisthētikos, which means ‘perceptible things’ and from aisthēta, which means ‘to perceive’. Aesthetic evaluation is a pre-reflexive and preverbal process of sensing the atmosphere of a situation. The atmosphere, the atmos, the exhalation of vapour and the globe is a meteorological term denoting the gas surrounding the planet we constantly touch. The emotions or reactions from interacting with the atmosphere are not personal or internal but shared in a boundless space where the perceiver participates. Atmospheres are inter-subjective and holistic feelings poured out into a certain lived environment (Giffero, 2010/2014, p. 6). Philosopher Schmitz (2003) considers feelings as atmospheres, not subjective moods projected outwards, but affect that fills up the spatial situation with which the individual perceiver gets involved and identifies the self. “‘My sadness’, in fact, implies ‘not that I possess it, Hold it or perform it’, but only that ‘it hits me, regards me, touches me in the flesh’ (Schmitz, 2003, p. 181). The concept of the atmosphere is ambiguous and loses meaning when one tries to put it into words. Atmospheres are hard to define and must be experienced to be understood. Perceiving the atmosphere means capturing a feeling in the surrounding space and being moved by something beyond what can be proven. The atmosphere is a shared space that is difficult to pin down but is integral to how we connect with others and the environment.

Aesthetic sensing and knowledge are implicit in psychotherapy practice and training, even though this fundamental fact is not well represented in psychotherapy Embracing aesthetics in psychotherapy expands our ability to fully grasp the suffering of our clients, which is the essential process of psychopathology. Being attuned to psychopathology establishes a connection between therapist and client crucial for therapeutic change. This approach allows therapists to move beyond the traditional psychiatric diagnosis of disorders, which often views clients as isolated individuals with symptoms. This narrow perspective can be limiting and problematic in practice. Instead, diagnosing through aesthetics encourages therapists to consider the client’s subjective experience and to view them as a whole person. Each person brings their perspective to the therapeutic encounter, and the relationship between therapist and client creates a unique field of interaction. Using the term phenomenology, as proposed by Karl Jaspers, emphasizes the importance of the client’s subjective experience in understanding their pathology. This approach de-objectifies the client and highlights how informed diagnosis and psychopathology are integral to the therapeutic encounter, underlying the rift between practice and research that has plagued the field for decades.

Read more on Therapeutic Autoethnography


Baumgarten, A. G. (1750/1936). Aesthetica. Bari: Laterza.

Giffero, T. (2010/2014). Atmospheres: Aesthetics of emotional spaces. (S. d. Sanctis, Trans.) Routledge.

Schmitz, H. (2003). Was ist Neue Phänomenologie? Koch: Rostock.

Vico, G. (1744/1948). The New Science of Giambattista Vico. Trans. Bergin, T. G. and Fisch, M. H. Ithaca, NY: Cornell University Press.

Therapeutic Autoethnography: A Research Method for Psychotherapy

This article is an introduction to my recent research in psychotherapy. I have streamlined this qualitative research method which engages the practitioner as the researcher or autoethnographer. The aim is to share and gain insights into the phenomenon of the psychotherapeutic process from the live-in perspective of the therapist. Watch this site for the release of my doctorate thesis, which will be soon released.

therapeutic autoethnography, psychotherapy research, infographic
Therapeutic Autoethnography info

Lecture at CONFERENCE 2021

A Psychotherapist’s lived Experience in session. An Autoethnographic Case Study.


Here is the transcript of my lecture in the conference above:

I want to thank the organizers of this conference for inviting me today and the editors of the European Journal of psychotherapy and Counselling for accepting my article.

It is a pleasure to be here to share this aspect of my work. 

I work in Singapore, and the time here is now 6:30 pm.

PROFESSIONALLY I identify myself foremost as a practitioner of psychotherapy. Currently, tail end getting my doctorate the Sigmund Freud University in Vienna.

I can say that

Gestalt therapy found me when I was already in my 40s; by then, I had lived for more than a decade in Austria.

It was then that I stumbled into a Gestalt therapy workshop.

