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Current Issues in Personality Psychology
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Original paper

Levels of personality organization and internal relational patterns

Emilia Soroko
,
Lidia Cierpiałkowska

Current Issues in Personality Psychology, 6(4), 292–304
Online publish date: 2018/12/19
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BACKGROUND

RELATIONAL PATTERNS AND CORE CONFLICTUAL RELATIONSHIP THEMES (CCRT)

Identifying interpersonal patterns is central to case conceptualization (serving as key concepts in pathomechanism and pathogenesis reconstruction), treatment planning and supervision in many approaches to therapy (Critchfield & Benjamin, 2010; Grenyer, 2012; Vinnars, Frydman Dixon, & Barber, 2013). Relationship patterns have been investigated both as external (interpersonal behaviors) and internal (psychological structures, as object relations) phenomena (see e.g., Soroko, 2014). In this paper, we take a psychodynamic perspective, and by a relational (relationship) pattern we mean a personal structural tendency to engage in important social relationships with certain wishes (intentions, needs), to expect (anticipate) certain reactions from others, and to respond to these reactions (see e.g., Luborsky, 1998). The word “pattern”, however, has at least two distinct, but important, meanings: 1) the pervasiveness of a selected type of relationship (the concept of a central relationship pattern; Luborsky, 1984; Luborsky & Barrett, 2007); 2) the configuration of components of such relational elements, such as the wish and the anticipated reactions that match each other in a unique personal way. In the first case, the repetitiveness and in the latter the combination are central concepts. Concepts such as Freud’s relationship templates and Bowlby’s internal working models are often quoted as examples of such patterns (Diguer et al., 2001).
The importance of relatedness is emphasized not only by psychodynamic or attachment theories but also by interpersonal or cognitive-behavioral approaches. A relational schema (organized representations of past behavior and experience in interpersonal relationships; an individual’s personal blueprint for future relationships) sets up unrealistic expectations from others, including the therapist, and tends to be self-confirmatory and a source of relational tensions, misunderstanding, conflict, and maladjustment (Crits-Christoph, Demorest, Muenz, & Baranackie, 1994). These themes are derived from a client’s history of painful interpersonal relationships, which may still be activated by everyday life stimuli (e.g., Sommerfeld, Orbach, Zim, & Mikulincer, 2008). Providing a good illustration of this, Dimaggio (2014, p. 66) presents a maladaptive internal relational pattern in a description of a process of interpersonal functioning: “[…] when a person is in distress, the attachment motive is triggered, the other person is perceived as unwilling to help, and to deal with the anticipated rejection, the person asks for help with minimal emotional display. The subsequent response is withdrawing and becoming depressed. Thus, the patient reads signs of criticism of lack of interest in the face of the others”.
If we assume that a mature personality has relatively stable and predictable patterns of adaptive behavior, the question arisese as to what rules could be applied in order to differentiate the patterns that prevail in pathology from those present in healthy normal personalities. According to Critchfield and Benjamin (2010), adaptive relational patterns reflect secure attachment and lead to positive self-concepts and collaborative engagement with the world, while maladaptive relating, by contrast, contains hostility, extremes of enmeshment (controlling or submitting to others), or extremes of differentiation (extreme separation, disconnection) in everyday social settings. Patterns are considered healthy if they are relatively positive (so that the