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  • 1. Ankarberg, Peter
    et al.
    Bergsten, Katja
    Bohman, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Bäck, Malin
    Falkenström, Fredrik
    Klingström, Anders
    Lilliengren, Peter
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Socialstyrelsens riktlinjer är partiska och ovetenskapliga!2017In: Psykoterapi, ISSN 2001-5836, Vol. 26, no 2, p. 30-34Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Denna artikel är ett remissvar med synpunkter på de nationella riktlinjerna för ångest och depression, som vi publicerar i sin helhet i tidskriften. Vi gör det på grund av den ingående kunskap om processerna i riktlinjearbetet som några av författarna har kunnat få genom egen medverkan och närvaro i det arbetet.

  • 2. 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.

  • 3.
    Bimont, Diane
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    "I've got you under my skin": Relational therapists' experiences of patients who occupy their inner world2018In: Counselling Psychology Quarterly, ISSN 0951-5070, E-ISSN 1469-3674, Vol. 31, no 2, p. 243-268Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to conduct an in-depth exploration of therapists' experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting "under their skin". In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists' reactions to having a patient "under their skin" varied from resistance to symbiotic relatedness. The therapists' ideas of their professional role influenced how the experience of carrying the patient's suffering was interpreted. The phenomenon of the patient's presence in the therapist's representational world might be interpreted as a distinct countertransference phenomenon when working in a more "thin boundary" manner with particular cases. The therapists' ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.

  • 4.
    Fatouros Bergman, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Spang, Jochen
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Preisler, Gunilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Merten, Jörg
    Interplay of gaze behaviour and facial affectivity in schizophrenia2011In: Psychosis, ISSN 1752-2439, E-ISSN 1752-2447, Vol. 3, no 2, p. 148-150Article in journal (Refereed)
    Abstract [en]

    Background: Some patients diagnosed with schizophrenia display reduced amounts of negative facial affectivity during mutual gaze in everyday conversations with non-professionals. Aims: The aim was to confirm this finding in clinical interviews. Method: Thirty-two video-recorded clinical interviews were conducted with eight patients diagnosed with schizophrenia. Selected sequences were coded for gaze behaviour and facial affective behaviour. Results: During mutual gaze, the patients showed as much negative facial affectivity as expected by chance. Previous findings were not confirmed. Conclusions: Findings suggests that the type of interview has importance for the facial affectivity in patients diagnosed with schizophrenia during mutual gaze.

  • 5.
    Fatouros-Bergman, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Spang, J.
    Universität des Saarland, Tyskland.
    Merten, J.
    Universität des Saarland, Tyskland.
    Preisler, Gunilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Stability of Facial Affective Expressions in Schizophrenia2012In: Schizophrenia Research and Treatment, ISSN 2090-2093, Vol. 2012, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Thirty-two videorecorded interviews were conducted by two interviewers with eight patients diagnosed with schizophrenia. Each patient was interviewed four times: three weekly interviews by the first interviewer and one additional interview by the second interviewer. 64 selected sequences where the patients were speaking about psychotic experiences were scored for facial affective behaviour with Emotion Facial Action Coding System (EMFACS). In accordance with previous research, the results show that patients diagnosed with schizophrenia express negative facial affectivity. Facial affective behaviour seems not to be dependent on temporality, since within-subjects ANOVA revealed no substantial changes in the amount of affects displayed across the weekly interview occasions. Whereas previous findings found contempt to be the most frequent affect in patients, in the present material disgust was as common, but depended on the interviewer. The results suggest that facial affectivity in these patients is primarily dominated by the negative emotions of disgust and, to a lesser extent, contempt and implies that this seems to be a fairly stable feature.

  • 6.
    Jacobsson, Gunnel
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Tysklind, Fredrik
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Young adults talk about their problems2011In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 52, no 3, p. 282-289Article in journal (Refereed)
    Abstract [en]

    This study aims to explore how young adults in psychotherapy and young adults in general describe their problems and how their problem formulations change over time. Two matched samples from longitudinal prospective studies were compared using thematic analysis. Semi-structured, in-depth interviews were conducted at baseline, 1.5 years after termination of psychotherapy (N = 12) in the clinical sample and 3 years after baseline in the non clinical sample (N = 12). Inductive thematic analysis revealed six themes: problems associated with oneself, family, intimate relationships, sense of belonging, occupation, and social roles. The psychotherapy sample was characterized by problems with oneself closely related to other problematic areas, at both pre-treatment and at follow-up 1.5 years after termination, while problematic sense of belonging was a general theme only prior to psychotherapy. However, they were less troubled by their problems after psychotherapy. Problems with oneself decreased considerably in the non-clinical sample, while problems with intimate relationships were twice as frequent at follow-up. In the psychotherapy sample, the initial experience of being passively trapped within their problems was transformed into an experience of being an active agent in their own life. However, considerable differences between the psychotherapy sample and non-clinical sample still persisted at follow-up.