I was impacted by the contact I made with others at that workshop. Something happened. Something changed. I changed.

I am aware that that change didn’t happen just because several people grouped together. Change occurred because there were therapists there who were attuned to what was present; they were dedicated to the work. 

I consider myself lucky that the first therapists I met made such an impression on me.

My curiosity leads me to enrol in the university (after having left school 25 yrs before with a Biochemistry degree), I yearned to grasp what I had experienced. I tried to read about psychotherapy, how therapy works, and how therapists work. But nothing could justly explain my experiences as a client in those “magical moments” of treatment. 

So, years later, having put myself through Masters and now the doctorate program in psychotherapy science, 

I find myself still a seeker. 

Notice that I am not referring to myself as a researcher but a seeker of understanding

of what psychotherapy is… versus… what the world thinks psychotherapy is for…

of what therapeutic change is… versus… what kind of change is expected of therapy.

And this leads me

I am proposing a method of inquiry into the psychotherapy process featured in my doctorate dissertation.

My contribution to this issue of the EUJPC is a distillation of this work. 

There are two parts to this:

  1. the case story… which reflects a therapeutic encounter that is relevant to the topic of diversity, inclusion and the psychotherapeutic process. It a psychotherapy case study recounted from my lived-experience as the psychotherapist working with an asylum seeker from Afghanistan, with the help of a translator.
  2.  the method of inquiry that i used, is an adaption of Autoethnography.

I shall very briefly describe the research methodology, and then introduce the case story.

The method of inquiry that I use here is adapted from Autoethnography… which is a qualitative research method traditionally applied to social studies. 

To apply Autoethnography in psychotherapy case study …

I needed to make several definitions and differentiations

I give this method the name, Therapeutic Autoethnography

<< See the infographic>>

Therapeutic Autoethnography is what I would describe as an aesthetic inquiry and an aesthetic representation of the studied psychotherapeutic encounter. 

the result is a story, an art form, 

What you will not get is a report,or an analysis about what has happened in the session, 

but a story that evokes in the reader a sense of how it feels like to be there with the client in that encounter. 

<<Case story>>

It is entitled Undercurrent 

Is a story of diversity and the will for inclusion within the therapeutic encounter 

The case story that I have written for this issue is based on my experience working with a patient some years ago, with whom I shared hardly any word with.

Culturally we were different. 

This is the year 2018… before the COVID pandemic happened, It was the time of the refugee crisis in Europe .

Ali, the client, was about 30 years old, from Afghanistan, seeking Asylum in Austria.

He was brought to the psychotherapy clinic diagnosed with PTSD.

In this therapeutic field there was also the therapist, myself, and I am from SG. In this story, I am also the practioner and autethonographer.

Since we spoke in different languages, we were accompanied by a Translator, Zaya, who, was about my age, a mother of 2, and she was from Iran.

Together we were foreigners who happened to have met in Austria.

So you can appreciate how each of us in this encounter bring in our own phenomenological fields. ANd this is beyond language, gender, socio-status and culture.

In this article I weave the story from what I experienced in the sessions (which lasted 9 months) with Ali and Zaya, how we were moved even though language seemed a barrier. 

How we brought the suffering that was hidden to the surface.


Time here is too short to read the story; you can read it in the article.

But I shall share with you the concluding paragraph.

“We gathered for nine months, three months longer than we had contracted to work

together. In this field, a story and plot emerged. Ali’s plot toggles between contents of his past and his future. From his past we hear of his suicide attempts, the violent treatment he endured from his uncle, the friends he had lost in the war. We hear of his concern for the women he had left behind in Afghanistan who had protected him— his uncle’s wife, and the mother of his friend, also named Ali. We hear also of betrayal. Ali’s future promises hope, despair, and uncertainty. What we had together in the therapeutic situation was in the here-and-now, like a pivot, holding space in an undifferentiated situation.

One can see how 

The writing is different from other forms of academic writing, and it comes across as being an easier read.

Oftentimes Academic articles that are easiest to read are the hardest to write. in many sense… it takes courage and creativity to write reflexively.

