Assessing the reliability, predictive validity, and clinical utility of the Core Conflictual Relationship Theme (CCRT) formulation method

This doctoral dissertation consists of three studies evaluating the reliability, predictive validity, and clinical utility of the Core Conflictual Relationship Theme (CCRT) formulation method. The CCRT method has generally relied on expert clinicians to derive formulations. The reliance on expert clinicians coupled with financial restrictions in healthcare has arguably reduced the application of the CCRT method to field settings. Therefore, Study 1 evaluated whether non-clinically trained bachelor-level research assistants could reliably perform all CCRT rating tasks employing audio recordings of case material. The results indicated that bachelor-level judges exhibited an acceptable degree of reliability, demonstrating that clinical training is not required to reliably derive a CCRT formulation.Study 3 represents the first comparison of the clinical effectiveness of interpretations addressing CCRT themes relative to interpretations addressing themes congruent with a traditional therapist-derived formulation. Existing CCRT research has evaluated the method as a measure of psychotherapy process and outcome and has not investigated whether the CCRT provides clinical benefit. The objective of Study 3 was to determine whether interpretations addressing the CCRT were associated with a stronger therapeutic alliance and more effective treatment outcome than interpretations addressing the therapist formulation. The results of Study 3 provide an initial indication that interpretations addressing the CCRT formulation were associated with moderately greater clinical benefit relative to interpretations addressing the therapist formulation.In the aggregate, the results imply that the CCRT formulation method represents a reliable measure of a patient's central interpersonal pattern that can be employed by bachelor-level judges, demonstrates an acceptable degree of predictive validity, and appears to be associated with clinical benefit.Study 2 attempted to replicate previous research demonstrating that psychotherapy addressing the patient's CCRT is directly associated with a better therapeutic alliance and positive outcome. Further, the study extended previous research by evaluating the influence of the patient's level of interpersonal functioning on the relationships between interpretive accuracy, alliance, and outcome. Although Study 2 did not replicate the exact findings of previous research, the results indicate that interpretive accuracy was associated with the therapeutic alliance and outcome, further strengthening the predictive validity of the CCRT method.