fulfilled and unfulfilled wishes are generally balanced), differentiated (in that many responses and reactions are allowed for), and flexible (meaning they are well-suited to both external and internal circumstances) (Cierpka et al., 1998). Closer to the pathological end, there are relational patterns marked by permanently unfulfilled needs (often regardless of the object reaction, and fulfilled and frustrated wishes are often not balanced). Moreover, relational patterns in psychopathology are only slightly differentiated, and in consequence, highly pervasive and repetitive (Colli, Tanzilli, Gualco, & Lingiardi, 2016) and often are characterized by an evidently dominant relational tendency or stereotype (Cierpka et al., 1998; Gonçalves et al., 2016).
There are several methods for operationalizing relational patterns, but the most important are the Structural Analysis of Social Behavior (SASB; Benjamin, 1996; Critchfield & Benjamin, 2010) and Core Conflictual Relationship Theme methods (CCRT; Luborsky, 1984; Luborsky & Friedman, 1998; Luborsky et al., 2004; Luborsky & Barrett, 2007; Barber, Luborsky, Diguer, & Crits-Christoph, 1995); the latter is the focus of this paper. The CCRT method is a clinically relevant tool developed to measure pervasive and conflictual relationship themes. It is based on content analysis of stories about important relationships (relational episodes often elicited by the Relational Anecdotes Paradigm interview; Luborsky, 1998). In this method, the content analysis is ordered by three consecutive components of relationship pattern: 1) wishes, needs, or intentions of the self (WS); 2) the response (experienced, anticipated, or fantasized) of the other (RO); 3) the subject’s response (experienced, anticipated, or fantasized) to the other, reaction from the self (RS), including symptoms. The combination of these three components and the repetitiveness of such components across many stories about relationships with a significant person are treated as the CCRT of the patient (Vinnars & Barber, 2008).
The CCRT is often used to investigate participants’ interpersonal functioning, but in our view it is more appropriate as a method for exploring mental representations – object relation representations based on desires and their consequences, e.g., projection mechanisms, for example, or dysfunctional interpersonal schemas (Sommerfeld et al., 2008). As Vinnars and colleagues (2013) suggest, the CCRT can also be conceptualized as an internalized psychological structure, similar to unconscious fantasy and the cognitive concept of schemas.
What needs special attention here is that the CCRT method is based on content analysis of relational episodes (stories of interpersonal relationship interactions that progress from the beginning, middle, to end stages of story development), so the relationship pattern is derived from relationship narratives, constructed in a relational setting with a psychologist (therapist, researcher). According to the narrative approach, the structure of the story is a vehicle of meaning concerning experiences, feelings, beliefs, expectations, anticipations, and so on. Hence, the relationship narratives recounted during a research interview or therapy session are a compromise of many processes, mainly story building, but also autobiographical memory, self-presentation, defenses, and self-regulation. We observe the effects of recalling autobiographical relationship episodes and constructing a narrative in a social (relational) context, so CCRT is seen as a narrative measure of relationship patterns. Wishes, reactions from others, and reactions from self thus are elements of the internal world determined by the maturity of intrapsychic structures (self-object-affect, according to Kernberg’s theory; Kernberg, 2004, 2005; Clarkin, Lenzenweger, Yeomans, Levy, & Kernberg, 2007), expressed in words, but also somehow regulated in the process of storytelling in a relational context in the company of the researcher or therapist.