Read the full article : Case Study using Autoethnography


Chew-Helbig, N. (2022). Writing evocative case studies: applying autoethnography as a research methodology for the psychotherapist. The British Gestalt Journal, 31(1), 35-42.

Chew-Helbig, N. (2022). A psychotherapist’s lived experience in-session with an asylum seeker and translator: An autoethnographic case study. European Journal of Psychotherapy & Counselling, 1-16.

3 Approaches to Psychotherapy: A Quick Comparison of the Gloria Tapes

This is a video I made to compare the Gloria sessions with three psychotherapists, Fritz Perls, Carl Rogers and Albert Ellis.

The psychotherapists demonstrate their different psychotherapeutic schools. Perls is a Gestalt therapist, Rogers is a person Centered Therapist and Ellis is a behavioral therapist.

Psychotherapy research of today has shown us that the he personality of the therapist is an essential factor in therapy process.

0:59 When we observe how the client at first moments of meeting the therapists behaves differently in each session, we may be able to understand the phenomenon of this idea.

At 3:37, we look at the body language of the therapist and client. 4:40 Non-verbal communication is sometimes more telling of the interaction.

At 5:50, we compare who spoke more, who had more air-time in the sessions.

To end the video, the representing theme of the Gloria tapes were discussed.

Research: Rupture Resolution Rating System (3RS)

Using the Rupture Resolution Rating System (3RS) for microanalysis of the psychotherapeutic dialogue. This article describes the use and function of this instrument in psychotherapy research.

The psychotherapeutic dialogue is the tangible aspect of the psychotherapeutic alliance. Within this alliance is the healing aspect of psychotherapy. An alliance rupture is defined in this manual as a deterioration in the alliance, in the sense that these occurrences are manifested by ab apparent lack of collaboration between patient and therapist on the task forward. While the concept of rupture may have  like a “negative” connotation in other alliances, ruptures are essential parts of the psychotherapeutic alliance.

The absence of rupture and repair in a therapeutic session is a sign  of confluence between therapist and client;  whereby both parties give in to each other’s requests throughout the session, without question or challenge. These mainly confluent, rupture-less relationships in psychotherapy do not lead to healing at best, and at worst, may lead to the client being dependent on the therapy.

By rupture, the authors Eubanks-Carter (2014) reiterate that it is not about lack of agreement, but lack of collaboration. The authors are also aware that agreement on the surface may actually be withdrawal, which is a kind of rupture.

“Note that a lack of ruptures is not necessarily the same as effective therapy. A patient and therapist could be in agreement and be working together very smoothly, but pursuing goals and tasks that are not the best choice for the patient’s situation. When coding ruptures, the focus is on the quality of the collaboration and bond between the patient and therapist—not the quality of the therapist’s case conceptualization, choice of treatment approach, or adherence or competence.” (p. 4)

Ruptures may be outside the consciousness of the therapist and client. In severe cases, ruptures can lead to dropout or failure of treatment.

2 subtypes of ruptures:

  1. withdrawal ruptures : moving away the therapist (avoiding questions, etc.) or moving towards the therapist in a way as to avoid experiences (being overtly appeasing, etc), avoiding the actual work of the therapy.
  2. confrontation ruptures : moving against the therapist, expressing anger, dissatisfaction by trying to pressure or control the therapist /therapy
  3. Both

Both therapist and client contribute to ruptures.
The coding system looks at the patient’s behaviors as markers of ruptures.

Resolution process is a process by which the rupture is repaired. This is a opportunity for rebinding the alliance, and reinstating new goals.

Resolution strategies are measures taken by the therapist to initiate the resolution process.

Signs of rupture (p. 5):

  •  Patient and therapist are not working together collaboratively and productively. They
  • are “not on the same page.”
  •  There is strain, tension, or awkwardness between patient and therapist.
  •  Patient and therapist are misaligned or misattuned.
  •  Patient and therapist seem distant from each other.
  •  Patient and therapist are working at cross purposes.
  •  Patient and therapist are acting friendly, but you sense tension or disagreement beneath the surface, such that the friendliness seems to be a pseudo-alliance.
  •  Patient and therapist seem to be caught in a vicious cycle or enactment.
  •  You feel very bored while watching a session. This might be a sign that a withdrawal rupture is occurring


Eubanks-Carter, C. F., Muran, J. C., & Safran, J. D. (2014). Rupture resolution rating system (3RS): Manual.