  • 7. Johansson, Lena
    et al.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Patients’ view of therapeutic action in psychoanalytic group psychotherapy2009In: Group Analysis, ISSN 0533-3164, E-ISSN 1461-717X, Vol. 42, no 2, p. 120-142Article in journal (Refereed)
    Abstract [en]

    Patients’ views of curative and hindering factors in psychoanalytic group psychotherapy are explored, starting with semi-structured interviews with 28 young adult patients at therapy termination. Using grounded theory methodology, a theoretical model of therapeutic action is constructed, elucidating the interactions between positive and negative experiences in the group. The focal point appears to be the patient’s experience of their own activity within the context of the group as whole, leading to increased self-knowledge and improved handling of emotions. The positively experienced change is also affected by people outside of therapy and real life events. The patients ascribed most frequent hindering factors to the absence of their own action to other group members and to the therapeutic frames. In contrast to therapist-based theoretical models, positive experience in the group leads patients to minimize the therapist’s role, while negative experiences lead patients to want a more active therapist.

  • 8. Levander, Sonja
    et al.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Personality-related responses to the psychoanalytic process: A systematic multicase study2012In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 29, no 1, p. 1-16Article in journal (Refereed)
    Abstract [en]

    Seven analysands and their analysts were repeatedly interviewed at the beginning, during, and after the analysis about the analysands' problems and helpful and hindering factors in the analytic process. Using the analysands' initial descriptions of their problems, the authors categorized them as anaclitic or introjective according to Blatt's personality model. The hypothesis was that they would differ as to experiences of the analytic work. The introjective group expected improved emotional control and ability to regulate interpersonal distance in addition to better understanding the roots of their problems. The anaclitic group believed that the analyst's strength and empathy would help them handle their need for support and love. The introjective group saw their own problems as the main hindrance in analysis but also directed critique to the analyst as a person. Their analysts experienced that the analysands wanted to do the work by themselves and were difficult to engage in the analytic process. The analysands in the anaclitic group were more occupied by hindrances in the psychoanalytic frame and attitude. Their analysts, on the other hand, sometimes found the work difficult and frustrating. The authors underline the importance of being aware of personality differences in analysands' response to specific dimensions of the analytic process.

  • 9.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Falkenström, Fredrik
    Sandell, Rolf
    Risholm Mothander, Pia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults2015In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 62, no 1, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning whereas the alliance predicted deterioration when both variables were modeled together. While limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of post-treatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

  • 10.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults2010In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 47, no 4, p. 570-585Article in journal (Refereed)
    Abstract [en]

    Studying experienced therapists' implicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations. In this study, 16 therapists' views of curative factors, hindering factors, and outcome were explored in 22 interviews conducted at termination of individual psychoanalytic psychotherapy with young adults. Grounded theory methodology was used to construct a tentative model of therapeutic action based on the therapists' implicit knowledge. The results indicated that developing a close, safe and trusting relationship was viewed as the core curative factor in interaction with the patient making positive experiences outside the therapy setting and the therapist challenging and developing the patient's thinking about the self. The therapeutic process was experienced as a joint activity resulting in the patient becoming a subject and acquiring an increasing capacity to think and process problems. The patient's fear about close relationships was seen as hindering treatment and leading to core problems remaining. The model is discussed in relation to major theories of therapeutic action in the psychoanalytic discourse and previous research focusing on young adults' view of curative and hindering factors in psychotherapy. Implications for practice and further research are suggested.

  • 11.
    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.

  • 12.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    A model of therapeutic action grounded in the patients’ view of curative and hindering factors in psychoanalytic psychotherapy2005In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 42, no 3, p. 324-339Article in journal (Refereed)
    Abstract [en]

    The patients’ view of curative and hindering factors in psychoanalytic psychotherapy was explored, starting from conducting the Private Theories Interview with 22 young adult patients at termination of their therapies. A tentative theoretical model of therapeutic action was constructed using grounded theory methodology.Talking About Oneself, Having a Special Place and Relationship, and Exploring Together With the Therapist were perceived as curative factors by the patients, leading to therapeutic impacts such as New Relational Experiences and Expanding Self-Awareness. Hindering aspects included experiencing that Talking Is Difficult and that Something Was Missing in therapy, interacting with negative impacts such as Self-Knowledge Is Not Enough and Experiencing Mismatch. Methodological issues, the question of common versus specific factors, and implications for clinical practice are discussed.

  • 13.
    Palmstierna, Vendela
    et al.
    Huddinge Municipality, Pupil Support Unit for Compulsory School, Huddinge, Sweden.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Child and Adolescent Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Successful psychotherapies with young adults: an explorative study of the participants' views2013In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 27, no 1, p. 21-40Article in journal (Refereed)
    Abstract [en]

    In order to understand mechanisms of change, patients' experiences are an invaluable source of information. Psychotherapy with young adults confronts therapists with specific challenges. This qualitative study explores experiences of therapeutic process and outcome in 11 cases of psychoanalytic psychotherapy that fulfilled the rigorous quantitative criteria for long-term therapeutic success. Interviews at termination and at a 1.5-year follow-up were analysed applying basic grounded theory methodology and the software ATLAS.ti. At the core of the tentative conceptual model is the experience of a growth-promoting and secure therapeutic relationship. Within the therapeutic frames, the patients and the therapists could overcome obstacles to their collaboration. The patients obtained support in close relationships and continued to apply therapeutic experiences after termination. The therapists experienced the therapeutic work in a strikingly similar way, worked actively towards joint goals, explored what was painful and actively promoted the use of new skills after termination. Positive factors in therapy and in life reinforced each other in a positive feedback loop. The patients' and their therapists' view of successful change processes confirms the centrality of the therapeutic relationship as a secure base for exploration and change.

