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Grenyer BFS, Marceau EM. Helping patients master core conflictual relationship themes in psychotherapy. J Clin Psychol 2022; 78:386-395. [PMID: 35043390 PMCID: PMC9306742 DOI: 10.1002/jclp.23314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
An important component of case formulation is to understand the patient's difficulties in the context of their relationships. The Core Conflictual Relationship Theme (CCRT) method provides a clinical guide for understanding the narratives of relationship conflicts told during therapy. We follow the case of Barbara, a 60 year old with a long history of chronic shyness. Her narratives follow a common CCRT: she wishes to feel safe, but fears that others are out to get her, which makes her withdraw. These patterns have pervasively repeated themselves in the past, present, and across different relationships (self, family, partners, colleagues). The therapist responds carefully by creating safety, tolerating her fears, and working to overcome these CCRT patterns, thus reducing her impulse to withdraw from treatment. Psychotherapists from many theoretical orientations can learn how patients mastering these repetitive negative CCRTs can lead to more adaptive relationship patterns that improve their mental health.
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Affiliation(s)
- Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Day NJS, Townsend ML, Grenyer BFS. Living with pathological narcissism: core conflictual relational themes within intimate relationships. BMC Psychiatry 2022; 22:30. [PMID: 35012497 PMCID: PMC8751322 DOI: 10.1186/s12888-021-03660-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pathological narcissism is a severe mental health condition that includes disturbances in interpersonal functioning. Interpersonal difficulties by those affected include aggressive, domineering, cold and coercive behaviours which often result in strong negative reactions from others. We sought to examine the moment-to-moment patterns that emerge within close relationships between intimate partners and family members. METHODS Participants (N = 15) were romantic partners (73.3%) and family members (26.6%) in a close and long-term relationship (+ 10 years) with an individual with pathological narcissism. Participants told verbatim relationship narratives involving five narrative interactions with their relative with pathological narcissism and five narrative interactions with others. Transcripts were coded using the using Core Conflictual Relationship Theme method. Participants also completed three versions of the Relationship Questionnaire, reporting on 1. their relationship style 'in general', 2. their relationship style 'with their relative' and 3. the relationship style of their relative. RESULTS A total of 133 relationship episodes were analysed, comprising 783 components (wishes, responses of others and responses of self). While the identified wishes (e.g., for love, for support) were consistent between relative and non-relative narratives, there was significantly higher disharmony and lower harmony in narratives involving relatives with pathological narcissism. Described disharmony in these relationships involved the relative's rejecting, subjugating and attacking behaviours, and participants rejecting and withdrawing behaviours. There was a prominent deactivation of participants attachment system when interacting with their relative with pathological narcissism, endorsing predominately dismissing relationship styles. Individuals with pathological narcissism were similarly rated as predominately dismissing. CONCLUSIONS Together, these results reflect the cycles of interpersonal dysfunction for individuals with pathological narcissism and their partners and family members. Treatment implications point to the risk of therapists withdrawing and dismissing a patient with high pathological narcissism in the countertransference. Strategies to monitor and manage these core relational themes in treatment remain a challenge.
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Affiliation(s)
- Nicholas J. S. Day
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Michelle L. Townsend
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Brin F. S. Grenyer
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
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Hegarty BD, Marceau EM, Gusset M, Grenyer BFS. Early treatment response in psychotherapy for depression and personality disorder: links with core conflictual relationship themes. Psychother Res 2019; 30:112-123. [PMID: 31018824 DOI: 10.1080/10503307.2019.1609114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: Depressed personality disorder patients showing an early rapid response (or sudden gain) in psychotherapy have better outcomes. Early responders are five times more likely to recover, despite equivalent ratings of working alliance. We explored core conflictual relationship themes (CCRTs) of early responders compared to others to further elucidate process-outcome links. Method: Patients (N = 20) with diagnosed major depression and personality disorder received 16 weeks of psychodynamic therapy. Early response was defined as a 50% reduction in Beck Depression Inventory symptoms during the first six sessions. Transcripts of therapy session three for early responders (n = 10) and others (n = 10) were analyzed using the CCRT Leipzig/Ulm method, identifying 728 components scored by two independent judges. Results: Relationship narratives showed CCRT-wish satisfaction was lower for those not having an early response, for both CCRT "Response of Other" and "Response of Self" components. These patients told narratives of others as more unreliable, aggressive, and less supportive, with less feelings of being loved and a lower experience of being self-determined. Conclusions: Specific negative relationship patterns may inhibit the ability to benefit from both therapy and extra-therapy relationships, contributing to a slower treatment response.