Research: Treatment Adherence & Treatment Differentiation

Treatment adherence consists of 2 components:

  1. Treatment Adherence : degree in which the treatment is conducted in accordance with the theoretical model and prescribed technique.
  2. Treatment Differentiation: degree in which different treatments differ in the intended direction with respect to therapeutic interventions (e.g. comparative outcomes).



Trijsburg, R. W., Frederiks, G. C., Gorlee, M., Klouwer, E., den Hollander, A. M., & Duivenvoorden, H. J. (2002). Development of the comprehensive psychotherapeutic interventions rating scale (CPIRS). Psychotherapy Research12(3), 287-317.

Research: Definition of Psychotherapy Process and Outcome in Research

“The process  of psychotherapy represents anything that can be conceptualized as a constituent  of the psychotherapeutic treatment; more specifically, it refers to all of the events that, during the course of a treatment, occur  as part of the therapy sessions and/or may be related to these sessions (Hill and Lambert 2004 ; Orlinsky et al. 2004 ). These events may refer to any domain (physiological, affective, cognitive, behavioral, etc.) that is ascribable to the client, to the therapist, and/or to their relationship. This definition is highly inclusive and, thus, analogous to the definition of the treatment  process that is given by Orlinsky et al (2004 ); therefore, it should be distinguished from the more specific change  process, which refers to those specific aspects of the treatment process that represent any clinically meaningful event “through which clients or patients are hypothesized to improve”(p. 312; also see Greenberg 1986 ; Rice and Greenberg 1984 ).”

“The outcome  of psychotherapy represents anything that can be conceptualized as a clinical effect of the psychotherapeutic treatment process; more specifically, it refers to those clinically meaningful changes that, during the course of a treatment and/or after its completion, may be observed as results  of the therapeutic process, as defined above. These changes refer to the client’s problematic domains (e.g., physiological, affective, cognitive, or behavioral) that represent the treatment’s target, and should be observed outside the treatment situation (Orlinsky et al. 2004 ).”



Gelo, O. C. G., & Manzo, S. (2015). Quantitative approaches to treatment process, change process, and process-outcome research. In Psychotherapy Research (pp. 247-277). Springer Vienna.

Research: Instruments used to Collect Data in Psychotherapy Process Research

This is a list of instruments used in psychotherapy research to study psychotherapy process.

Relational patterns

Core Conflictual Relationship Themes (CCRT) Observational Nominal category system J Micro Luborsky (1998)

Structural Analysis of Social Behavior (SASB) Observational Nominal category system J Micro Benjamin, Rothweiler, and Critchfield (2006)

Therapeutic alliance Working Alliance Inventory (WAI) Self-report, Observational Set of ordinal/ interval scales C, T, J Macro, Micro Horvath and Greenberg (1989)

Alliance Negotiation Scale (ANS) Self-report Set of ordinal/ interval scales C Macro Doran et al. (2012)

Collaborative Interaction Scale (CIS) Observational Set of ordinal/ interval scales J Micro Colli and Lingiardi (2009)

Narrative processes

Narrative Process Coding System (NPCS) Observational Nominal category system J Micro Angus et al. (2012)

Innovative self-narratives

Innovative Moments Coding System (IMCS) Observational Nominal category system J Micro Gonc¸alves et al. (2011)


Metacognition Assessment Scale (MAS) Observational Set of dichotomous scales J Micro Semerari et al. (2003)

Reflective functioning

Computerized Reflective Functioning Scale (CRF) Observational Nominal category system Com Micro Fertuck et al. (2012)

Therapist interventions

Comparative Psychotherapy Process Scale (CPPS) Observational Set of ordinal/ interval scales J Macro Hilsenroth et al. (2005)

Psychodynamic Intervention Rating Scale (PIRS) Observational Set of ordinal/ interval scales J Micro Milbrath et al. (1999)

Comprehensive Psychotherapy Intervention Rating Scale (CPIRS) Observational Set of ordinal/ interval scales J Micro Trijsburg et al. (2002).