BORDERLINE PERSONALITY DISORDER AND BORDERLINE PERSONALITY ORGANIZATION IN THE PERSPECTIVE OF CCRT

Generally, studies in this field can be divided into two groups: in one group, relational patterns were assessed and analyzed in association with the level (severity) of the personality pathology; the second group concentrated mainly on borderline personality disorder and its relational patterns. Cierpka and colleagues (1998) studied patients’ stereotypical relationship patterns, and they noticed that there was a relation between the severity of psychopathology and the extent of stereotypical patterns in interpersonal relationships, and that thus held true, not only for participants with psychiatric symptoms, but also for normal controls. The wish components are generally considered less flexible – they remain the same across different situations – than the response components, which are more conscious and under cognitive control. They believed that the repetitions of the wish components in particular have a high potential to discriminate between the three groups of subjects with different levels of personality organization. Wilczek and colleagues (2000), in their naturalistic study of patients beginning psychodynamic psychotherapy, noticed that only a few differences were found between patients with different kinds and severity of psychopathology and relationship patterns, as defined by the CCRT.
Research conducted by Diguer and colleagues (2001) showed some differences in the prevalence of two of the three of the CCRT clusters (RO and RS) between people with psychotic personality organization (PPO) and those with higher levels of organization (borderline, BPO; neurotic personality organization, NPO). Participants with PPO scored lower in Rejecting object (RO5), Upset object (RO 3) and Anxious self (RS8) than did those with BPO or NPO. Moreover, they had lower scores in Disappointed self (RS7) and Helpful self (RS1) than the NPO group. In another study including integrated personality organization (Soroko, 2014), the majority of negative reactions of self were detected in the BPO sample and the frequency distribution was significantly higher than in NPO and IPO groups. In that same study, the results showed that the most frequent pattern configurations in BPO were: “libidinal wishes + frustrating object reactions + negative reactions of self” and “aggressive wishes + frustrating object reaction + negative reaction of self”, and the former was also significantly more frequent than in IPO and NPO groups. In the NPO group, the most frequent (among other patterns) configuration in the NPO group was “libidinal wish + fulfilling object reaction + positive reaction of self”.
Other studies in this area cover the relational patterns in BPD. Drapeau and Perry (2009; Drapeau, Perry, & Körner, 2010) found that patients with BPD had more wishes to be distant and to be like others, and more wishes to be hurt and to hurt others. Others were perceived as controlling and bad, and patients with BPD were less open, helpful, and self-confident in response than those without BPD. In a recent study, Trepanier and colleagues (2013) found that “rejecting and opposing others” (RO5) was the most prevalent response of others across three models of relational patterns in BPD, and among responses from the self, “disappointed and depressed” (RS7) was most prevalent, followed by “anxious and ashamed” (RS8). When comparing BPD and non-BPD subjects (Drapeau & Perry, 2004), the results indicated that BPD subjects displayed fewer wishes to attend to others, to perceive others as more loving and subjugating, and to more often feel dissatisfied and scared. This suggests both a need for closeness with the object, the anticipation of love – but in the end, a frustration of needs.
In conclusion, the research to date involving relational patterns in individuals with different levels of personality organization, following Kernberg’s concept, have dealt with the psychotic level, not the integrated level (sometimes referred to as normal personality). Such research proceeded from more general questions to attempts to investigate the specific nature of borderline personality disorder, and encountered difficulties arising from the heterogeneity of the symptoms, postulating increasingly detailed divisions into borderline personality disorder subtypes. We believe that it is important to investigate further relational patterns in personality disorders, both treated as descriptive categories – types and subtypes, as Drapeau and colleagues (2010) argue – but the opposite direction should be investigated, that is relational patterns in connection to the severity of the personality dysfunction (e.g., level of personality organization).
So far, the research has focused mainly on individual components and their durability, rather than on their configurations. In addition, the CCRT method has often been used to attempt to collect information on interpersonal functioning (also in the social sense), or to interpret conclusions, putting significantly less emphasis on the representation of the relationship with the subject and the perspective of the subject’s narrative. Representations of relations with an object, although they affect behavior in interpersonal relations, are not identical with it as constructs, schemes, or representations. The present research is planned as complementary to the above approaches, specifically to focus on the study of relational patterns in the context of the personality structure (levels of personality organization).

RESEARCH AIMS AND HYPOTHESES

This 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 of this study were: 1) to explore whether and how the components of the internal relationship patterns are related to personality organization, when integrated personality organization (IPO) is taken into account; and 2) to describe the features of internal relationship pattern configurations in borderline (BPO), neurotic (NPO), and IPO, and to identify the differences between levels of personality organization according to the configurations of relational patterns. Although the research aims are mainly exploratory, we formulated some initial hypo­theses that were justified by both psychodynamic theory and research. First, we expected that CCRT components would differentiate levels of personality organization, because they reflect intrapsychic structures – especially the maturity of object relations. In this view, the BPO group should differ from higher levels of personality organization, as the internal structure is organized around splitting, while NPO and IPO are presumed to be based on repression. Second, we expected that IPO would present higher fulfillment in reactions from the object (RO) and positivity in reactions from the self (RS) than BPO and NPO.