  • 14.
    Philips, Björn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm City Council, Sweden; Karolinska Institutet, Sweden.
    Karlsson, Roger
    Nygren, Rebecca
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rother-Schirren, Amelie
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Early therapeutic process related to dropout in mentalization-based treatment with dual diagnosis patients2018In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 35, no 2, p. 205-216Article in journal (Refereed)
    Abstract [en]

    Negative therapeutic reaction was first described by Freud, and theories about this phenomenon have focused on various patient factors, for example, unconscious guilt, narcissistic pride, and overwhelming feelings of shame, as well as devaluation of the therapist as a defense against envy. Different strategies to counteract negative therapeutic reactions in patients with severe personality disorder have been proposed. Bateman and Fonagy suggested that some psychoanalytic techniques are iatrogenic for patients with borderline personality disorder and, thus, the therapeutic method must be modified. One manifestation of negative therapeutic reaction is that patients discontinue therapy prematurely. The aim of this study was to explore the differences in the early therapeutic process between therapy dropouts and therapy completers in mentalization-based treatment (MBT) for patients with concurrent borderline personality disorder (BPD) and substance use disorder (SUD). The first 2 videotaped therapy sessions from 6 MBT therapies were selected—3 therapies that were completed and 3 therapies that were prematurely discontinued by the patient. The therapy process was analyzed using the Psychotherapy Process Q set (PQS). Lists of the most frequent and least frequent PQS items among therapy completers versus dropouts are presented. In comparing the sessions from therapy completers and dropouts, significant differences in frequencies were detected for 13 PQS items. These items included therapist and patient activities, as well as features of the therapeutic interaction. Continuation in therapy seems to be related to therapists’ general skills and adherence to MBT, as well as patients bringing up significant material and not being distant.

  • 15. Roos, Johanna
    et al.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Terapeut- och processfaktorer bakom avbrutna psykoterapier2014In: En i veckan, ISSN 2001-2829, p. 2014/03/06-Article, review/survey (Other academic)
    Abstract [sv]

    Avhopp från psykoterapi är ett vittomfattande klinisk problem även om det råder viss oenighet bland forskare både kring dess mer exakta omfattning och om dess definition. Sammantaget talar dock forskningen om en avhoppsfrekvens på mellan 30% och 50%. Avhopp inträffar oftast tidigt i kontakterna, inom de fem första besöken. Den mest relevanta definitionen är att patienten/klienten ensidigt avbryter kontakten utan terapeutens samtycke genom att meddela detta eller genom att utebli från besöken. Alla former av terapeutiska metodinriktningar förefaller drabbas av avhoppade klienter i ungefär lika stor omfattning. Avhopp har flera negativa konsekvenser, framförallt för klienten som blir utan den hjälp som denne behövt och sökt, men det kan också leda till kliniska, moraliska och finansiella problem för terapeuten, organisationen inom vilken terapin bedrivs och för vårdapparaten i sin helhet som genom bristande kostnadseffektivitet låtit resurser gå till spillo. Avhopp från psykoterapi är således ett viktigt kliniskt problem att undersöka, och det har också undersökts grundligt genom åren. Problemperspektivet har emellertid varit tydligt orienterat mot faktorer hos klienten som lämnat terapeut. Processperspektivet har kommit i skymundan. Detta är upprinnelsen till vår studie som vi sammanfattar här.

    Denna sammanfattning bygger på: Roos, J., & Werbart, A. (2013). Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review. Psychotherapy Research, 23, 394-418. doi:10.1080/10503307.2013.775528

  • 16. 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.

  • 17.
    Salomonsson, Björn
    et al.
    Karolinska Institutet, Enheten för barn- och ungdomspsykiatri.
    Sandell, Rolf
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rydelius, Per-Anders
    Karolinska Institutet, Enheten för barn- och ungdomspsykiatri.
    Psykoanalytisk behandling vid störningar i mor–barnrelationen2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 18, p. 984-987Article in journal (Refereed)
    Abstract [sv]

    I en studie som jämför resultaten av sedvanlig BVC-behandling med en kortare psykoanalytisk mor–spädbarnsbehandling har vi undersökt 80 mammor med spädbarn, där inklusionskriterierna var att mamman upplevde problem i fråga om barnets funktion, sitt eget psykiska tillstånd eller i kontakten med barnet. Behandlingen gav signifikanta effekter på självrapporterad depression, intervjuarbedömd mor–barnrelation och hos mamman i hennes samspel med barnet. Nästan signifikanta effekter erhölls på självrapporterad stress. Kvalitativa bedömningar gjorda före behandlingarna indikerade att analysbehandlingen mest tycktes hjälpa de mammor som anade sin roll i problemen, liksom de barn som var kliniskt påverkade av relationsproblemen. Resultaten publiceras i Infant Mental Health Journal våren 2011.