Symbolization of internal experience Experiencing Scale Observational Set of ordinal/ interval scales J Micro Klein et al. (1986)

Computerized Referential Activity (CRA) Observational Nominal category system Com Micro Bucci and Maskit (2006), Mergenthaler and Bucci (1999)

Defense mechanisms

Defense Mechanism Rating Scale (DMRS) Observational Set of dichotomous scales J Macro Perry (1990)

Defense Mechanism Rating Scales-Q (DMRS-Q) Observational Q-sort J Macro Di Giuseppe et al. (2014)

Emotional-cognitive regulation Therapeutic Cycle Model (TCM) Observational Nominal category system Com Micro Mergenthaler (2008, 1996b)

Linguistic content Automated Co-occurrence Analysis for Semantic Mapping (ACASM) Observational Nominal category system Com + J Macro Salvatore et al. (2012)

Dimensions of psychotherapy process

Psychotherapy Process Q-set Observational Q-sort J Macro Jones (1985)

Therapy Session Reports

Self-report Set of ordinal/ interval scales C Macro Orlinsky and Howard (1986)

Bern Post-Session Report (BPSR) Self-report Set of ordinal/ interval scales C, T Macro Flu¨ckiger et al. (2010)

Session Evaluation Questionnaire (SEQ) Self-report Set of ordinal/ interval scales C, T Macro Stiles and Snow (1984)

Intersession experience

Intersession Experience Questionnaire (IEQ) Self-report Set of ordinal/ interval scales C Macro Lundy and Orlinsky (1987), Hartmann et al. (2003)

School-independent change processes

Generic Change Indicators (GCI) Observational Nominal category system J Micro Krause et al. (2007)


Gelo, O. C. G., & Manzo, S. (2015). Quantitative approaches to treatment process, change process, and process-outcome research. In Psychotherapy Research (pp. 247-277). Springer Vienna.

Reaearch: Defining Trauma with Traumatic Antecedents Interview (TAI) Scale

When is trauma really trauma?

Researchers and psychotherapists alike are concerned about the historical accuracy of the narratives reported. Memories can fail or phantasies can be mistaken for memories. This is not that we disbelief the subject or client. Even as therapists ourselves who have done hundreds of hours of personal therapy, we are aware of the fact that we too are not sure about what we remember and what we forget. Forgetting is after all a very present phenomenon of trauma.

Retrospective reports are driven by current experiences. What is in the foreground today may affect how we perceive the background.

Studies have also shown that childhood exposure to trauma leads to sometime destructive relationship patterns.

“Recent research has shown not only the accuracy of retrospectively obtained abuse histories, but also the stability over time of these reports, even when comparing pre- and post-therapy reports (Maughan & Rutter, 1997; Paivio, 2001). This study also used an interview-based method in which the rater was required to identify vignettes in which the individual trauma types could be identified. This approach may protect against false positives.” (Drapeu & Perry 2004)

What is traumatic?

When is an event traumatic enough to be considered as trauma, to the point of having a significant effect on the person?

This raises two possibilities in regards to the present study. The comparison of adult relationship patterns is made between trauma and non-trauma group.

“In this case, trauma could be seen as a dichotomous variable (present–absent). However, secondly, if the effects of trauma are cumulative, then correlations may reveal positive findings not captured by group comparisons. In this case, a dichotomous approach would not be sufficient, and other aspects of trauma such as duration or severity of the abuse or number of perpetrators should also be considered.”

the Traumatic Antecedents Interview (TAI) Scale.

What are the necessary conditions that have the impact of being traumatic?