PARTICIPANTS AND PROCEDURE

PARTICIPANTS

The sample (N = 90) included voluntary participants from both a clinical sample (psychiatric ambulatory or day units; n = 42) and from a nonclinical sample (students of subjects other than psychology; n = 48), consisting of 69 women and 21 men. At the beginning, there were a total of 380 participants, all of whom gave their informed consent (women n = 271; 96.00% secondary and high education; age M = 21.80, SD = 1.90). Clinical sampling was performed at neurotic and personality disorder treatment hospital wards and at ambulatory mental health care institutions, where most of the patients were diagnosed with anxiety and/or personality disorders. However, the following criteria were also used by psychiatrists or psychologists, who were contact persons between a researcher and participant, to exclude participants with psychotic disorder, bipolar disorder, delusional disorder, dementia, and/or amnestic as well as other neurocognitive disorders and a current life crisis.
The target sample was selected in two steps: 1) through a screening procedure allowing the classification of the participants into groups with different levels of personality organization (BPO, NPO, and IPO), and 2) using a narrative qualitative interview that aimed to form a relational autobiographical story in response to the following request: “Please tell a story about an important relationship you were involved in recently. Narrate how the relation started, how it developed and how you perceive the relation now”. In the nonclinical sample, the questionnaires were filled in first, and then the participants were requested to take part in an interview at the university research center. The clinical sample participated in the questionnaire survey and in the interview during the same session.
The women ranged in age from 19 to 39 (M = 24.00, SD = 4.63), and the men from 21 to 35 (M = 26.48, SD = 4.03); the difference in age was significant (t = –2.39, df = 37.46, p = .022). The IPO, NPO, and BPO groups also differed in age (F(2, 78) = 6.65, p = .003) and, based on multiple Tukey comparisons of means, the BPO group was significantly older than the IPO group (p = .001) and the NPO group was older than the IPO group (p = .048); this should be considered in generalizing the results of the study. The personality organization groups were not equivalent according to sex (IPO: 87.50% women; NPO: 88.00% women; BPO: 59.40% women; χ2(2) = 8.69, p = .013). However, neither age nor sex was related to the results in the dependent variable (relationship components). A large majority of the sample had secondary (60.50%) or higher education (35.20%) and there were no differences in education according to personality organization.

PROCEDURE

The interviewers were trained and instructed to remain in the background. After the narrative stimulus, the rest of the interview was devoted to elaborating on the concerns expressed by the participants and reflecting on the narrated experience (see narrative interview in clinical research; Soroko, 2009). The participants freely chose which relationship to report on (self-narrative theme), and their answer was audio-recorded and transcribed verbatim using chosen notations (covering nonverbal behavior, paralinguistic vocalizations, and pauses), based on the Jeffersonian system (Jefferson, 2004). The self-narratives were then extracted from the transcripts of the whole interview and their contents were analyzed using the method of competent judges (with both tailor-made categories and standard categories). The average narrative was 800 words in length (the minimum was 137 and the maximum was 9440), with the word count excluding maze words (that is, words, initial parts of words, or unattached fragments which do not contribute meaning to the ongoing flow of language; Loban, 1976). Participants generally reported on one important relationship (M = 1.48, SD = 0.81); the maximum number of relationships spoken about was five (the number of relationships reported was determined by the competent judges with 100% agreement).