  • 18. Törnblom, Annelie Werbart
    et al.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rydelius, Per-Anders
    Shame Behind the Masks: The Parents' Perspective on Their Sons' Suicide2013In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, Vol. 17, no 3, p. 242-261Article in journal (Refereed)
    Abstract [en]

    Suicides are more frequent among boys than girls. A tentative, conceptual model of processes behind suicide among boys and young men (aged 12-25), grounded in their parents' views, is presented. Extensive interviews with parents in 33 cases of suicide were analyzed using grounded-theory methodology. Family alliances, coalitions, and secrets interacted with the boy concealing problems and hiding behind a mask, while the professionals did not understand the emergency. Four interwoven paths to suicide were found: the boy was hunted and haunted, addicted, depressed, or psychotic. Different forms of shame were hidden behind the masks of the clown, the warrior, and the prince. Future preventive programs need to address barriers to communication among all parties involved.

  • 19.
    von Below, Camilla
    et al.
    Uppsala County Council, Sweden.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view2012In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 26, no 3, p. 211-229Article in journal (Refereed)
    Abstract [en]

    Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.

  • 20.
    von Below, Camilla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rehnberg, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Experiences of overcoming depression in young adults in psychoanalytic psychotherapy2010In: European Journal of Psychotherapy, ISSN 1364-2537, E-ISSN 1469-5901, Vol. 12, no 2, p. 129-147Article in journal (Refereed)
    Abstract [en]

    The study aims to explore the process of overcoming depression as experienced by young adult psychotherapy patients. Seventeen patients in individual or group psychotherapy with diagnoses within the depression spectrum were interviewed at termination of psychotherapy and at 1.5 years' follow-up. Grounded theory analysis of transcripts resulted in 15 distinct categories, organized into five general domains: experiences of positive change, in-therapy contributions to positive change, extra-therapeutic contributions to positive change, obstacles in therapy and negative experienced outcomes. Exploration of interplay between these domains resulted in a process model for the way out of depression. The positive changes experienced extended beyond symptom relief. The patients emphasised finding out how they wanted to live and how they started forming their lives in that direction. Obstacles in therapy interplayed with the experience of being stuck in depression. These findings are related to age-specific challenges on the threshold of adulthood.

  • 21.
    Wang, Mo
    et al.
    Karolinska Institutet.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Not starting psychotherapy is more often initiated by the therapist than the patient2014In: Counselling Psychology Quarterly, ISSN 0951-5070, E-ISSN 1469-3674, Vol. 27, no 1, p. 75-95Article in journal (Refereed)
    Abstract [en]

    The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.

  • 22.
    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)
  • 23.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Changes in mental representations and personality configurations after psychoanalysis and psychoanalytic psychotherapy2015In: An open door review of outcome and process studies in psychoanalysis / [ed] M. Leuzinger-Bohleber & H. Kächele, London: International Psychoanalytical Association , 2015, p. 246-247Chapter in book (Other academic)
    Abstract [en]

    Treatment goals in psychoanalysis often include changes in underlying dynamic mental structures, such as self- and object representations, or personality configurations. The aim of this ongoing research program is to study changes in self- and object representations, and in the anaclitic- introjective personality configuration following psychoanalysis and long-term psychoanalytic psychotherapy. Furthermore, we investigate personality related responses to the psychoanalytic process, as well as patients’ experiences of changes in dynamic mental structure. This research program combines quantitative and qualitative methods, and integrates theory-neutral and empirically- driven, inductive approach with a theory-driven, deductive approach.

  • 24.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Die Kunst der Freiheit: Sieben psychoanalytische Thesen zu Kreativität und Grenzen2016In: Subjektivität und Verstehen: Psychoanalyse und Sozialwissenschaften im Dialog: Jörg Frommer zum 60. Geburtstag / [ed] Robert Müller-Herwig, Matthias Vogel, Giessen: Psychosozial-Verlag , 2016, p. 133-144Chapter in book (Other (popular science, discussion, etc.))
  • 25.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    EMILE, OR ON DEVASTATION: WHEN VIRTUAL BOUNDLESSNESS MEETS INNER EMPTINESS2014In: The Psychoanalytic quarterly, ISSN 0033-2828, E-ISSN 2167-4086, Vol. 83, no 1, p. 71-96Article in journal (Refereed)
    Abstract [en]

    The author's starting point is a psychoanalysis conducted with Emile, a teenager who was unable to form close relationships and was living in a virtual world, planning a school massacre. For him, virtual reality functioned as a bottomless container in which he was no longer a victim of bullying but rather a god. When the boundlessness of cyberspace encounters a black hole in the psyche, any fantasies can be put into virtual realization and actions. By recounting his wickedness, violence, destructiveness, and perversion, Emile could start restoring his self boundaries and create his own autobiographical narrative. Unable to sustain the pain of mourning his envelope of invulnerability and omnipotence, however, he prematurely terminated analysis.