“Childhood events can be considered traumatic either as a matter of definition or because a stressful event had certain traumatogenic qualities, such as feeling threatened, unable to protect oneself, fend off, or otherwise master a threat, and feeling responsible for its occurrence. Most research takes the approach of identifying traumas ostensively and focusing on clear-cut events such as physical or sexual abuse that are considered gross psychological traumas by wide consensus (Roy & Perry, 2004).”

Thus, trauma is often divided into two broad categories:

  • (1) gross psychological trauma and
  • (2) patterns of experiences or more subjective or “subtle” trauma. e.g. CPTSD

Studies on the first category, that is, with major traumata, as assessed using the TAI (Herman, Perry, & Van der Kolk, 1989), because this type of trauma can be relatively objectively described and quantified according to the number of perpetrators and the duration over which the events leading to trauma took place.

In its original form (Herman et al., 1989), the TAI was a 100-item semi-structured interview designed to elicit the reporting of both intra- and extra-familial interpersonal childhood trauma.


In the research by Drapeau & Perry (2004), three additional variables have been added for the present study to assess 12 areas, 10 of which are considered as possible gross trauma. These include Physical abuse, Sexual abuse, Witnessing violence, Physical neglect, Emo- M. Drapeau, J.C. Perry / Child Abuse & Neglect 28 (2004) 1049–1066  neglect, Significant separations, Losses, Domestic chaos, Verbal abuse, and Parental discord. Two additional positive variables are also included: the presence of Caretakers/confidantes and the display of Mutual affection between the parents.

For scoring purposes, a subject’s childhood is divided into three periods, including an early period (0–6 years), a middle period (7–12 years), and a late period (13–18 years). In this study, however, only the total scores across all three-age periods will be examined.

Physical and Sexual abuse, Witnessing violence, Significant separations, Losses, and Verbal abuse are each given scores from 0 to n, with n being the number of perpetrators (or significant separations or losses) in each of the three developmental periods. Physical and Emotional neglect, Domestic chaos, Parental discord, and Parental mutual affection are given scores of 0 (absence) or 1 (presence) for each developmental period. Caretakers/confidantes are scored from 0 to 2 for each age period, reflecting the common finding of two caretakers in a healthy, western nuclear family. Specific predefined criteria are provided for eight of the variables in the instrument’s rating manual (Perry & Herman, 1992). This manual also contains examples of scored vignettes to which the rater can refer when scoring the TAI. The reliability of the TAI variables ranged from acceptable to excellent (median Intraclass R = .73) (Roy & Perry, 2004), and previous studies have demonstrated robust associations between specific types of trauma and both Axis II disorders and self-destructive phenomena (Herman et al., 1989; Van der Kolk, Perry, & Herman, 1991).


Drapeau, M., & Perry, J. C. (2004). Childhood trauma and adult interpersonal functioning: A study using the Core Conflictual Relationship Theme Method (CCRT). Child abuse & neglect28(10), 1049-1066.

Herman, J. L., Perry, J. C., & Van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146, 490–495.

Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood origins of self-destructive behavior. American Journal of Psychiatry, 148, 1665–1671.

Research: Core Conflictual Relationship Theme Method (CCRT)

The Core Conflictual Relationship Theme Method (CCRT) is an instrument used in researching process of psychotherapy.  In this article, a research work is cited in which this instrument is used in psychotherapy research.

The CCRT method is a measure of central relationship schemas of a person that are revealed through his/her narratives.

The CCRT (Luborsky, 1998) is one of the most employed methods of assessing relationship patterns. Over the last decade, it has been used to study numerous forms of psychopathology and symptom impairment, as well as the process of psychotherapy.

There is also evidence that the CCRT shares many characteristics with Freud’s transference theory. The CCRT assesses interpersonal narratives in three components:

  • (1) the wishes, needs, motivations or intentions of a subject (W);
  • (2) the response of others to the subject’s wishes (RO); and
  • (3) the response of the subject to others’ response (RS).

These three components are rated using the standard categories provided by the method, which includes 35 Wishes, 30 ROs, and 31 RSs. The manual gives detailed descriptions for each Wish, RO, and RS.

