Personality Disorders as a Possible Moderator of the Effects of Relational Interventions in Short-Term Psychoanalytic Psychotherapy with Depressed Adolescents

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. BACKGROUND: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. METHODS: Depressed adolescents (N = 69), aged 16-18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including "time", "treatment group" and "number of PD criteria". RESULTS: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient-therapist relationship in the here and now. CONCLUSION: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology

Therapists’ Feelings in Psychodynamic Therapy: A Study of self-reported Countertransference and long-term Outcome

The therapeutic relationship is one factor that makes consistent contribution to outcome independent of type of therapy. The emotional exchange between persons is a vital part of any relationship, and psychotherapists’ feelings are an inescapable aspect of every session. The overall aim in this dissertation was to investigate a significant domain within the therapists’ countertransference, that is, the feelings the therapists became aware of, acknowledged, remembered, and were willing to report on a feeling word checklist (FWC-58) after each session. Data from the First Experimental Study of Transference (FEST), a randomized clinical trial with dismantling design, was used. FEST aimed at studying the effects of a core ingredient in dynamic psychotherapy; transference work. Transference work was defined as therapist interventions focusing on the patient-therapist interaction. Hundred patients were randomized to therapy with or without transference work for one year. Long-term effects of transference work in the context of parental CT (composed of the feeling words: Motherly, Affectionate, Dominating and Important), and patients’ level of personality pathology were investigated. The results showed that both parental CT and the patients’ personality pathology strongly influenced the long-term effect of transference work: In the context of increasing parental CT the positive effect of transference work became even more positive for patients with high level of personality pathology. For patients with low levels of personality pathology the positive effect of transference work became negative. In-depth qualitative and quantitative analyses of two cases complemented the statistical analyses. These studies add to the literature which suggests that patient characteristics, technique variables, and therapist variables interact in complex ways to determine psychotherapy outcome. More specifically, the results are consistent with theory and research that emphasizes the therapists’ need to be actively aware of their countertransference. In addition, patients with high levels of personality pathology might need an emotionally involved therapist

Do Sleep Disturbances Improve Following Psychoanalytic Psychotherapy for Adolescent Depression?

Sleep disturbance is often a prominent symptom in adolescents diagnosed with major depressive disorder (MDD). Recent evidence indicates that short-term psychoanalytic psychotherapy (STPP) for depression may have an effect in reducing co-occurring sleep disturbance in youth. It is unknown if transference work (exploration of the patient-therapist relationship) has an additional effect in reducing sleep disturbance. Adolescents aged 16-18 years (n = 69, 84% female) who met diagnostic criteria for MDD based on the Mini International Neuropsychiatric Interview (M.I.N.I) were randomized to either STPP with transference work or without. Sleep problems were assessed at baseline, therapy session 20 (20 weeks), post-treatment (28 weeks), and one-year follow-up (80 weeks) with the Symptom Checklist-90-R. At baseline, 69% of the adolescents exhibited moderately to extreme sleep difficulties. Sleep disturbance was significantly correlated to depression depth at session 20 and at follow-up. Symptoms of insomnia significantly decreased from baseline to the end of treatment. Treatment gains were maintained until follow-up. No differences in recovery of sleep disturbance were found between the two treatment groups. The findings suggest that sleep disturbance improves following STPP for depression, with or without transference work. Future research should assess those with residual symptoms by different sleep measure

Does Insight Mediate Treatment and Enhance Outcome?

According to psychoanalytic and psychodynamic theory, insight is an important mechanism which may lead to better interpersonal functioning. In the present paper we have summarized empirical studies attempting to shed some light on insight as a putative mediator of treatment effects. Two case examples illustrate how improved insight might lead to clinical change. This is an Accepted Manuscript of an article published by Taylor & Francis : http://www.tandfonline.com

Core conflictual relationship theme: the reliability of a simplified scoring procedure

Background Creating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient’s interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns. The CCRT method is based on the assumption that humans display a central relationship theme, which is shown in most relationships as well as in the patient-therapist relation. The CCRT scoring is based on how the patient describes interactions with others, in therapy sessions or in a specific interview. These descriptions are transcribed. Raters then score the identified relational episodes by choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. The method has shown high validity and reliability. Inter rater reliability is generally good: Cohen’s kappa ranging from 0.55 to 0.70. To decide CCRT pattern from transcribed material is time consuming and labour intensive This study investigates a labour- and timesaving version of the method. Methods This study aimed to investigate rater agreement in a simplified method of scoring the CCRT, based directly on live semi-structured dynamic interviews without transcribing the material. Fifty-two patients referred for psychotherapy in a clinical trial, were scored for CCRT pattern. Based on information that came forth during the two-hour interview, raters scored the patients choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. More than one category in each component could be chosen without ranking. Five raters compared two by two were investigated. Inter rater reliability was measured by Cohen’s kappa. Results Mean kappa for Wishes, Response from Others and Response from Self was .33, .41 and .45 respectively. Mean kappa for CCRT in total was .41 among 5 raters. Conclusion In this simplified method to score the CCRT based on oral dynamic interviews, fair to moderate IRR was obtained. Trial registration First Experimental Study of Transference-interpretations (FEST307/95). Registration number: ClinicalTrials.gov Identifier: NCT00423462