MEASURES

Personality organization. To determine personality organization, two questionnaires were used in combination: The Borderline Personality Inventory (BPI, Leichsenring, 1999; Polish adaptation by Cierpiałkowska, 2001; cf. Górska, 2006) and the Neuroticism subscale from the Eysenck Personality Questionnaire (EPQ-R, Eysenck, Eysenck, & Barrett, 1985; Polish adaptation by Brzozowski & Drwal, 1995). The BPI is a highly reliable and valid self-reporting method, used in borderline personality screening and in borderline personality organization classification (Leichsenring, 1999). It consists of 53 items and quantitatively assesses borderline pathology on four subscales: primitive defenses, identity diffusion, fear of closeness, and deficits in reality testing. BPO was diagnosed when the score on the BPI was above 20, which is consistent with the suggestion of the test’s author. NPO was diagnosed when the Neuroticism score was high or medium (using normalized scores, sixth sten and higher; see Brzozowski & Drwal, 1995) but when the BPI score was below 20 at the same time. Thus, in classifying participants in the NPO group, we included people who self-reported neurotic symptoms, but excluded those with symptoms specific to BPO. The NPO group consisted of people suffering from emotional instability, indefinable somatic symptoms, or emotional dysregulation, but at the same time not employing pathological splitting or dissociation (low BPI score). In other words, we excluded people with splitting and included people who suffer from emotional disturbances, which probably reflects neurotic personality organization (for other ways of selecting NPO groups see: Benedik, 2009; Leichsenring, 2004; Hibbard, Porcerelli, Kamoo, Schwartz, & Abell, 2010). Consequently, low scores in both Neuroticism and BPI were recognized as IPO.
In object relations theory, implicit processes and structures are more pivotal than explicit symptoms, but the former lead to the latter, and might be seen as a cause. However, it is possible to determine the level of personality organization indirectly through the prevalence of symptoms, because severe symptoms (such as derealization associated with identity diffusion) are not present at higher personality organization levels, and if neurotic symptoms (such as anxiety or lack of self-worth) occur alone, without more severe symptoms, they indicate a higher personality organization level. Nonetheless, we assume that the combined symptoms help us to determine the personality organization level. The most important characteristics of the groups distinguished here are the internal aspects, such as defense mechanisms (splitting vs. repression), identity issues (diffusion vs. consolidation), as well as the differentiation and integration of mental representations.
Internal relational patterns. In order to investigate relational patterns, a modification of the Core Conflictual Relationship Theme method (CCRT; Luborsky, 1984, 1998; Luborsky & Friedman, 1998; Luborsky et al., 2004; Luborsky & Barrett, 2007; Barber et al., 1995) was applied. Internal relational patterns were assessed by identifying three components of the CCRT method (WS: wish of self; RO: reaction from other; RS: reaction from self) in narratives about close relationships, but the analytic procedure was a modification of the original version of CCRT, in terms of the calculations (with a different scale for assessing clusters of components), resigning, and analyzing the repetitiveness and pervasiveness (as one relational episode per person was analyzed).
In the study presented here, three components (WS, RO, and RS) were assessed through self-narratives by two trained raters (psychodynamically oriented) using first tailor-made categories. Each text was assessed by two raters (judges). The raters were expected to read the text, interpret it according to the three components, and note which expressions were the most adequate, selecting about five to ten. Judges were then asked to translate their tailor-made scoring into the standard categories (clusters) provided by the CCRT, which cover eight WSs, eight ROs, and eight RSs (Luborsky & Barrett, 2007) (see Table 1). In each self-narrative, every component (8 × WS, 8 × RO, 8 × RS) was assessed on a scale ranging from 0 (absent) to 5 (very intense), with higher scores on this scale indicating higher levels of intensity of the selected cluster of the component. The inter-rater agreement, calculated on the whole sample, was moderate – for the wishes (WS), the Krippendorff’s α was .41; for the response of the other (RO), Krippendorff’s α was .44; while for the self-response (RS), Krippendorff’s α was .51. To establish the final score for each participant for each component cluster, the mean of two independent raters was calculated.
In order to more explicitly explore the relationship patterns, and to reduce the many diverse distinct categories, the standard categories (clusters) were each merged into two general categories (see Table 1). After the coding procedure, the components (WS, RO, and RS) were additionally aggregated, each into 2 main groups. The wishes (WS) were denoted as either aggressive or libidinal (according to the classical distinction of drives as aggressive or libidinal; for example, Freud, 1915/2002); the responses of other (RO) were denoted as frustrating or fulfilling (in the character analysis tradition); and the responses of self (RS) as affectively positive or negative (according to the dichotomous affect valence experienced when the problematic situation in a relationship ended). This same aggregation was present in previous studies (Soroko, 2014) and similar notions about the negativity vs. positivity of RO and RS components were used by Diguer and colleagues (2001; see also Bourke & Grenyer, 2010). To establish, for example, whether there was a positive or negative RS, the balance between positive and negative RS was calculated. These same calculations were performed for the WSs and ROs. Thus, the proposed reduction was theory-based and resulted in the opportunity: 1) to establish the prevalence of one of two tendencies in every component (WS: aggressive vs. libidinal; RO: frustrating vs. fulfilling; RS: positive vs. negative), and 2) to assess relationship patterns in the configurations WS plus RO plus RS. This led to eight possible configurations present in the self-narrations in this study.

