current issues in personality psychology · volume 6(4), 8
doi: https://doi.org/10.5114/cipp.2018.80198
original article
Levels of personality organization
and internal relational patterns
Emilia SorokoA,B,C,D,E,F,G, Lidia CierpiałkowskaD,E,F
Adam Mickiewicz University, Poznań, Poland
background
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 were to
explore whether and how the components of the internal
relationship pattern, and whether and how the configurations of the components, are related to personality organization, when integrated personality organization (IPO) is
taken into account.
hurt, control), five responses of others (RO4 Bad; RO5 Rejecting; RO6 Helpful; RO7 Likes me; RO8 Understanding),
and three responses of self (RS1 Helpful; RS4 Oppose and
hurt others; RS8 Anxious). Considering the configurations
of WS + RO + RS, the results indicate that in the borderline
personality organization (BPO) group, the WS Libidinal
+ RO Frustrating + RS Negative pattern is most prevalent,
while in the neurotic personality organization (NPO) and
IPO groups, the WS Libidinal + RO Fulfilling + RS Negative
and the WS Libidinal + RO Fulfilling + RS Positive configurations are most frequent.
participants and procedure
Assessment of the relational patterns was based on the
Core Conflictual Relationship Theme (CCRT) – wishes
(WS), responses from others (RO), and responses of the
self (RS) – as identified from participants’ self-narratives
about important relationships (N = 90).
conclusions
The study supports the thesis that component relationship patterns and their configurations might be related to
personality organization. The main differences were found
between BPO and IPO with NPO placed between them, in
a way congruent with Kernberg’s theory.
results
One-way analysis of variance revealed significant differences between groups with different levels of personality
organization, according to one wish of self (WS2 To oppose,
key words
personality organization; borderline; relational patterns;
Kernberg
corresponding author – Emilia Soroko, Ph.D, Adam Mickiewicz University, 89 Szamarzewskiego Str., 60-578 Poznań,
Poland, e-mail: soroko@amu.edu.pl
authors’ contribution – A: Study design · B: Data collection · C: Statistical analysis · D: Data interpretation ·
E: Manuscript preparation · F: Literature search · G: Funds collection
to cite this article – Soroko, E., & Cierpiałkowska, L. (2018). Levels of personality organization and internal relational
patterns. Current Issues in Personality Psychology, 6(4), 292–304.
received 20.09.2017 · reviewed 13.09.2018 · accepted 13.09.2018 · published 07.12.2018
Emilia Soroko, Lidia Cierpiałkowska
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).
volume 6(4), 8 293
Personality organization and internal relational patterns
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-objectaffect, 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
294 current issues in personality psychology
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 selfconfident 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 nonBPD subjects (Drapeau & Perry, 2004), the results
indicated that BPD subjects displayed fewer wishes
to attend to others, to perceive others as more loving
Emilia Soroko, Lidia Cierpiałkowska
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,
volume 6(4), 8 295
Personality organization and internal relational patterns
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,
296 current issues in personality psychology
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
Emilia Soroko, Lidia Cierpiałkowska
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.
Table 1
Standard categories (clusters) of wishes (WS), responses from other (RO), and responses from self (RS), and their
aggregation
Wish (WS) and its aggregation
Response from other (RO)
Response from self (RS)
1. To assert self
Agg
1. Strong
Fru or Ful 1. Helpful
Pos
2. To oppose, hurt,
control
Agg
2. Controlling
Fru
2. Unreceptive
Neg
3. To be controlled,
hurt, and not
responsible
Agg
3. Upset
Fru
3. Respected
and accepted
Pos
4. To be distant and
avoid conflicts
Agg
4. Bad
Fru
4. Oppose and hurt
others
Neg
5. To be close and
accepting
Lib
5. Rejecting
and opposing
Fru
5. Self-controlled
and self-confident
Pos
6. To be loved and
understood
Lib
6. Helpful
Ful
6. Helpless
Neg
7. To feel good and
comfortable
Lib
7. Likes me
Ful
7. Disappointed
and depressed
Neg
8. To achieve and help
others
Lib
8. Understanding
Ful
8. Anxious and
ashamed
Neg
Note. Aggregated WS: Agg – aggressive; Lib – libidinal; aggregated RO: Ful – fulfilling; Fru – frustrating; aggregated RS: Pos – positive;
Neg – negative.