  • 26.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Everyday evidence: Patient characteristics, therapy types, and outcomes of psychotherapy in Swedish public health service settings2011In: Book of Abstracts: 42nd International Meeting of the Society for Psychotherapy Research, Ulm, Germany: Ulmer Textbank , 2011, p. 177-177Conference paper (Other academic)
    Abstract [en]

    Aim: Defining empirically supported treatments exclusively in terms of randomized controlled trials has numerous limitations. This naturalistic study presents patients’ pre-treatment characteristics and compares outcomes for three psychotherapy types as practiced in psychiatric routine care. Method: Data were collected during a 3-year period at 13 out-patient psychiatric care services participating in the on-line system for Quality Assurance of Psychotherapy in Sweden (QAPS). Of the 1,498 registered patients 14% never started psychotherapy, 17% dropped out from treatment and 36% are dropouts from data collection. Outcomes were studied for 180 patients who received CBT, PDT or integrative/eclectic psychotherapy. Results: Some minor differences were found between patients who remained in therapy, dropouts from treatment and from data collection. There were no significant differences in psychological distress pre-treatment between the three psychotherapy types, and patients showed significant improvements post-treatment. There were no statistically significant differences in effectiveness between psychotherapy types. Discussion: Overall, the psychotherapy delivered by the Swedish public health services included in this study is effective for the majority of patients who complete treatment. The theoretically different psychotherapy approaches had equivalent outcomes. Variations in the size and type of improvement were noted depending on outcome measure, indicating that a majority of patients may experience reduced symptoms through brief psychotherapy, but not necessarily an increased life satisfaction to the same extent. The results must be interpreted with caution since there were no treatment integrity or adherence controls, non-random assignment to treatments, large attrition, and incomplete data.

  • 27.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Intersubjektivität und therapeutische Technik: Was ist neu und was alt?2011In: Äußere und innere Realität: Theorie und Behandlungstechnik der Psychoanalyse im Wandel / [ed] Peter Diederichs, Jörg Frommer, Franz Wellendorf, Stuttgart: Klett-Cotta, 2011, 1, p. 171-181Chapter in book (Other (popular science, discussion, etc.))
    Abstract [de]

    Behandlungs-Zimmer ohne Aussicht?

    Für die Behandlungstechnik ist nach dem Einfluss der realen Person des Psychoanalytikers auf den analytischen Prozess zu fragen. Im Zentrum dieses Buches steht daher das neue Paradigma in der Behandlungstechnik: die Relationale 
Psychoanalyse oder Intersubjektivität.

    Im Zentrum dieses Buches steht daher das neue Paradigma in der Behandlungstechnik:die Relationale Psychoanalyse oder Intersubjektivität.Zwanzig Jahre nach der Wiedervereinigung behandelt ein weiterer Schwerpunkt die spannende Frage der Auswirkungen »äußerer« politischer Systeme auf »innere« psychische Prozesse und Strukturen im Individuum.Der Band enthält Beiträge führender deutscher und internationaler Psychoanalytiker.

  • 28.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Mentalisera (och forska) mera med familjer2011In: Glimtar från forskningsfronten, no 32, p. 3-4Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Sammanlagt finns det idag en alltmer omfattande teoretisk och klinisk litteratur om mentaliseringsbaserad barnterapi och familjebehandling (se vidare Bateman & Fonagy, 2011; Verheugt- Pleiter m.fl., 2008). Det finns flera publicerade manualer och de olika versionerna av metoden har fördelen att de kräver en relativt liten utbildningsinsats. Forskningen om MBT för barn och familjer befinner sig dock fortfarande i inledningsskedet. Det är också angeläget att denna behandlingsform utvärderas av flera oberoende forskargrupper. Här finns en viktig forskningsuppgift när metoden får allt större spridning inte bara i Sverige utan även i andra nordiska länder.

  • 29.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Minding the gap between clinical practice and empirical research in psychoanalysis: Review of H. Kächele, J. Schachter, & H. Thomä, 'From psychoanalytic narrative to empirical single case research: Implications for psychoanalytic practice'2009In: International Journal of Psychoanalysis, ISSN 0020-7578, E-ISSN 1745-8315, Vol. 90, no 6, p. 1459-1466Article, book review (Refereed)
  • 30.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Patient and therapist perspective on therapeutic action in psychoanalysis and psychoanalytic psychotherapy: helpful and hindering factors2015In: An open door review of outcome and process studies in psychoanalysis / [ed] Marianne Leuzinger-Bohleber & Horst Kächele, London: International Psychoanalytical Association , 2015, 3, p. 244-245Chapter in book (Other academic)
    Abstract [en]

    This research program aims to explore patient and therapist views of helpful and hindering factors in psychoanalysis and psychoanalytic psychotherapy, applying rigorous qualitative methods. A series of studies was based on periodical interviews with seven analysands and their analysts (Werbart & Levander, 2006, 2011). Double sets of private theories of cure were found among analysands and their analysts. Ideas of utopian cure involved a profound transformation of the personality by way of deep regression. Ideas of an attainable and more limited cure included new ways of managing old problems and new ways of thinking and reflecting. The ongoing treatment was then seen as the ‘next-best solution’. Both parties’ mourning of the preferred but abandoned utopian theories of cure seems to be an important ingredient in the psychoanalytic process. Furthermore, the utopian fantasy of creating ‘the new person’ by means of ‘proper’ psychoanalysis or analytic training has far-reaching consequences for psychoanalytic education and supervision.

