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  • 1. Arvidsson, David
    et al.
    Sikström, Sverker
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Changes in self and object representations following psychotherapy measured by a theory-free, computational, semantic space method2011In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 21, no 4, p. 430-446Article in journal (Refereed)
    Abstract [en]

    We propose a theory-neutral, computational and data-driven method for assessing changes in semantic content of object representations following long-term psychodynamic psychotherapy. Young adults in psychotherapy are compared with an age-matched, non-clinical sample at three time points. Verbatim transcripts of descriptions of the self and parents were quantified in a semantic space constructed by Latent Semantic Analysis. In the psychotherapy group, all representations changed from baseline to follow-up, whereas no comparable changes could be observed in the comparison group. The semantic space method supports the hypothesis that long-term psychodynamic psychotherapy contributes to sustained change of affective-cognitive schemas of self and others.

  • 2. Carlsson, Jan
    et al.
    Norberg, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sandell, Rolf
    Schubert, Johan
    Searching for recognition: The professional development of psychodynamic psychotherapists during training and the first few years after it2011In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 21, no 2, p. 141-153Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate the development of psychotherapists' professional self during training and the first few years after it. Constant comparison analysis was conducted on interviews with former students (N = 18) at a training institute for psychoanalytic psychotherapy. The resulting core category osearching for recognitiono indicated that participants' ambition during the studied time period was to reach high status by becoming psychotherapists. During training, this was expressed by the category oattachment to preformed professional self,o meaning that students wanted their preconceptions about therapy to be acknowledged by teachers. After training, participants experienced achieved recognition and, as a result, a sense of freedom to use their own judgment.

  • 3. Hatcher, Robert L.
    et al.
    Lindqvist, Karin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Falkenström, Fredrik
    Psychometric evaluation of the Working Alliance Inventory?Therapist version: Current and new short forms2019In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381Article in journal (Refereed)
    Abstract [en]

    Background: The Working Alliance Inventory (WAI) and its short forms are widely used, although the properties of the therapists? versions have been little studied. Method: We examined the psychometric properties of two short forms (WAI-S-T, WAI-SR-T), and explored the creation of a psychometrically stronger short form using contemporary measure development techniques. Well-fitting items from the full 36-item WAI were identified in a development sample (131 therapists, 688 patients) using multi-level Bayesian Structural Equation Modeling, accounting for therapist rated effects. Multi-level Item Response Theory (IRT) methods aided creation of a revised short form (WAI-S-T-IRT). Factor structures of the three forms were assessed using multi-level ML estimation with robust standard errors. Results: Collinearity problems for the Goal and Task dimensions led to testing a two-factor model (Goal?Task, Bond). All three measures showed satisfactory fit; the WAI-S-T-IRT fit slightly better but differences were minor. Testing the structures in an independent sample (N?=?1117) yielded essentially the same results. No version showed strong measurement invariance. Discussion: Continued use of current therapist forms is supported; differentiation of theoretical dimensions is difficult with current measures, and may not be possible with self-report forms.

  • 4.
    Heffler, Bo
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sandell, Rolf
    The role of learning style in choosing one´s therapeutic orientation2009In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 19, no 3, p. 283-292Article in journal (Refereed)
    Abstract [en]

    The motives of the beginning psychotherapist for choosing his or her orientation are an underresearched issue in psychotherapy training. This study focuses on the role of personality-based factors, specifically the epistemological preferences of the therapist that Kolb (1984) has termed “learningstyle” (LS). The aim of the present study was to explore possible associations between psychology students’ developing LSs and their choice of psychotherapeutic orientation (psychodynamic vs. cognitive).

  • 5.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Risholm Mothander, Pia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ekström, August
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sjögren, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ögren, Marie-Louise
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Patient attachment to therapist rating scale: development and psychometric properties2014In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 2, p. 184-201Article in journal (Refereed)
    Abstract [en]

    Objective: To report on the development and initial psychometric properties of a new rating scale for patent-therapist attachment. Method: Seventy interviews from the Young Adult Psychotherapy Project (YAPP) were rated. Results: Excellent internal consistency (Cronbach's > .90) was observed for all four subscales (Security, Deactivation, Hyperactivation, and Disorganization). Three subscales showed good inter-rater reliability (ICC > .60), while one (Hyperactivation) had poor (ICC < .40). Correlations with measures of alliance, mental representations, and symptom distress support the construct validity of the reliable subscales. Exploratory factor analysis indicated three underlying factors explaining 82% of the variance. Conclusions: The Patient Attachment to Therapist Rating Scale is a promising approach for assessing the quality of attachment to therapist from patient narratives. Future development should focus on improving the discrimination of the insecure subscales.

  • 6.
    Ramnerö, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Therapists’ and clients’ perceptions of each other and working alliance in the behavioral treatment of panic disorder with agoraphobia2007In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 7, no 3, p. 320-328Article in journal (Refereed)
    Abstract [en]

    Fifty-nine patients who fulfilled criteria for a primary diagnosis of panic disorder with moderate to severe agoraphobia were treated with 16 sessions of behavioral therapy. The study investigated the relationship between therapists' and clients' perception of each other, working alliance, and outcome. There was initially a low correspondence between therapist and client perceptions but a growing consensus during treatment. This was most pronounced regarding high ratings of therapist qualities and the perception of the client as attractive. Clients' perceptions showed virtually zero correlation with outcome regardless of time. Therapist perception of client as showing active participation and goal direction yielded positive correlations with outcome at posttreatment and follow-up from Session 4 and throughout treatment. No significant relation between working alliance and outcome was found apart from the fact that those who improved during follow-up rated the alliance significantly higher than those who did not improve.