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Affiliation(s)
- Bronwyn D Hegarty
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Monique Gusset
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
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Group psychotherapy with young adults: Exploring change using the Core Conflictual Relationship Theme method. ARTS IN PSYCHOTHERAPY 2019. [DOI: 10.1016/j.aip.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tanzilli A, Colli A, Gualco I, Lingiardi V. Patient Personality and Relational Patterns in Psychotherapy: Factor Structure, Reliability, and Validity of the Psychotherapy Relationship Questionnaire. J Pers Assess 2017; 100:96-106. [DOI: 10.1080/00223891.2016.1272050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Antonello Colli
- Department of Humanistic Studies, University “Carlo Bo,” Urbino, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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Wiseman H, Tishby O. Applying relationship anecdotes paradigm interviews to study client-therapist relationship narratives: Core conflictual relationship theme analyses. Psychother Res 2017; 27:283-299. [PMID: 28102111 DOI: 10.1080/10503307.2016.1271958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE We describe client-therapist relational narratives collected in relationship anecdotes paradigm (RAP) interviews during psychotherapy and the application of the core conflictual relationship theme (CCRT) method. Changes in clients' and therapists' CCRT in relation to each other are examined and associations between their CCRTs and self-reported ruptures and repairs are explored. METHOD Sixty-seven clients and 27 therapists underwent RAP interviews and completed self-report rupture and repair items at early, middle, and late psychodynamic psychotherapy. Client-therapist relationship narratives were rated on the CCRT and the relational interplay within dyads was explored qualitatively. RESULTS CCRT changes from early to late therapy showed that with time clients perceived the therapist (RO) and the self (RS) more positively, and the therapist perceived the self (RS) less negatively. Some associations were found between tension in the session and clients' and therapists' negative RO and RS. Therapists' reports of alliance repairs were associated with positive RO and RS. CONCLUSIONS Relational narratives that clients and therapists tell in RAP interviews about meaningful interactions between them, enhance our understanding of clients' and therapists' inner experiences during interpersonal dances in the therapeutic relationship. Limitations and directions for future research are discussed, and implications for training are suggested.
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Affiliation(s)
- Hadas Wiseman
- a Department of Counseling and Human Development, Faculty of Education , University of Haifa , Haifa , Israel
| | - Orya Tishby
- b Department of Psychology , Hebrew University , Jerusalem , Israel
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Krause M, Altimir C. Introduction: current developments in psychotherapy process research /Introducción: desarrollos actuales en la investigación del proceso psicoterapéutico. STUDIES IN PSYCHOLOGY 2016. [DOI: 10.1080/02109395.2016.1227574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Valdés N, Arriagada L, Alamo N. Relational offers and demands: analysing the conflictual interactional components of anaclitic and introjective female depressive patients /Ofertas y demandas relacionales: análisis de los componentes interaccionales conflictivos de pacientes mujeres depresivas anaclíticas e introyectivas. STUDIES IN PSYCHOLOGY 2016. [DOI: 10.1080/02109395.2016.1205872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Representations of Self and Parents, and Relationship Themes, in Adolescents with Post Traumatic Stress Disorder (PTSD). JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 44:887-99. [DOI: 10.1007/s10802-015-0100-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Simmonds J, Constantinides P, Perry JC, Drapeau M, Sheptycki AR. Assessing Psychodynamic Conflict. Psychodyn Psychiatry 2015; 43:349-377. [PMID: 26301758 DOI: 10.1521/pdps.2015.43.3.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Psychodynamic psychotherapies suggest that symptomatic relief is provided, in part, with the resolution of psychic conflicts. Clinical researchers have used innovative methods to investigate such phenomenon. This article aims to review the literature on quantitative psychodynamic conflict rating scales. An electronic search of the literature was conducted to retrieve quantitative observer-rated scales used to assess conflict noting each measure's theoretical model, information source, and training and clinical experience required. Scales were also examined for levels of reliability and validity. Five quantitative observer-rated conflict scales were identified. Reliability varied from poor to excellent with each measure demonstrating good validity. However a small number of studies and limited links to current conflict theory suggest further clinical research is needed.
