Swiss Journal of Psychology 63 (1), 2004, 53–57

Original communication

Interpersonal conflicts in
borderline personality disorder:
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An exploratory study using the

CCRT-LU
Martin Drapeau and J. Christopher Perry
The Erikson Institute for Training and Research of the Austen Riggs Center & Harvard Medical School, and McGill University &
The Institute of Community and Family Psychiatry of the Sir Mortimer B. Davis Montreal Jewish General Hospital

This exploratory study compared the relationship patterns of 12 patients with borderline personality disorder
(BPD) with those of 11 patients without Axis II pathology using the newly developed CCRT-LU. Results showed
that the most prevalent wishes of patients with BPD reflect both a desire and a fear of establishing relationships
with significant others. Results also showed that BPDs felt dissatisfied and scared, and determined by others,
dependent and weak in interpersonal situations. When comparing BPD and non-BPD subjects, results indicated
that BPD subjects display fewer wishes to attend to others, perceive others as more loving and subjugating, more
often feel dissatisfied and scared, and are less attacking than subjects without BPD.

Keywords: Core Conflictual Relationship Theme, CCRT, CCRT-LU, borderline personality disorder

An individual’s capacity to make use of a large repertoire
of positive and diversified ways of interacting with others
is often considered to be an indication of mental health.
On the other hand, psychopathology is associated with in-
terpersonal schemas of greater rigidity and with fewer pos-
sible alternatives in interactions with others (Cierpka et
al., 1998). It has been empirically demonstrated that in-
terpersonal patterns may be differentially related to per-
sonality disorders or structures (Diguer et al., 2001; Ruiz,
Pincus, & Bedics, 1999; Stern, Heron, Primavera, & Kaku-
ma, 1997; Wiggins & Pincus, 1994). As such, examining
disturbed interpersonal functioning in particular person-
ality disorders is certainly warranted.
One specific area of research on the interpersonal pat-
terns in borderline personality disorder (BPD) has given
limited results. In an empirical review of the models of in-
terpersonal functioning suggested by Benjamin (1992),
Diguer et al. (2001), Ruiz et al.(1999), and Stern et al.
(1997), Drapeau and Perry (2004a) concluded that the em-
pirical validation and clinical significance of these mod-
els require further study. They suggested an empirically-
derived model of interpersonal functioning in BPD
(Drapeau & Perry, 2004b) using the Core Conflictual
Relationship Theme method (CCRT; Luborsky & Crits-
Christoph, 1990). In examining 77 BPDs and 81 non-
BPDs, they demonstrated that the core interpersonal pat-
terns of patients with BPD generally reflect their desire
and hesitation to establish relationships with significant
others. Furthermore, indications of splitting of object rep-
resentations were found in the relationship patterns of pa-
tients with BPD, as objects were often seen as rejecting
and opposing, or as understanding. Finally, patients with
BPD often felt disappointed and depressed, or anxious and
ashamed in interactions with others. It was also shown that
specific interpersonal behaviors explained up to 19% of
the variance in the Borderline Personality Disorder Scale