volume 6(4), 8 297
Personality organization and internal relational patterns
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
Table 2
Results of ANOVA and post hoc (statistically significant results only)
Component
WS2
To oppose, hurt,
control
RO4
Bad, insufficient,
incompetent
RO5
Rejecting and
opposing
RO6
Helpful
RO7
Likes me
RO8
Understanding
RS1
Helpful
RS4
Oppose and hurt
others
RS8
Anxious and
ashamed
Group
n
M
SD
SE
IPO
24
0.09
0.39
0.07
NPO
25
0.11
0.29
0.05
BPO
32
0.57
1.24
0.21
IPO
24
0.18a
0.53
0.10
NPO
25
0.43a
1.01
0.19
BPO
32
1.79b
2.09
0.36
IPO
24
0.89
1.63
0.31
NPO
25
1.08
1.75
0.33
BPO
32
2.00
1.99
0.34
IPO
24
1.64
2.01
0.38
NPO
25
1.81
1.87
0.35
BPO
32
0.74
1.50
0.26
IPO
24
2.40a
2.13
0.40
NPO
25
1.99a
1.84
0.35
BPO
32
0.92b
1.53
0.26
IPO
24
1.18a
1.73
0.33
NPO
25
1.09a
1.62
0.31
BPO
32
0.07b
0.23
0.04
IPO
24
0.82
1.34
0.25
NPO
25
0.29
0.57
0.11
BPO
32
0.19
0.52
0.09
IPO
24
0.00a
0.00
0.00
NPO
25
0.16a,b
0.62
0.12
BPO
32
0.38b
0.83
0.14
IPO
24
0.20a
0.57
0.11
NPO
25
1.34b
1.93
0.37
BPO
32
0.81a,b
1.42
0.24
F(2, 87)
Sig.
adj. Sig.
χ2
3.54
p = .029
.522
0.08
11.62
p < .001
.000
0.21
3.41
p = .003
.063
0.07
3.27
p = .040
.690
0.07
5.50
p = .001
.023
0.12
6.91
p = .001
.023
0.14
4.49
p = .020
.400
0.09
3.00
p = .050
.998
0.07
4.52
p = .025
.475
0.09
Note. The symbols “a” and “b” indicate differences between groups, significant at p < .05 according to post hoc multiple comparisons
tests (Dunnett T3); in column “adj. Sig.” Holm’s adjustment is presented; χ2 ≥ 0.06 = moderate effect, χ2 ≥ 0.14 = large effect.
WS – wishes, RO – responses of others, RS – responses from self, IPO – integrated personality organization, NPO – neurotic personality
organization, BPO – borderline personality organization.
298 current issues in personality psychology
Emilia Soroko, Lidia Cierpiałkowska
RO4
(Bad,
not trustworthy)
RS8
(Anxious,
ashamed)
1
Dim. 2
BPO
0
WS2
RS4 (To oppose, hurt, control)
(Oppose,
hurt others)
–1
NPO
RO8
(Open,
RO6
understanding)
(Helpful,
RO7
cooperative)
(Likes me,
respects)
IPO
RO5
(Rejecting,
opposing)
RS1
(Helpful, open)
–2
–2
–1
0
1
2
Dim. 1
Note. WS – wishes, RO – responses of others, RS – responses from
self, IPO – integrated personality organization, NPO – neurotic
personality organization, BPO – borderline personality organization.
Figure 1. Two-dimensional presentation of intergroup differences in WS, RO and RS, from principal component analysis.
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
volume 6(4), 8 299
Personality organization and internal relational patterns
Table 3
Frequencies of configurations of relational patterns in BPO, NPO, and IPO groups
Pattern: WS + RO + RS
WS Lib + RO Ful + RS Pos
WS Lib + RO Ful + RS Neg
WS Lib + RO Fru + RS Neg
Total
IPO
NPO
BPO
Total
10
11
3
24
41.70%
45.80%
12.50%
36.40%
8
10
3
21
38.10%
47.60%
14.30%
31.80%
3
4
14
21
14.30%
19.10%
66.80%
31.80%
21
25
20
66
Note. WS – wishes, RO – responses of others, RS – responses from self, IPO – integrated personality organization, NPO – neurotic
personality organization, BPO – borderline personality organization.
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
300 current issues in personality psychology
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
Emilia Soroko, Lidia Cierpiałkowska
(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
volume 6(4), 8 301
Personality organization and internal relational patterns
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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