Off The Couch #4 CCRT (Core Conflictual Relationship Themes)

In episode four of “Off the Couch”, Dr. Daniel P. Brown discusses treatment and assessment of CCRT (Core Conflictual Relationship Themes). Dr. Brown was fortunate to have studied with all three generations of people who developed the CCRT formulation including Thomas French, Erika Fromm and Franz Alexander at the Chicago Institute for Psychoanalysis.

Read the Full Transcript:

Dan Brown: There’s a second relational map that develops in the third and fourth year of life – much older. That’s when children have the capacity for highly developed emotional ideas, when they can have highly developed stable beliefs and schemas. They develop limiting beliefs and schemas about what’s possible for the self in relationships. We call those CCRT problems, “core conflict relational themes.” So, if a person doesn’t have an attachment disturbance, and they have the capacity for secure attachment, they can still have significant relational problems. What they learn is to select for dysfunctional relationships. So, if they describe each one of their intimate relationships in life, and you get 10 to 15 intimate relationships that they’ve been involved with, some of them worked and others didn’t work, most of them didn’t work. If you step back and look at the patterns, you’ll see that it’s like a musical score, with one or two central patterns and infinite variations on the same one or two themes. That’s called “developing a core conflict relational theme map,” and if you spell out the map to the individual at the onset of treatment, in roughly about 30 to 50 patient hours going over that, you can develop a new positive map and change that map, so they select differently. So, we don’t keep playing out the same old, same old dysfunctional relationship and behavior over and over again. I had the fortune of studying with all three generations of people who developed the CCRT formulation. The first was Tom French, Erika Fromm, and Franz Alexander, at the Chicago Psychoanalytic Institute.

Caroline Baltzer: I didn’t realize Erika had been involved in that.

Dan Brown: Yeah. She was a colleague of Tom French, who developed the first method, what’s called the “focal conflict method,” for working with relational dysfunctions, in the 1940s. They were looking for a short version of psychoanalysis, and they thought if they picked out the core conflict that was played out over and over again, they could shorten analysis to one to two years. They wrote a textbook on that, and it came out in the mid-1940s. And the American Psychoanalytic Association had them take the book off the market. They told the Chicago Institute that they would lose their membership in the organization if they tried to advocate for watered-down, cheaper analysis and make much less money, of course.

Caroline Baltzer: Oh my goodness.

Dan Brown: So, the book was pulled, and it took 20 more years, until Bob Langs came out with his work on Psychoanalytic Psychotherapy in New York, that they rediscovered the same wheel again, and began to say that now is the time, in this more current generation, that shorter treatments are more relevant and are acceptable within the profession.

Caroline Baltzer: Who was that clinician?

Dan Brown: Robert Lang and his work on psychodynamic psychotherapy, in the 1970s.

Caroline Baltzer: R. D. Lang?

Dan Brown: No, Robert Lang, not R. D. Lang, who was an existential psychiatrist from London. Robert Lang was a psychiatrist in New York. Then, the second generation of core conflict relational themes was the work of Margaret Brenman-Gibson and Mert Gill, at the Menninger Foundation. And Mert did something that no one had ever done before. He audio-recorded full psychoanalysis. Then, just by analyzing the recordings of the analyses, he developed a method to cut down the time wasted in analysis by developing an approach called “the here-and-now transference approach.” He put out a two-volume set called The Analysis of Transference. I was working at the Menninger Foundation at the time and knew Mert from there. I knew Mert also from when we were both consultants to the Fetzer Foundation for various projects and initiatives that they had. Mert was a rather polemic, brilliant genius, but he was the one who was the mastermind behind how you think about formulating the core conflict relational theme in a patient and playing it off the here-and-now transference relentlessly, to get the person better. And at the Foundation, at that time, there were two postdocs that eventually went on to set up their own libraries. One was Lester Luborsky, and the other was Hans Strupp. They both set up labs, one at Vanderbilt, and the other at Penn. And then, Margaret Brenman-Gibson came to Cambridge Hospital, she was in my department, and we taught a course on core conflict relational theme assessment for 10 years at Cambridge. So, I trained with all three generations of the CCRT method, and then, we developed our own method of positive remapping of core conflict relational themes. It was more effective than just trying to change the patient’s reaction of self or reaction of others; to actually change the entire map in a positive way.

Watch the full clinical interview series:
1. Meet Dr. Daniel P. Brown 
2. Overview of Trauma Treatment
3. Attachment Disturbances 
4. CCRT (Core Conflictual Relationship Themes)
5. Three Pillars Approach (Treatment for Attachment)
6. Teaching Psychology
7. Conversion Disorders 
8. Factitious & Dissociative Disorder
9. Psychological Assessments
10. Bipolar Disorder Treatment
11. Trauma Bonding Maps
12. Conclusion 

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