RESULTS

In order to explore whether particular components of internal relationship patterns are related to personality organization, the ANOVA and post hoc multiple comparisons test (Dunnett T3) were applied. Type I error adjustment (Holm’s method) was also reported because of the high number of outcome measures. However, the effect size (η2 ≥ 0.06 = moderate effect, η2 ≥ 0.14 = large effect) was the main criterion for further study of intergroup differences.
One-way analysis of variance revealed significant differences between groups of people with different levels of personality organization, according to one wish of self (To oppose, hurt, control – WS2), five responses of others: Bad (RO4), Rejecting and opposing (RO5), Helpful (RO6), Likes me (RO7), Understanding (RO8), and three responses of self: Helpful (RS1), Oppose and hurt others (RS4), Anxious and ashamed (RS8). The significant differences are shown in Table 2 and Figure 1.
In order to visualize intergroup differences in WS, RO, and RS, principal component analysis was performed (see Figure 1). The intergroup differences were coded nominally (0 = no difference, 1 = higher score, –1 = lower score) and reduced to bi-dimensional form. The first dimension reflects negative vs. positive responses from other and from self (with one aggressive wish on the “negative” end). The second dimension is harder to interpret but seems to reflects the neurotic vs. non-neurotic polarity. It is possible to discern that the BPO (“negative end”) is in opposition with the IPO (“positive end”) and that NPO lies between them. Moreover, NPO is most likely characterized by passive reactions from self and object.
Below we present abbreviated but exact statements of people with different levels of personality organization, which well illustrate the differences described above and also the following results.
BPO:
• He cared about me but I was always unhappy
• It forced me to actually reflect on it, and it was a pleasure for me to do so to some extent
• And with the elapse of time this my cloddishness
• And I became a parasite, and he was even more distant
• Then used force for this
• He caused that the view to-date of life on love for all values that I had turned around the world by one hundred and eighty degrees
• Still at the end practically to some extend trampled on this
• And now I am trying again to find myself
NPO:
• I can tell you about my relationship with my current boyfriend
• At the beginning I didn’t even pay so much attention to him, but later we met at a party and I found out that I actually even like him
• But it lasted several months before we started to be together
• And I was almost ready to give up, but then he dared and we met
• And then we kissed for the first time and since then we have started to meet regularly
• A month ago, he went abroad for an apprenticeship for five months
• So now we will have such a trial period ahead of us
• But so far this month has passed quite quickly
• Maybe because now the exams are approaching so I have a lot to do
• I don’t even have time to miss what it really is like to be there
• I was a bit worried about it because I would feel more calm if I missed him a lot more
IPO:
• We are only less than a year after the wedding
• He was looking after me and finally I just started to see something cool in him
• And then such a love broke out between us and after a year we practically got married
• This relationship is very important to me because I simply see it as a support for me, I trust it very much
• I also know that I am important to him because he shows me this very often
• And it also causes that I am just calming down emotionally next to it
• We must share the different duties and tasks
• As it always happens, sometimes you simply do not want to but somehow we share there is ok
When aggregated components are taken into account, there are differences (based on ANOVA and post hoc tests as above) between groups with different levels of personality organization: 1) RO frustrating (F(2, 78) = 7.63, p = .001, ω2 = .141; according to the Tukey multiple comparisons of means, the BPO group has more frustrated responses from others than the IPO (p = .004) and NPO (p = .049) groups); 2) RO fulfilling (F(2, 78) = 14.62, p < .001, ω2 = .252; according to the Tukey test, the BPO group has fewer fulfilling responses from others than the IPO (p < .001) and NPO (p < .001) groups); 3) RS negative (F(2, 78) = 4.08, p = .021, ω2 = .071; according to the Tukey test, the BPO group has a larger negative reaction of self than the IPO (p = .015) group).
To broaden the picture of relationship patterns, the aggregated aspects of the components were assessed for their frequency in the BPO, NPO, and IPO groups. Desires for aggression in terms of libi­dinal desires were distributed 18.00%/82.00% in the IPO group, 4.00%/96.00% in the NPO group, and 35.00%/65.00% in the BPO group. The differences between these frequency distributions are statistically significant (χ2(2) = 9.77, p = .008). Taking into account the frustrating and satisfying responses of the object, the proportions were as follows: 25.00%/75.00% in the IPO and NPO groups, and the other way around in the BPO group, at 71.00%/29.00%. These differences in frequency are also statistically significant (χ2(2) = 18.02, p < .001). The self-responses to object reactions, subdivided into negative and positive, break down as: 43.00%/57.00% in the IPO group, 50.00%/50.00% in the NPO group, and 71.00%/29.00% in the BPO group. This distributions are not statistically significant (χ2(2) = 5.29, p = .071).
Moreover, based on aggregated and balanced components, the possible patterns of WS + RO + RS configurations were identified: WS (aggressive vs. libidinal) plus RO (frustrating vs. fulfilling) plus RS (positive vs. negative). First, all patterns in the sample were identified more than once – for example, “WS aggressive + RO fulfilling + RS negative” occurred twice and had the lowest frequency. Second, only the three most frequent were selected to test the differences in the pattern frequencies between the BPO (n = 20), NPO (n = 25), and IPO (n = 21) groups. These three patterns did not differ by WS, which was libidinal in all cases. Third, Fisher’s exact test was applied to find significant differences (χ2 = 19.37,p < .001, N = 66). The results show that, in the BPO group, the pattern “WS libidinal + RO frustrating + RS negative” is most prevalent (67.00%), while the patterns “WS libidinal + RO fulfilling + RS negative” and “WS libidinal + RO fulfilling + RS positive” are each present in about 13.00% of cases.