  • 31.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Patterns of Repetition and Change in a Psychoanalytically Informed Therapeutic Environment for Severely Disturbed Patients1997Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Factors in the environment and therapeutic relationship which facilitate, as well as those which obstruct the process of psychic change were investigated in patients with psychoses or severe personality disorders, starting from a preliminary theoretical model for psychoanalytically oriented treatment. Ten patients consecutively admitted to a Swedish therapeutic community, Bikupan, and who completed the treatment, as well as their 9 therapists were studied in detail during, and up to five years after the treatment. Explorative and supportive factors in the ward atmosphere were investigated. In a programmatic study, the Bikupan project was placed in the context of the current methodological debate. Some of the basic assumptions of current psychotherapy research were critically examined. The chosen research strategy included multiple qualitative and quantitative methods. The starting point was the experiences and subjective pictures of the involved parties, as well as a systematic comparison of their views. A research strategy for systematic case studies was developed, based on independent judges and consensus analysis of narratives.

    The ward atmosphere at Bikupan was compared with two other Swedish therapeutic communities with a cognate orientation. The conclusion was that a beneficial psychotherapeutic environment requires consistency in the applied treatment model, including an organisation and setting which tallies with the explicit treatment philosophy, well mirrored in the patients' perceptions. In the psychotherapy studies, more concordance at termination between the patient's and the therapist's view of their collaboration was preceded by working through of some of the patient's pivotal difficulties, as they appeared in the therapeutic relationship. More discordance at termination was connected with severe obstacles to the therapeutic task through the whole treatment period. Seven of the 10 cases were consistent with the hypothesis about the significance of therapeutic work with intra-therapeutic separations for the longitudinal outcome. Absence of signs of mourning seemed to be connected with less emotional and functional improvement. Besides the therapist's contribution in the middle phase, the patients' different ways of dealing with the trauma of termination probably have decisive impact on long-term courses. The investigation showed inconsistencies in the applied treatment model, which stimulated attachment and regression, but neglected the actualised feelings and relationship patterns. The process of repetition and change continued in the post-treatment phase and influenced the longitudinal outcome.

  • 32.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Psykoterapin har mycket att lära av patienten2011In: Psykologtidningen, no 10, p. 29-31Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Psykoterapiforskningen har upprepade gånger visat att patienterna anger som mest hjälpsamma sådana faktorer som är gemensamma för många former av psykologisk behandling. Även i icke-terapeutiska kontakter är det behandlaren som person som är en viktig kurativ faktor för patienten. Terapeuter som har ett intresse för barn, kan visa dem värme och delta i barnens värld får bättre resultat om de aktivt involverar barnen i familjeterapin. Missnöjda KBT-patienters tankar om psykoterapi verkar stämma bättre överens med arbetssätt i PDT och tvärtom. Patienterna tenderar att betona annorlunda aspekter av relationen än deras terapeuter. Patienternas upplevelser av hindrande faktorer i terapin är ofta okända för terapeuten. Särskilt hindrande är, förutom terapeutens rambrott, om terapeuten upplevs sakna ”mänskliga egenskaper” och vara oengagerad, kritisk, kall, rigid och oförmögen att förstå patienten. Missnöjda patienters beskrivningar av hindrande faktorer handlar däremot oftast om den specifika terapeutiska metoden.

  • 33.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The art of freedom: seven psychoanalytic theses on creativity and boundaries2014In: Art and freedom: psychoanalytical reflection on the meaning of creativity / [ed] Sala Elżbieta, Krakow: MOCAK, Museum of contemporary art in Krakow , 2014, 1, p. 102-111Chapter in book (Refereed)
  • 34.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    “The Skin is the Cradle of the Soul”: Didier Anzieu on the Skin-Ego, Boundaries, and Boundlessness2019In: Journal of the American Psychoanalytic Association, ISSN 0003-0651, E-ISSN 1941-2460, Vol. 67, no 1, p. 37-58Article in journal (Refereed)
    Abstract [en]

    Didier Anzieu’s notion of the skin-ego builds on a long psychoanalytic tradition that began with Freud’s idea that the ego is first and foremost a body ego, a projection in the psyche of the surface of the body, or, in other words, the idea that psychic phenomena are always embodied. An interface, a container for the ego, but also its origin: thus did Anzieu conceptualize the skin’s psychic function. The baby’s fantasy of having a common skin with the mother is the concrete starting point for a development that, through the prohibition on touching, leads to the experience of being a separate and individual person. Psychoanalytic work with severe mental disorders makes it necessary to investigate deficiencies in the skin-ego’s containing function before the patient’s psychic contents can be explored. In the psychoanalytic situation, the analyst’s words replace tactile contact and thereby contribute to healing injuries to the skin-ego. The clinical implications of Anzieu’s theoretical model are illustrated by examples from psychoanalyses of children and adults. The close connection between touch, psychic envelopes, and thinking opens a wider perspective on the necessity of setting limits to violence, against both nature and human beings.