The CCRT components are identified in a series of Relationship Episodes (RE) told by the subject during an interview designed to collect such narratives (Relationship Anecdotes Paradigm [RAP]). An RE is a brief story or vignette of an interaction the subject had with another person.

Table is excerpt from Bond 1987


Table is excerpt from Bond 1987

The client’s relationship pattern is studied by analyzing the recorded transcripts of the therapeutic session.

Example from Drapeau & Perry (2004) research:

Title of this research paper is: Childhood trauma and adult interpersonal functioning: A study using the Core Conflictual Relationship Theme Method (CCRT).

The interview starts with the interviewer saying: “I am going to ask you to tell me stories of interactions you have had with others that struck you as particularly important, interesting or troublesome or a combination of those. These interactions must have happened within these last 6 months.” During the interview, the interviewer inquires about the wishes or desires the subject had during the interaction, how the other person involved in the interaction felt or reacted, and how the subject felt or reacted as a result of the other person’s response. The subjects in this study freely chose which stories to report, although the direction specified three general types, specifically occupation, close relationships and any therapy or professional relationship, all within a time-frame of the past 6 months.

The narratives or relationship episodes from 119 subjects were recorded, transcribed then scored using the CCRT method, with each subject giving approximately 10 or 11 recent relationship episodes. The interviews were scored using CCRT coding procedures and the data considered quantitatively.

For any given relationship episode, the rater is required to identify :

  1. which segments represent a W, a RO, and a RS and
  2. use the definitions provided in the manual to attribute a standard category to this specific segment.

This standard category, or score, is descriptive and reflects a specific type of motive or behavior.

Considering the data quantitatively allows us to examine the proportion of each CCRT category across the entire interview in comparison with the proportions in the other categories.

Two experienced raters were used. They rated a total of 8000 relationship episodes. Consensus rating and reliability assessment were don on randomly selected cases (20% of total).

Defining Trauma: Traumatic Antecedents Interview (TAI) Scale is used to determine which of the subject have what kind of traumatic experience. These factors, together with the results of the CCRT scores were tabulated as such.

Here is an example of how the results were interpreted

Example: “Verbal abuse (see table 1). The verbally abused group reported more of the wish to be distant from others (W10; trend only). The verbally abused group experienced others as less strong (RO24) and in interpersonal interactions, they themselves more often reacted by being not open (RS8). However, none of these differences remained significant following the Bonferroni corrections.”



The CCRT instrument seems to give a clear quantified overview of and individual’s relationship patterns. The purpose of reading this research article was to learn about how the CCRT is applied. In addition we are also offered an insight into childhood trauma.



Bond, J. A., Hansell, J., & Shevrin, H. (1987). Locating transference paradigms in psychotherapy transcripts: Reliability of relationship episode location in the core conflictual relationship theme (CCRT) method. Psychotherapy: Theory, Research, Practice, Training24(4), 736.

Luborsky, L. (1998). The Core Conflictual Relationship Theme: A basic case formulation method. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (pp. 53–83). New York: The Guilford Press.

Luborsky, L., & Crits-Christoph, P. (1998). Understanding transference: The Core Conflictual Relationship Theme method (2nd ed.). Washington, DC: American Psychological Association.

Drapeau, M., & Perry, J. C. (2004). Childhood trauma and adult interpersonal functioning: A study using the Core Conflictual Relationship Theme Method (CCRT). Child abuse & neglect28(10), 1049-1066.

Research: Aspects of Therapy Session Dialogue

The proceedings of the Society of Psychotherapy Research in Copenhagen (SPR 2014 ) and previous regular meetings include reports on these channels:

• Relationship patterns in transcripts

• Attachment representation in projective or narrative text

• Affective dictionary

• Affective content coded second-by-second during the whole course of therapy

• Primary process markers

• Ruptures and their repairment

• Crying during the therapy session

• Laughing during the therapy session

• Stress measured by physiological parameters

• Tone of speech

• Mimic signals. . .  and many other phenomena until . . .

• The commonly shared silence

Pokorny, D. (2015) Quantitative data analysis in psychotherapy research.