Patient factors predict therapists' emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

Objective: Recently, studies have reported systematic relationships between the therapists’ emotional response/countertransference (CT) during therapy and a variety of patient characteristics, speaking to the communicative potential of CT. Within an RCT assessing the role of transference work (TW) in psychodynamic therapy, we investigated whether therapist CT was related to patients’ pre-treatment interpersonal problems, degree of personality pathology and motivation for psychodynamic therapy. Secondly, we explored if these relationships depended on whether the therapists used TW or not in sessions. Method: One hundred outpatients were treated with psychodynamic psychotherapy (with or without TW) for one year. Their therapists’ emotional reactions after sessions (CT) were assessed with the Feeling Word Checklist-58 (FWC-58). Results: Four subscales of the FWC-58; Inadequate, Confident, Disengaged and Parental feelings were differentially predicted by patient characteristics. Some of the associations depended on treatment condition such that degree of PD pathology was associated with therapists feeling more inadequate in the non-TW-group. Patients’ motivation for treatment was associated with less disturbing CT feelings, such as Inadequate and Disengaged CT (the latter especially in the TW group), and feeling more Confident CT. Conclusion: Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

Parental Bonding and Relationships with Friends and Siblings in Adolescents with Depression

According to attachment theory, the quality of the early child-parent bond determines the child's interpersonal relationships later in life. Utilising data from The First Experimental Study of Transference Work-In Teenagers (FEST-IT), the current paper investigated the connection between the self-reported quality of bonding with mother and father and the self-reported importance of relationships with friends and siblings in adolescents with depression. The scales employed were the Parental Bonding Instrument (PBI) and the Adolescent Relationship scale (ARS). A Pearson's correlation tested the relationship between the reported levels of maternal and paternal care and control, and the reported importance of friendship and relationship with siblings. Results revealed a statistically significant negative correlation between high levels of maternal control and importance of friendship, and a statistically significant positive correlation between high levels of paternal care and importance of relationships with siblings. The results are in line with Bowlby's theory of attachment

Psykodynamisk kartlegging av ungdom og voksne ved hjelp av semistrukturert intervju og funksjonsskalaer

Få redskaper finnes for å kartlegge og evaluere dynamisk endring i forbindelse med psykodynamisk terapi. Psykodynamiske funksjonsskalaer (PFS) er revidert og oversatt til norsk. Basert på et psykodynamisk intervju er skalaene egnet for kartlegging av dynamisk fingering hos ungdom og voksne. I denne artikkelen presenteres en revidert versjon av PFS som er oversatt fra engelsk til norsk. En guide for det semistrukturerte intervjuet er også inkludert. Dette verket har følgende lisens: Erkännande-Ickekommersiell-IngaBearbetningar 2.5 Sverige (CC BY-NC-ND 2.5 SE

Psychotherapy dropout: Using the Adolescent Psychotherapy Q-Set to explore the early in-session Process of short-term psychodynamic psychotherapy

Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16–18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature

Conflicted anger as a central dynamic in depression in adolescents—a double case study

The incidence of depression in teenagers has increased for many years and is one of the most common diagnosis in adolescent psychiatry. Effective and accessible psychotherapy methods need sustained attention since psychopharmaceutic treatment might be less effective in younger people than in adults. The First Experimental Study of Transference–In Teenagers (FEST-IT) is a Randomized Controlled Study (RCT) with a dismantling design. The main intention in this study was to illustrate a way to address parts of a case formulation by focusing a psychodynamic feature in two different therapies with a good outcome suffering from depression. We present two representative patients from the FEST-IT with case formulations revealing conflicted anger. The patients were different in many aspects, as were the therapeutic methods. Therapies with and without transference interpretations may help to understand what is helpful in therapy in general. It may also show how a more individualized approach can guide the therapy beyond diagnosis and to make it more effective for the specific patient. Looking into individual cases with good outcomes can help us address dynamic features in therapy and give some ideas about what works for whom. The use of nested qualitative double case studies may together add more knowledge about working aspects in successful therapies