DOI 10.1024/1421-0185.63.1.53 Swiss J Psychol 63 (1), 2004, © Verlag Hans Huber, Bern
 54 M. Drapeau, J. C. Perry: Interpersonal models of borderline functioning
(Perry, 1982). This empirical model suggested that pa-
tients with BPD did not have a wish to be opened up to
nor to be good, and perceived others’ reactions as con-
trolling and bad, hence leading to depression and shame.
Overall, Drapeau, and Perry (2004b) found that BPDs
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differed from non-BPDs in the following terms: BPDs had
less wish to be opened up to and to help others but more
wish to be hurt; and BPDs felt more often guilty and
ashamed, and less often happy. However, this empirical
model was based on the use of the CCRT method, which
has recently been criticized in many regards (Albani,
Pokorny, Dahlbender, & Kächele, 1994; Albani et al.,
1999; Wilczek, Weinrib, Barber, Gustavsson, & Asberg,
2000). Because of the method’s limitations, researchers
and clinicians have recently suggested a new CCRT
method: the Core Conflictual Relationship Theme-
Leipzig-Ulm/Logically-Unified (CCRT-LU; Albani,
Pokorny et al., 2002).
The first empirical applications of the CCRT-LU
showed that it allows for a higher degree of differentiation
in attachment patterns than the original CCRT categories.
Furthermore, a recent single-case study suggests that the
method yields a considerably higher level of differentia-
tion when analyzing object-specific relationship patterns
(Albani, Blaser, Körner, Geyer, & Strauss, 2002; for a re-
view, see Albani, Pokorny et al., 2002).
The aim of this exploratory study is to further explore
the relationship patterns in the functioning of patients with
BPD, by such examining whether the newly-developed
CCRT-LU provides additional information on this func-
tioning.
Method
Subjects
The sample for this study was selected from a larger pool
of patients treated at the Austen Riggs Center, a residen-
tial treatment facility for treatment-resistant patients. Pa-
tients admitted into the center receive intensive psychi-
atric treatment including psychopharmacology, as well as
four-times-weekly individual dynamic psychotherapy.
The study sample is part of a naturalistic follow-along
study of patients during and after treatment at the center.
Details about the center and the follow-along study can be
found elsewhere (Plakun, 2003).
All patients admitted to the center are assessed by ex-
perienced clinicians for Axis I and Axis II disorders using
the Guided Clinical Interview (Perry, 1992; Perry, Greif,
Ianni, & Roy, 1999). Axis I disorders are also assessed us-
ing the Longitudinal Interval Follow-up Evaluation (LIFE;
Swiss J Psychol 63 (1), 2004, © Verlag Hans Huber, Bern
Keller, Lavori, & Friedman, 1987). For all measures, raters
established satisfactory interrater reliability (Plakun,
2003).
A first group of 12 patients with DSM-IV borderline
personality disorder was selected for this study (BPD
group). This selection was based on the fact that these pa-
tients, unlike most subjects in the Austen Riggs Follow-
along Study, did not present with any other personality
disorder (i.e., no Axis II comorbidity). A second group of
11 patients was selected because they did not meet the cri-
teria for a DSM-IV personality disorder (non-BPD group).
All subjects were women. The mean age for the sample
(BPD and non-BPD groups) was 31 years (SD = 9.03).
The mean best GAF score in the last year was 53 (SD =
8.49) with a mean current GAF score of 42 (SD = 7.34).
No difference was found between the BPD and non-BPD
groups in terms of age and GAF. All subjects met criteria
for a major depressive disorder and/or dysthymia. Other
diagnoses included generalized anxiety disorder (35%),
post-traumatic stress disorder (21%), and social phobia
(16%). The subjects gave informed written consent after
detailed explanations about the study.
Instrument
The relationship patterns of the 23 subjects were scored
using the CCRT-LU method (Albani, Pokorny, et al.,
2002). A research assistant administered the Relationship
Anecdote Paradigm (RAP; Luborsky, 1998) interview
which collects a series of vignettes about interpersonal in-
teractions called Relationship Episodes (REs; see
Luborsky, 1998, for details). The RAP is semi-structured
with the interviewer beginning by saying: “I am going to
ask you to tell me stories of interactions you have had with
others that struck you as particularly important, interesting
or troublesome. These interactions must have happened
within these last 6 months”. During the interview, the in-
terviewer inquires about what the wishes or desires of the
subject were during the interaction, how the other person
involved in the interaction felt or reacted, and how the sub-
