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

Background Pathological 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. Methods Participants (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. Results A 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. Conclusions Together, 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.

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.

Core Conflictual Relationship Theme: The reliability of a simplified scoring procedure.

Background: Creating 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.Methods: This 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. 52 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. 5 raters compared two by two were investigated. Inter rater reliability was measured by Cohen’s kappa.Results: Mean kappa for Wishes, Response from Others and Response from Self was .33, .44 and .45 respectively. Mean kappa for CCRT in total was .44 among 5 raters.Conclusion: In this simplified method to score the CCRT based on oral dynamic interviews, fair to moderate IRR was obtained. Trial Registration: First Experimental Study of Transference-interpretations (FEST307/95) Registration number: ClinicalTrials.gov Identifier: NCT00423462.

Core Conflictual Relationship Theme: The reliability of a simplified scoring procedure.

Background: Creating 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.Methods: This 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. 52 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. 5 raters compared two by two were investigated. Inter rater reliability was measured by Cohen’s kappa.Results: Mean kappa for Wishes, Response from Others and Response from Self was .33, .44 and .45 respectively. Mean kappa for CCRT in total was .44 among 5 raters.Conclusion: In this simplified method to score the CCRT based on oral dynamic interviews, fair to moderate IRR was obtained.