DISCUSSION

The results of our study support the thesis that the level of personality organization is associated with relational patterns detected in an autobiographical narrative about an important interpersonal relationship. Several components of relational patterns were significantly different when personality organization was taken into account. These were one wish of self (To oppose, hurt, control – WS2), five responses of others (Bad – RO4; Rejecting and opposing – RO5; Helpful – RO6; Likes me – RO7; Understanding – RO8), and three responses of self (Helpful – RS1; Oppose and hurt others – RS4; Anxious and ashamed – RS8). As shown in Figure 1, there are two theoretically justified dimensions in the empirical data that show how the differences are distributed between groups with different levels of personality organization.
The first dimension reflects the negative vs. positive responses from other and from self (with one aggressive wish on the “negative” end). The content of the WS, RO, and RS components indicates the intensity of the internal conflicts from the developmental stages that match the fixation period attributed to the level of personality organization. In other words, fixation in the separation-individuation phase (Mahler in Edward, Ruskin, & Turrini, 1981) can be detected in the BPO group in notions about simultaneous themes of deliberate search for an object, avoidance of intimate contact, and the presence of hostility accompanying frustration (WS2, RS4, RO5). The aggressiveness of WS was not directly detected in this study, as in previous research (Drapeau & Perry, 2009) and as is observed in clinical contexts with borderline patients (Kernberg, 2005), and nor were the contradictory tendencies such as a wish to be close that often co-occurs with an opposing wish for distance. However, both tendencies are present in analyzing and interpreting the landscape of internal representations of the self, object, and their relations, depending on the specific phase of child development. For instance, the wish to hurt and control the object (WS2) demonstrates early processes of “shadowing” of mother and “darting away”, which is crucial for identity formation, especially in the rapprochement sub-phase of development (Edward et al., 1981). The wish to control and hurt (WS2) is explicit, but opposing and hurting others as a reaction of the self (RS4) can be treated as an identification with an aggressive object who frustrated the self in its need for closeness; however, the need for closeness is not expressed explicitly. On the other hand, these wishes (WS2, RS4) may reflect effortful emerging of the self at the moment when less aggressive wishes were blocked (e.g., when not supported by caregivers). The prevalence of positive ROs in the IPO group reflects the attainment of object constancy as an effect of the differentiation of representations of the self from the representations of the object, providing contact with positive, fulfilling representation of the object. The positive reactions from the object are both discerned and anticipated, so a sense of security is experienced.
The second dimension (Figure 1) is harder to interpret, but it seems to reflects the neurotic vs. nonneurotic polarity, with ‘nonneurotic’ here referring to a helpful reaction of the self (RS1) and perceiving the other as opposing and rejecting (RO5). This draws attention to the psychological defenses (repression and its consequences) that prevent those in the NPO group from perceiving others as openly rejecting them, as it is too confrontational to notice others’ aggressiveness toward the self. It is also forbidden to sustain an operative helpful reaction, perhaps because of worries and relational concerns (in favor of feeling anxious or ashamed, and perceiving others as bad or helpful). The suggestion can thus be made that the second dimension represents passive vs. active manifestations of reactions, both from the object and from the self.
In line with expectations, BPO (“negative end”) is in opposition to IPO (“positive end”), with NPO located between them. Moreover, NPO is characterized by passive reactions from the self and object. This suggests not only that the BPO group differs from the higher level personality organization groups due to splitting as an organizational structure, but also that the NPO group has its own specificities. This supports Kernberg’s theory and contributes to the notion of repression as a defense that leads to the attribution of a greater passivity to relations, while in BPO, when splitting is active, contradictory identifications not tempered by reflection are actively present (and manifest in autobiographical narrations about important close relationships) (Górska & Soroko, 2017; for more detailed reflection on interrelations between CCRT and defenses, see de Roten, Drapeau, Stigler, & Despland, 2004).
Apart from that, we assessed the aggregated aspects of components for their frequencies in BPO, NPO, and IPO. Aggressive wishes in BPO were more prevalent than libidinal wishes, and frustrating responses prevailed over fulfilling ones. It contributes to the hypothesis that wishes are probably experienced very intensely and without sufficient regulation, perhaps for temperamental reasons, but also perhaps because the response of the other is not ample enough (Kernberg, 2005). Aggressive wishes might be direct (accessible as split, devaluated aspects of self), but frustrating responses from the other might be recognized as responses to the previously aroused wish for closeness, which is very hard to retain as an attribute of the self. In the NPO group, we observed almost no aggressive wishes, which might be the result of repression. Moreover, in the NPO and IPO groups, the object is perceived as rather fulfilling. When the aggregated components in configurations are taken into account, we expected that IPO would present higher fulfillment in reactions from object (RO) and more positivity in reactions from self (RS) than BPO and NPO. The hypothesis was partly confirmed: the IPO group has less frustrating responses from others and lower negative reactions of self than the BPO group, but this difference is not significant for the NPO group. This is in fact a measurement of the balance between two aspects of WS, RO, and RS. Furthermore, based on aggregated and balanced components, we observed that every combination of the WS + RO + RS patterns was present. The three most prevalent patterns were WSLib + ROFru + RSNeg (most frequent in BPO) and WSLib + ROFul + RSNeg and WSLib + ROFul + RSPos (most frequent in NPO and IPO). It seems that the tendency to narrate about fulfilling reactions of others is salient in the NPO and IPO groups.
Although 1) Drapeau and colleagues (2009) insist that existing models based on the CCRT method (and those based on the SASB method and translated into CCRT categories) do not appear to provide much discriminant power for distinguishing patients with BPD from those with other disorders, and 2) still there is no empirical evidence to support the claim that some CCRTs are typical of particular psychodynamic problems or types of personality disorders (Vinnars et al., 2013), the current study brings promising results. It suggests that moving from specific disorders to the levels of personality pathology is an encouraging way to examine relational patterns and their relationships with personality disorders. Splitting and repression (as well as other structural criteria of personality organization) might contribute to differences in the features of relational patterns observed in patients with personality pathology, although the context of activation of the psychological structures needs to be examined in future studies. In our study, this context was a relation with an interviewer and a narrative stimulus allowing the subject to freely narrate about an important other; however, this is only one of many possible options.