  • 35.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ytterligheter: så funkar omaka par2015In: Relationer från A till Ö: ett psykologiskt lexikon / [ed] Mattson, J., Stockholm: Vetenskapsmedia , 2015, p. 214-215Chapter in book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Varför väljer en livlig och utåtriktad människa ofta en tyst, asocial eller tillbakadragen partner – och tvärtom? Är det något slags jämvikt som naturen eftersträvar? Svar: Det är en spännande fråga du ställer. Som vanligt finns det flera svar. Sedan antiken har västerländsk kultur präglats av två oförenliga föreställningar om partnerval: ”lika dras till lika” – vi har en naturlig tendens att inleda relationer med människor vars värderingar och strävan liknar våra – och ”motsatser dras till varandra” – vi söker partner som har egenskaper som vi själva saknar.

    Flera biologiska och sociologiska argument har använts för båda dessa föreställningar. Psykoanalytiker har tidigt intresserat sig för frågan. Enligt Freud har vår förmåga att bli förälskade sin källa i barnets självkärlek. Narcissistiskt val innebär att man letar efter en kärlekspartner med sig själv som förebild. Anaklitiskt eller stödberoende val utgår från identifikation med den person som vi varit beroende av under vår tidiga barndom. Flera moderna psykologiska teorier beskriver, i olika termer, våra två grundläggande strävanden och två sammanvävda utvecklingslinjer: egen lycka och gemenskap, egoism och altruism, att värna om självbilden och att hysa medkänsla, att sträva efter oberoende och att värna om att bli omtyckt. Dessa två huvudspår, självavgränsning och relaterande, finns hos oss alla. Kanske söker vi i kärleken det vi själva saknar för att bättre älska oss själva och för att uppnå bättre balans. Men när obalansen blir för stor påverkas vår förmåga att älska både oss själva och en annan person, och vi kan få psykiska problem.

  • 36.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Aldén, Siri
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Diedrichs, Anders
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults2017In: Research in Psychotherapy: Psychopathology, Process and Outcome, ISSN 2239-8031, Vol. 20, no 1, p. 30-42Article in journal (Refereed)
    Abstract [en]

    Treatment goals in psychoanalytic psychotherapy often include changes in underlying psychological structures, rather than only symptom reduction. This study examines changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults in relation to outcomes. Thirty-three patients were interviewed pretreatment and at termination using the Object Relations Inventory (ORI). Prototype Matching of Anaclitic-Introjective Personality Configuration (PMAI) was applied to the ORI material by two independent judges (intraclass correlation coefficient=0.73). The patients were classified pretreatment as predominately anaclitic (n=13) or introjective (n=20). Outcome measures included the Symptom Checklist-90-R (SCL-90) and Differentiation-Relatedness scale (D-R) pretreatment, at termination, at the 1.5-year and three-year follow-up. Both groups improved post-treatment in terms of symptoms and developmental levels of representations of self, mother, and father. No significant differences between the anaclitic and the introjective group were found in this respect, and could not be expected due to the low power (0.27). The anaclitic group showed better balance between relatedness and self-definition post-treatment, while this improvement was not significant in the introjective group. Further and larger studies are needed to draw more farreaching conclusions about the relations between changes in personality configurations over the course of treatment and the treatment efficacy. The clinical implications of this approach to underlying dynamic psychological structures are discussed.

  • 37.
    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.

  • 38.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Annevall, Amanda
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hillblom, Johan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Successful and Less Successful Psychotherapies Compared: Three Therapists and Their Six Contrasting Cases2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 816Article in journal (Refereed)
    Abstract [en]

    Despite the general effectiveness of bona fide psychotherapies, the number of patients who deteriorate or fail to improve is still problematic. Furthermore, there is an increased awareness in the field that the therapists’ individual skills make a significant contribution to the variance in outcome. While some therapists are generally more successful than others, most therapists have experienced both therapeutic success and failure in different cases. The aim of this case-series study was to deepen our understanding of what matters for the therapists’ success in some cases, whereas other patients do not improve. How do the patients and their therapists make sense of and reflect on their therapy experiences in most successful and unsuccessful cases? Are there any distinctive features experienced by the participants at the outset of treatment? To explore these issues, we applied a mixed-method design. Trying to keep the therapist factor constant, we selected contrasting cases from the caseloads of three therapists, following the criterion of reliable and clinically significant symptom reduction or non-improvement at termination. Transcripts of 12 patient interviews and 12 therapist interviews (at baseline and at termination) were analyzed, applying inductive thematic analysis and the multiple-case comparison method. The comparisons within the three therapists’ caseloads revealed that in the successful cases the patient and the therapist shared a common understanding of the presenting problems and the goals of therapy and experienced the therapeutic relationship as both supportive and challenging. Furthermore, the therapists adjusted their way of working to their patients’ needs. In non-improved cases, the participants presented diverging views of the therapeutic process and outcome. The therapists described difficulties in the therapeutic collaboration but not how they dealt with obstacles. They tended to disregard their own role in the interactions and to explain difficulties as being caused by the nature of their patients’ problems. This could indicate that the therapists had difficulty in reflecting on their own contributions, accepting feedback from their patients, and adjusting their work accordingly. These within-therapist differences indicate that taking a “third position” is most needed and seems to be most difficult, when early signs of a lack of therapeutic progress appear.