ject felt or reacted as a result of the other person’s response.
Each subject provided approximately 11 REs. These nar-
ratives were collected at the time of admission into treat-
ment.
Like the original CCRT method, the CCRT-LU is ap-
plied to the subjects’ REs. These narratives are generally
assessed according to three elements: (1) the wishes,
needs, motivations or intentions of the subject (W); (2) the
response of others to the subject (RO); and (3) the response
of the subject to others (RS). However, unlike the origi-
nal CCRT, the CCRT-LU rates wishes for the subject (WS:
I want to…) and for the object (WO: the other should…).
It also introduces subdimensions addressing direction,
 M. Drapeau, J. C. Perry: Interpersonal models of borderline functioning
hence allowing for a classification of object-directed and
subject-directed wishes and responses.
The method includes 13 cluster categories to which are
assigned 119 subcategories. Because of the sample size
used in this study, paired-comparisons were not possible
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for all 119 subcategories. Hence, this study addressed on-
ly the 13 clusters of the CCRT-LU for each of the three el-
ements by examining their proportion. More specifically,
it examined the 13 clusters of the Wishes of the Subject
(WS: I want…) and of the Object (WO: the object
should…), the Responses of the Object (RO: the object
does…), and the Responses of the Subject (RS: I do…).
Results
Reliability [ICC (2,1)] was calculated on 80 randomly se-
lected segments. This was preferred to the usual reliabil-
ity assessment on a few complete interviews because it al-
lowed for greater diversity. Both raters had extensive
experience in the use of the original CCRT but little ex-
perience in the use of the CCRT-LU. Reliability was good
with IR = .84 for the WO, .89 for the WS, .90 for the RO,
and .79 for the RS. In 66% of cases, both raters gave the
exact same rating for a given randomly selected segment.
Considering the BPD group alone, we found that the 2
most prevalent WO, WS, RO, and RS of patients with BPD
were as follows: WO: BPDs want others to support (M =
.44, SD = .20) and attend to them (M = .25, SD = .26); WS:
BPDs want to withdraw (M = .29, SD = .18), and be self-
determined and autonomous (M = .19, SD = .17); RO:
BPDs perceive others’ actions as rejecting (M = .20; SD =
.14) and supporting (M = .19, SD = .13); RS: BPDs feel
dissatisfied and scared (M = .19, SD = .10), and deter-
mined by others, dependent and weak (M = .18, SD = .09).
Next we examined differences between the BPD and
non-BPD groups. Because of the sample size, non-para-
metric Mann-Whitney U-tests without correction for the
p-value were used to compare BPD with non-BPD. Fur-
thermore, the p-value was set at .10 for exploratory pur-
Table 1
Mean proportion and standard deviation for the CCRT-LU clusters different in BPDs and non-BPDs
Cluster BPD
N = 12
M SD
WS-A: I want to attend to the other .02 .03
RO-C: the other is loving .06 .06
RO-K: the other is subjugating .08 .10
RS-F: I am dissatisfied .19 .10
RS-L: I attack .02 .03
* p < .10; ** p < .05; *** p < .01
55
poses. Results show no significant difference between
BPDs and non-BPDs on most clusters. Clusters with a dif-
ference in prevalence can be found in Table 1. Results sug-
gest that patients with BPD have less wish to attend to oth-
ers, perceive others as more loving and subjugating, more
often feel dissatisfied and scared, and are less attacking
than patients without BPD.
Discussion
The most prevalent wishes (WO and WS) of patients with
BPD may reflect their desire and fear of establishing re-
lationships with significant others. For instance, they want
others to support and attend to them, but they also want to
withdraw and be self-determined and autonomous. This
conflict was also found in our previous examination (Dra-
peau & Perry, 2004b) of the interpersonal patterns in BPD.
Using the original CCRT method, we found that BPDs had
both a strong desire to be loved and understood, and to be
distant and avoid conflicts. Results also showed that pa-
tients with BPD perceived others’ reactions as either re-
jecting, or as supporting. This is also in agreement with
an earlier study using the original CCRT method which
has shown that patients with BPD described others as re-
jecting and opposing, and as understanding. Such a per-
ception of the actions of significant others may reflect
splitting of object representations. At times, significant
others may be seen as all good and helpful, while at oth-
er times, they may be seen as all bad. Finally, patients with
BPD mostly felt dissatisfied and scared, and determined
by others, dependent and weak when interacting with sig-