THE CONTENT ANALYSIS METHOD: LIMITATIONS AND REFLECTIONS

This study has some limitations concerning both the generalization of its results and the analysis procedure. Our findings are relevant to a heterogeneous groups of patients (different diagnoses are possibly present), both from clinical and nonclinical settings, but at the same time the participants are homogeneous with respect to psychometric properties. Nevertheless, there exist potentially important variables – such as the psychological state during the interview, the intensity of treatment in the clinical sample, and the self-narrative inclination of participants – that were not controlled in this study. The subject and circumstances of the self-narration (a story about an important close relationship told in a research context) that was analyzed in search of WSs, ROs, and RSs are very specific. It should also be noted that, in this study, we considered patterns in terms of configurations of wishes and anticipated reactions from object and self, but not central themes (such as a generalized tendency or pervasiveness of a certain relational pattern among many interpersonal relationships). Moreover, the results are treated and interpreted as indicators of internal psychological structure and fixation at a certain developmental period in early childhood. Due to the intrapsychic perspective and the focus on configurations, only one autobiographical narration (though one freely selected as a significant one) was taken as sufficient here for the study of relational patterns, but for more decontextualized results – and when the question is not about internal personality structures in general but about the significance of activation stimuli – more than one relationship should be studied to compare relationship patterns in different activation conditions (see e.g., Marszał, 2015).
Considering the research procedure and analysis, it is important to note the consequences of modifying the CCRT method. The CCRT clusters used here as a point of departure, as well as their aggregations, may be too broad to capture participant idiosyncrasies, and the calculation method cannot be directly compared with other CCRT studies. Moreover, we obtained moderate inter-rater reliability, possibly because the clusters of components overlap (see Wilczek et al., 2000), but the calculations were based on the mean scores of two raters. Each self-narration was analyzed by two raters in order to spot the raters being ambiguous about some components. This is justified by the interpretive nature of the study. There is no doubt that the CCRT method itself is a very useful tool for psychodynamic case formulation, but it is also worth pointing out that the research modification of CCRT presented here seems to be an efficient way to analyze relational patterns when a standard but open-structured interview is performed.

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