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Affiliation(s)
- Joshua Simmonds
- Licensed Psychologist in Private Practice, Quebec Order of Psychologists, Canada
| | | | - J Christopher Perry
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, and McGill University
| | - Martin Drapeau
- Associate Professor of Counselling Psychology and Psychiatry, and Chair (CFI) and Director of Research of the McGill Psychotherapy Research Group
| | - Amanda R Sheptycki
- Student, Department of Counselling Psychology and Psychiatry, McGill University
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Atzil-Slonim D, Wiseman H, Tishby O. Relationship representations and change in adolescents and emerging adults during psychodynamic psychotherapy. Psychother Res 2015; 26:279-96. [PMID: 25732876 DOI: 10.1080/10503307.2015.1010627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Two groups of clients at sequential developmental stages, adolescents and emerging adults, were compared regarding their presenting problems, psychological distress, and relationship representations over one year of psychotherapy. METHOD Thirty adolescents aged 14-18 years and 30 emerging adults aged 22-28 years, with similar demographic background, completed outcome measures and interviews according to the Core Conflictual Relationship Theme (CCRT) method. RESULTS The groups differed significantly in the presenting problems but did not differ in their initial levels of distress; their symptoms improved to a similar extent after one year of psychotherapy; differences between the groups in the representations of others were consistent with age-specific developmental challenges; levels of representations were associated with levels of symptoms at the end-point of treatment. CONCLUSION Clinicians need to be attuned to the specific difficulties and challenges of these continuous yet distinct developmental stages.
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Affiliation(s)
- Dana Atzil-Slonim
- a Department of Counseling and Human Development , University of Haifa , Haifa , Israel.,b Psychology Department and School of Social Work , Hebrew University , Jerusalem , Israel
| | - Hadas Wiseman
- a Department of Counseling and Human Development , University of Haifa , Haifa , Israel
| | - Orya Tishby
- b Psychology Department and School of Social Work , Hebrew University , Jerusalem , Israel
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Slonim DA, Shefler G, Slonim N, Tishby O. Adolescents in psychodynamic psychotherapy: changes in internal representations of relationships with parents. Psychother Res 2013; 23:201-17. [PMID: 23577626 DOI: 10.1080/10503307.2013.765998] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study explored whether and how internal representations of adolescents' relationship with their parents--a fundamental concept in psychodynamic theory--changed in the course of a year of treatment and whether the observed changes were related to changes in symptoms. Seventy two adolescents (ages 15-18; 30 in treatment and 42 in a non-treatment "community group") underwent Relationship Anecdote Paradigm (RAP) interviews according to the Core Conflictual Relationship Theme method (CCRT; Luborsky & Crits-Christoph, 1998) and completed outcome measures at two time points. A novel data-driven approach to clustering CCRT categories was used to characterize internal representations. The potential contribution of this approach to the CCRT method is discussed. The results indicate that adolescents' internal representations of their relationships with their parents changed significantly throughout treatment, and were related to changes in symptoms.
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Wilczek A, Weinryb RM, Barber JP, Gustavsson JP, Asberg M. Change in the core conflictual relationship theme after long-term dynamic psychotherapy. Psychother Res 2012; 14:107-25. [PMID: 22011120 DOI: 10.1093/ptr/kph007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This naturalistic study focuses on changes in central relationship patterns after long-term dynamic psychotherapy (mean duration = 3 years) with experienced psychotherapists. Relationship patterns before and after treatment were assessed according to the core conflictual relationship theme (CCRT) method, which includes 3 components: most frequent wish, response from others, and response of the self. Overall, the main CCRT did not change substantially after therapy. There were, however, a few significant changes for some of the standard cluster categories after therapy. Patients' flexibility regarding their use of different wishes and negative responses from others and the self increased, as did the frequency of positive responses from others and the self. The positive changes in relationship patterns were only rarely related to changes in symptoms and character pathology.