  • 7. Roos, Johanna
    et al.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review2013In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 23, no 4, p. 394-418Article, review/survey (Refereed)
    Abstract [en]

    Among potential predictors of dropout, client variables are most thoroughly examined. This qualitative literature review examines the current state of knowledge about therapist, relationship and process factors influencing dropout. Databases searches identified 44 relevant studies published January 2000-June 2011. Dropout rates varied widely with a weighted rate of 35%. Fewer than half of the studies directly addressed questions of dropout rates in relation to therapist, relationship or process factors. Therapists' experience, training and skills, together with providing concrete support and being emotionally supportive, had an impact on dropout rates. Furthermore, the quality of therapeutic alliance, client dissatisfaction and pre-therapy preparation influenced dropout. To reduce dropout rates, therapists need enhanced skills in building and repairing the therapeutic relationship.

  • 8.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Book review of H. Kächele, J. Schachter, & H. Thomä, 'From psychoanalytic narrative to empirical single case research: Implications for psychoanalytic practice'2010In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 20, no 6, p. 731-733Article, book review (Other academic)
  • 9.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sandell, Rolf
    Dropout revisited: Patient- and therapist-initiated discontinuation of psychotherapy as a function of organizational instability2014In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 6, p. 724-737Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the association between the stability or instability of services' organizational structure and patient- and therapist-initiated discontinuation of therapy in routine mental health. Method: Three groups, comprising altogether 750 cases in routine mental health care in eight different clinics, were included: cases with patient-initiated discontinuation, therapist-initiated discontinuation, and patients remaining in treatment. Multilevel multinomial regression was used to estimate three models: An initial, unconditional intercept-only model, another one including patient variables, and a final model with significant patient and therapist variables including the organizational stability of the therapists' clinic. Results: High between-therapist variability was noted. Odds ratios and significance tests indicated a strong association of organizational instability with patient-initiated premature termination in particular. Conclusions: The question of how organizational factors influence the treatment results needs further research. Future studies have to be designed in ways that permit clinically meaningful subdivision of the patients' and the therapists' decisions for premature termination.

  • 10.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Missios, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Waldenström, Fredrik
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    “It was hard work every session”: Therapists’ view of successful psychoanalytic treatments2019In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 29, no 3, p. 354-371Article in journal (Refereed)
    Abstract [en]

    Objective: To explore therapists’ experiences of the therapeutic process in successful cases of psychoanalytic psychotherapy.

    Method: A two-stage, mixed-method design was used. Sixteen successful cases were drawn from a sample of 92 young adults in psychoanalytic psychotherapy according to Jacobson’s criteria for reliable and clinically significant improvement. Therapist interviews at baseline and termination were analyzed applying Inductive Thematic Analysis.

    Results: Three core themes emerged: Being Particularly Motivated to be This Patient’s Therapist, Maintaining a Safe and Attentive Therapeutic Position, and Assiduous Work Every Session. The therapists experienced positive feelings towards the patient from the outset of treatment and described active, relational work that included paying attention to incongruities in the patient’s self-presentation and being mindful of patient’s avoidant behavior. The therapist’s motivation and attentive position made it possible to balance support and challenge in the therapeutic relationship.

    Conclusions: Successful therapeutic work presupposes positive expectations, an active therapeutic stance and assiduous work session-by-session. Therapist expertise may involve the ability to mobilize and work effectively with patient-specific resources and obstacles from the beginning of treatment. In addition to identifying the characteristics and actions of effective therapists, research should also focus on processes emerging within effective therapeutic dyads.

    Clinical or methodological significance of this article: Our study indicates several factors that seem to characterize therapist expertise and can inform psychotherapy training. Successful therapeutic work presupposes positive expectations, an active therapeutic stance, courage to challenge the patient, and assiduous work session-by-session. Therapist expertise may involve the ability to mobilize and work effectively with patient-specific resources and obstacles from the beginning of treatment. In addition to identifying the characteristics and actions of effective therapists, research should also focus on processes emerging within effective therapeutic dyads.

  • 11.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Von Below, Camilla
    St Lukas in Uppsala, Sweden.
    Brun, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Gunnarsdottir, Hulda
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    "Spinning one's wheels": Nonimproved patients view their psychotherapy2015In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 25, no 5, p. 546-564Article in journal (Refereed)
    Abstract [en]

    Objective: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. Method: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. Results: Spinning One's Wheels emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. Conclusions: When the therapist does not contribute to the achievement of the patient's treatment goals-even when the patient gains some benefit-the patient does not fully profit from the therapy.

  • 12.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    von Below, Camilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Engqvist, Karin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lind, Sofia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    “It was like having half of the patient in therapy”: Therapists of nonimproved patients looking back on their work2019In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 29, no 7, p. 894-907Article in journal (Refereed)
    Abstract [en]

    Objective: To explore therapists’ experiences of therapeutic process in psychoanalytic psychotherapy with nonimproved young adults. Method: Eight nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of therapist interviews (8 at baseline and 8 at termination) were analyzed applying grounded-theory methodology. Results: A tentative conceptual process model was constructed around the core category Having Half of the Patient in Therapy. Initially, the therapists experienced collaboration as stimulating, at the same time as the therapeutic relationship was marked by distance. At termination negative processes predominated: the patient reacted with aversion to closeness and the therapist experienced struggle and loss of control in therapy. The therapists described therapy outcome as favorable in form of increased insight and mitigated problems, while core problems remained. Conclusions: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist one-sidedly allied herself with the patient’s capable and seemingly well-functioning parts. The therapists’ experiences could be compared to the nonimproved patients’ “spinning one’s wheels” in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients’ core problems, despite attempts to meta-communicate.

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