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 et.al 1987

 

Table is excerpt from Bond et.al 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.”

 

Comments

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.

 

Bibliography

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.

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Research: CCRT Method comparison of Personality Organization

Diguer et.al (2001) used the Core Conflictual Relationship Theme (CCRT) method to differentiate between patients diagnosed with psychotic, borderline and neurotic personality organizations (PO). This model of  3 POs — the psychotic, the borderline and the neurotic– is the work of Otto Kernberg in 1984. Refer to these articles: Normal Personality Traits vs. Personality Disorders, Working with the Antisocial and Malignant Narcissistic Personality Disorder Spectrum . 

This is the abstract of the paper:

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Participants in the research were evaluated with SCID-I and SCID-II plus other diagnostic instruments, one of which is the Personality Organizations Diagnostic Forms (PODF) by Diguer & Normandin (1997), which is an observer rated scale. They were then asked to give 10 narratives relating to incidents or events in relation to another person, according to the Relationship Anecdotes Paradigm (RAP) interview method by Lubrovsky (1998). Participants were also asked to describe 3 significant others as well as themselves according to Object Relationship Inventory (ORI). In all over 800 narratives were collected.

The test revealed little differentiation between the 3 PO groups of patients, although in the graph below one can see that the PPO group rated less (were less pervasive) in most categories, their results were also less negative. There are many factors that can account for this. I am not discounting for the possibility of medication as affecting the results. Kernberg also mentions that there is more repression going on with people with this condition.

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The article also alluded to the non-significance of measuring more than the dimensions of WS, RS, WO and RO, due to the psychoanalytic theory of displacement.

Other studies were also mentioned in the paper with pointed towards a general negative rating of ROs and RSs, even in non-clinical samples. This alludes to the general tendency of people to remember the negatives better, and that these are unfinished businesses.

 

My Comments and Notes

I was looking forward to seeing marked differences in their results, however, this article provides an explanation for what the CCRT method is not effective at doing, and that is , making general comparisons of different groups of people.

The other question I have is, if it is justified to measure a predicate as “negative” or “positive”.

“Negative defines a reaction that is restrictive to the patient’s fulfillment of a wish, and positive means that a patient’s wishes have been fulfilled. (Stirn et. al, 2005)”

Could it be useful to used this method to observe how the predicates change for each client over time. E.g. RO (controlling) –> RO (likes me) ?

Source:

Diguer, L., Lefebvre, R., Drapeau, M., Luborsky, L., Rousseau, J. P., Hébert, E., … & Descôteaux, J. (2001). The core conflictual relationship theme of psychotic, borderline, and neurotic personality organizations. Psychotherapy Research11(2), 169-186.

Stirn, A., Overbeck, G., & Pokorny, D. (2005). The core conflictual relationship theme (CCRT) applied to literary works: An analysis of two novels written by authors suffering from anorexia nervosa. International Journal of Eating Disorders38(2), 147-156.

Research: CCRT used to study Gestalt and Emotive Behavioral Therapy

CCRT is employed in this research paper to study Gestalt and Emotive Behavioral Therapy sessions with adolescence.

With a standard treatment CCRT, 4 sessions are analyzed, 2 early

and 2 late with around 20 RE’s in all.

“In this study, only one therapy session for each of two clients was available and, therefore, only single session CCRT’s were formulated. A session CCRT is said to be “a special version of the CCRT and may differ slightly from the treatment CCRT” (Luborsky, 1990b, p. 32). “

Therefore n=2.

“Relationship episodes (RE’s) were demarcated on the written transcripts and judged as to their completeness. When the RE’s judged complete enough for the study were isolated, they were then examined for the three major components: wishes, responses from others and responses from self. A set of standard categories is available for describing the three components of the CCRT (Barber, Crits Christoph & Luborsky, 1990).”

“The standard category system is recommended for use with research while a tailor-made system seems to be more useful for clinical work. The second edition of the standard category system was used in this study. After each component was categorized, those occurring with the greatest frequency across RE’s were drawn together and the clients’ CCRT’s were formulated. A comparison was then made between the two treatment orientations.”

 

 


Bibliography

 

Agin, S., & Fodor, I. E. (1996). The use of the Core Conflictual Relationship Theme method in describing and comparing gestalt and rational emotive behavior therapy with adolescents. Journal of rational-emotive and cognitive-behavior therapy, 14(3), 173-186.

Research: CCRT-LU

  • Albani et. al (2002) introduces their revised version of Lubrovsky’s Core Conflictual Relationship Theme instrument, used in psychotherapy research. Read about the CCRT method here.

One of the main changes of the CCRT in CCRT-LU is the an introduction of “sub-dimensions of direction” subject-object and object-subject classification of wishes and responses. Whereas CCRT has got 4 main component dimensions (WO, RO, WS, RS), CCRT-LU has got 8 dimensions (WOO, WOS, WSS, WSO, ROO, ROS, RSO, RSS).

These dimensions are coded according to terms in the predicate lists.

 

 

Albani, C., Pokorny, D., Blaser, G., Gruninger, S., Konig, S., Marschke, F., … & Kachele, H. (2002). Reformulation of the core conflictual relationship theme (CCRT) categories: The CCRT-LU category system. Psychotherapy research12(3), 319-338.

Research: CCRT Method used to analyze Literature

This short note features the work of Stirn et.al. (2005) entitled, An analysis of two novels written by authors suffering from anorexia nervosa. 

The methodology was to analyze 2 novels written by 2 different authors who are known to have survived anorexia nervosa.

ABSTRACT

Objective: Two literary works of authors suffering from anorexia nervosa were analyzed with the method of the core conflictual relationship theme (CCRT) to prove that novels and/or personal accounts may reveal the same maladaptive relationship patterns typically revealed in psychotherapy sessions with this nosologic group.

Method: Two novels,  Valerie Valere’s The House of the Crazy Kids and  Andrea Graf’s Die Suppenkasperin, were selected which promised applicability of the CCRT method due to the completeness of the described relationship episodes.

Results: After several methodologic adjustments, the application of the CCRT method revealed the different courses and developments of the novels. Both the positive and negative as well as the conscious and unconscious relationship patterns were clearly expressed.

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Discussion: The results indicate that after certain adjustments, the CCRT method may be successfully applied to data obtained from sources other than psychotherapy sessions.

More examples of tables:
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Stirn, A., Overbeck, G., & Pokorny, D. (2005). The core conflictual relationship theme (CCRT) applied to literary works: An analysis of two novels written by authors suffering from anorexia nervosa. International Journal of Eating Disorders38(2), 147-156.