Keynote Speaker - Eva-Lotta Brakemeier
Using the Interpersonal Circumplex in psychotherapy: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP)
Eva-Lotta Brakemeier, PhD
Philipps-University of Marburg, Germany
The SITAR meeting 2016 in Berlin was organized by Johannes Zimmermann – whom I know as an outstanding expert in – amongst other things – interpersonal research for many years. Thus, I was honored when he asked me to be one of two keynote speakers at the 2016 SITAR meeting. Here, I provide a brief summary of my talk.
First, I pointed out that persistent depressive disorder (PDD) has often been associated with profound interpersonal difficulties. These difficulties manifest in the patient’s everyday life and also within the therapeutic relationship. Based on this observation, James McCullough has developed the Cognitive Behavioral Analysis System of Psychotherapy (CBASP).
The central assumption of CBASP is this: while current interpersonal behavior of patients with persistent depressive disorder is problematic, their behavior can be understood against the background of experiences these patients have made with early significant others. Their hurtful interpersonal experiences have resulted in a perceptual disconnection that makes it difficult for these patients to learn from current experience in interpersonal interactions. CBASP therapy techniques therefore focus on a behavioral analysis of interpersonal contingencies to reconnect patients perceptually with their interpersonal environment. The efficacy of CBASP has been demonstrated in several published randomized controlled trials (compare the first meta-analysis: Negt, Brakemeier et al., 2016).
During the main part of my talk I tried to I tried to demonstrate how helpful the inclusion of the Kiesler Circle as an interpersonal circumplex models is in CBASP by using video clips of CBASP individual and group therapy sessions.
Finally, I addressed the interpersonal profile of 70 PDD inpatients and their change of interpersonal characteristics during CBASP. The 70 inpatients with PDD, high level of treatment-resistance and trauma history were treated with the CBASP inpatient program over 12 weeks. Interpersonal characteristics were measured pre and post therapy with the self-report Inventory of Interpersonal Problems (IIP) and the Impact Message Inventory (IMI) rated by the therapists. Patients’ dominance and affiliation as well as interpersonal distress were calculated from these measures. Depressive and general symptomatology was assessed at pre, post, as well as 6 and 12 months follow-up. While 76% met response criterion and 40% remission criterion in the intention-to-treat sample, none of the patients deteriorated reliably after 12 weeks of treatment. 25% of responders relapsed 6 months and 48% 12 months after discharge (comp. Brakemeier et al., 2015). Interestingly, analyses of the IMI pre post showed that patients could on average change their stimulus character ending in appearing more friendly and dominant. The results of the IMIs by the dyads couples patient – therapist pre an post underline that healing relationship experiences might indeed occur because at the end the profiles were nearly identical with high values on friendly and friendly-dominant.
To sum, our analyses concerning the interpersonal characteristics pointed out that change in interpersonal characteristics is indeed possible most likely due to extensive use of situational analyses with role-playing and use of the Kiesler Circle. As a next step, we are currently planning a randomized controlled multicenter study comparing CBASP with Behavioral Activation investigating change in interpersonal problems as a potential mediator variable.
To end, I would like to thank Johannes Zimmermann and SITAR for giving me the chance to demonstrate the interpersonal CBASP techniques and to share some ideas and results during my keynote. Having enjoyed the stimulating atmosphere and exciting discussion during the SITAR conference I hope that we will keep in touch and cooperation. Friendly-dominant regards!
Brakemeier, E. L., Radtke, M. Engel, V., Zimmermann, J., Tuschen-Caffier, B., Schramm, E., Hautzinger, M., Berger, M., Normann, C. (2015). Overcoming treatment-resistance in chronic depression: Outcome and feasibility of the Cognitive Behavioral Analysis System of Psychotherapy as an inpatient treatment program. Psychotherapy and Psychosomatics, 84, 51–56.
Negt, P., Brakemeier, E.L., Michalak, M., Winter, L., Bleich, S., Kahl, K.G. (2016). The treatment of chronic depression with Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A systematic review and meta-analysis of randomized-controlled clinical trials. Brain and Behavior, 2016; 0(0), e00486, doi: 10.1002/brb3.486