nificant others. This finding is also in agreement with pre-
vious work by Drapeau and Perry (2004b) which has
shown that patients with BPD tend to feel disappointed
and depressed, and anxious and ashamed in interactions
with others.
Overall, patients with BPD seemed to show ambiva-
lence in getting involved in intimate relationships. Al-
though they very much desire help and support from the
non-BPD
N = 11
M SD U
.10 .18 41.00*
.02 .04 41.50*
.19 .15 35.00**
.08 .06 26.50***
.10 .18 24.00***
Swiss J Psychol 63 (1), 2004, © Verlag Hans Huber, Bern
 56 M. Drapeau, J. C. Perry: Interpersonal models of borderline functioning
people around them, they also make frantic efforts to re-
main independent and distant. The response of others to
the wishes of the patient with BPD appears to be construed
as all good or all bad, as a result of splitting of object rep-
resentations. In many interactions, the patient with BPD
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ends up feeling dissatisfied and scared, as well as depen-
dent and weak. As such, rejection from others, but also
support, seem to be followed by feelings of fear and de-
pendency.
The findings of this exploratory study are less clear
when comparing patients with BPD with other patients
without any personality disorder. We found a trend for the
wish to attend to someone else, which was identified less
often in BPDs than in non-BPDs. Previous work by Dra-
peau and Perry (2004b) has shown similar results, with
BPDs having fewer wishes to be opened up to and to help
others when compared to non-BPDs. This may suggest
that patients with BPD have difficulty in realizing that oth-
ers need help and to wish to attend them. A second trend
was found for “others are loving”, in which BPDs perceive
others as more loving than non-BPDs. As it has been ar-
gued elsewhere (Drapeau, de Roten, & Körner, 2004), such
a finding may result from the fact that subjects highly in-
vest in relationship episodes in which a significant object
reacts positively to the subject. As such, patients with BPD
give great significance to interactions where an object is
loving and not rejecting as in most interactions. If this is
true, it is no surprise, then, that patients with BPD men-
tion fewer interactions in which the object is subjugating
and dominating, and they themselves are attacking. Fi-
nally, a difference was found in the prevalence of “I feel
dissatisfied and scared”. This is in agreement with Dra-
peau and Perry’s (2004b) study using the original CCRT
method, which has shown that patients with BPD more
often feel guilty and ashamed and less often happy than
non-BPDs. As such, even if BPDs give great importance
to relationship episodes where a significant other is loving,
they feel dissatisfied and scared even at such moments.
We do not yet know how stable these findings are over
time. Left for further study is whether multiple RAP in-
terviews over months or even years will demonstrate a
similar pattern, which would validate the importance of
these findings.
Conclusion
This study is exploratory and as such, results must be in-
terpreted with great caution. Limitations include the small
sample size and low statistical power to detect differences
between the two groups. Future studies will also need to
select groups where Axis I pathology is less salient or
Swiss J Psychol 63 (1), 2004, © Verlag Hans Huber, Bern
where the patients with a borderline personality disorder
are matched in terms of Axis I disorders and general func-
tioning with patients without Axis II pathology. Although
comorbidity is common in BPD, it is necessary to study
the patterns of behaviors specific to this disorder by se-
lecting subjects presenting minimal comorbidity. Such ef-
forts are needed to better define the criteria used in its di-
agnosis.
Nonetheless, in general, these preliminary findings are
in agreement with previous work on BPD using the orig-
inal CCRT method. Because this study only used the
CCRT-LU clusters, future studies with a greater sample
size are necessary to take fully advantage of the improve-
ments of the new method over the original CCRT. Fur-
thermore, these preliminary results suggest that there is
great interest in the empirical study of the relationship pat-
terns associated to borderline personality disorder, and to
Axis II pathology in general. Until such studies are un-
dertaken, any empirically based classification of person-
ality disorders will remain incomplete.
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Martin Drapeau
ECP – McGill University
3700 McTavish Street
Montreal, Quebec
H3A 1Y2
CANADA
E-mail: martin.drapeau@mcgill.ca
Swiss J Psychol 63 (1), 2004, © Verlag Hans Huber, Bern