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Dennhag I, Armelius BÅ. Baseline training in cognitive and psychodynamic psychotherapy during a psychologist training program. Exploring client outcomes in therapies of one or two semesters. Psychother Res 2012; 22:515-26. [PMID: 22468963 DOI: 10.1080/10503307.2012.677332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This effectiveness study explored the outcomes of 187 clients seen by 187 students undergoing baseline training in psychotherapy. Clients reduced their symptoms (SCL-90) and increased their positive self-image (SASB introject) during the therapy. Multiple regression analyses showed no differences between the cognitive and the psychodynamic training approaches and no differences between one and two semesters duration of the therapies. However, 2-3% of variance in end states was accounted for by the interaction between the variables, indicating a moderating effect of duration in the two approaches. Outcomes for clients in the cognitive training approach were significantly better with two semesters than with one semester, while there was no such difference in the psychodynamic approach. Consequences for baseline training are discussed.
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Affiliation(s)
- Inga Dennhag
- Department of Psychology, Umeå University, Umeå, Sweden.
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Bourke ME, Grenyer BFS. Psychotherapists' response to borderline personality disorder: A core conflictual relationship theme analysis. Psychother Res 2010; 20:680-91. [DOI: 10.1080/10503307.2010.504242] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Parker LM, Grenyer BFS. New developments in core conflictual relationship theme (CCRT) research: a comparison of the QUAINT and CCRT–LU coding systems. Psychother Res 2007. [DOI: 10.1080/10503300600953538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pokorny D. Multiple perspectives: Psychometrics beyond “right” and “wrong”: An introduction to two different applications of the relationship questionnaire. Psychother Res 2006. [DOI: 10.1093/ptr/kph035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Drapeau M, Perry JC. Interpersonal conflicts in borderline personality disorder: An exploratory study using the CCRT-LU. SWISS JOURNAL OF PSYCHOLOGY 2004. [DOI: 10.1024/1421-0185.63.1.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Martin Drapeau
- 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
| | - 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
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Popp C, Luborsky L, Descôteaux J, Diguer L, Andrusyna TP, Kirk D, Cotsonis G. Relationships between God and people in the Bible, part III: When the other is an outsider. Psychiatry 2004; 67:26-37. [PMID: 15139583 DOI: 10.1521/psyc.67.1.26.31255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study considers intergroup attitudes in the Bible and compares relationships between God or Jesus and (a) Torah non-Israelites; (b) New Testament people who were not followers of Jesus; and (c) New Testament people who were not Jewish. Torah non-Israelites belonged to an out-group with respect to the Hebrew Torah, New Testament people who were not followers of Jesus belonged to an out-group with respect to the Christian New Testament, and New Testament people who were not Jewish were an in-group with respect to Christians. Results were that God or Jesus' relationships were very negative with people in the Torah who were non-Israelites and with people in the New Testament who were not followers, while relationships were positive with people in the New Testament who were not Jewish. Thus, in conclusion, results indicate that both the New Testament and the Torah portray negative relationships between God or Jesus and members of out-groups. Relationships portrayed in New Testament narratives about God and people who were not followers were sometimes more negative than observed for other groups in the New Testament and the Torah; for people who were viewed as outsiders, the New Testament could sometimes be more negative than the Torah. An aim of this study was to identify patterns of relationships between God or Jesus and different types of people in narratives of the Torah and in the New Testament. One of the characteristics of different types of people, including people described in biblical narratives, is whether they are members of in-groups or out-groups. Our focus in this report is on biblical narratives about people who are members of out-groups. The results contribute a clinical-quantitative assessment of out-groups in the Torah and New Testament that is focused on relationship with God, a central issue in the psychology of religion and the Bible.
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Affiliation(s)
- Carol Popp
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA
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