  • 39.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Swedish Psychoanalytical Society, Sweden.
    Brusell, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Iggedal, Rebecka
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lavfors, Kristin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Widholm, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Changes in Self-Representations Following Psychoanalytic Psychotherapy for Young Adults: A Comparative Typology2016In: Journal of the American Psychoanalytic Association, ISSN 0003-0651, E-ISSN 1941-2460, Vol. 64, no 5, p. 917-958Article in journal (Refereed)
    Abstract [en]

    Changes in dynamic psychological structures are often a treatment goal in psychotherapy. The present study aimed at creating a typology of self-representations among young women and men in psychoanalytic psychotherapy, to study longitudinal changes in self-representations, and to compare self-representations in the clinical sample with those of a nonclinical group. Twenty-five women and sixteen men were interviewed according to Blatt’s Object Relations Inventory pretreatment, at termination, and at a 1.5-year follow-up. In the comparison group, eleven women and nine men were interviewed at baseline, 1.5 years, and three years later. Typologies of the 123 self-descriptions in the clinical group and 60 in the nonclinical group were constructed by means of ideal-type analysis for men and women separately. Clusters of self-representations could be depicted on a two-dimensional matrix with the axes Relatedness-Self-definition and Integration-Nonintegration. In most cases, the self-descriptions changed over time in terms of belonging to different ideal-type clusters. In the clinical group, there was a movement toward increased integration in self-representations, but above all toward a better balance between relatedness and self-definition. The changes continued after termination, paralleled by reduced symptoms, improved functioning, and higher developmental levels of representations. No corresponding tendency could be observed in the nonclinical group.

  • 40.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Engqvist, Karin
    Lind, Sofia
    Therapists of Nonimproved Patients Looking Back on Their Work2017Conference paper (Other academic)
    Abstract [en]

    Aim: Despite clear evidence that about 5 to 10% of patients deteriorate and 35 to 40% does not improve in psychotherapy, nonimproved cases are seldom scrutinized. The therapists’ experiences of their work with nonimproved patients might be a rich source of clinically relevant knowledge. Our study explores therapists’ experiences of therapeutic process in unsuccessful cases of psychoanalytic psychotherapy with young adults. Method: A two-stage, mixed-method design was used. Nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of 16 therapist interviews (8 pretreatment 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 alleviated problems, while core problems remained. Discussion: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist allies herself with the patient’s capable and seemingly well-functioning parts. The therapists’ experiences could be compared to the nonimproved patients’ descriptions of “spinning one’s wheels” in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients’ problems, despite their attempts to meta-communicate.

  • 41.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsstrom, David
    Jeanneau, Madeleine
    Long term outcomes of psychodynamic residential treatment for severely disturbed young adults: a naturalistic study at a Swedish therapeutic community2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 6, p. 367-375Article in journal (Refereed)
    Abstract [en]

    Aims: This study examined the long-term effectiveness of a treatment model at a Swedish therapeutic community for young adults with severe personality disorders, combining milieu therapy and inpatient long-term psychodynamic psychotherapy. Methods: Data were collected for the 56 residents between 1994 and 2008 at intake, termination and 2-year follow-up. Patient residency ranged from 2 to 60 months, with average psychotherapy duration of 30 months. Self-rated outcome was measured using the Symptom Checklist-90-R. Expert-rated outcomes comprised the Global Assessment of Functioning, the Strauss-Carpenter Outcome Scale and the Integration/Sealing-over Scale. A series of mixed-model analyses of variance with one fixed factor (time) was performed to examine the outcomes for the total sample of completers. Effect sizes for within-group change and percentages of improved, unchanged and deteriorated patients were calculated for patients participating in the data collection on all three time points. Results: All outcome measures showed significant improvement on a group level from intake to discharge. Most patients had maintained the therapeutic gains at the 2-year follow-up. The effect sizes were high and the Reliable Change Index provided evidence of good outcome for 92% of the patients at follow-up. The expert ratings gave somewhat larger effect sizes than the patients' self-ratings. Conclusions: The effect sizes and success rates are at a comparable level with corresponding studies of long-term treatments of personality disorders. Most patients had a substantial individual improvement from intake to termination and follow-up. This indicates the effectiveness of this highly specialized and intensive treatment approach for severely disturbed young adult patients.

  • 42.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Changes in anaclitic–introjective personality dimensions, outcomes, and psychoanalytic technique: a multi-case study2014In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 28, no 4, p. 397-410Article in journal (Refereed)
    Abstract [en]

    This study investigates changes in latent mental structures along the anaclitic and introjective dimensions in relation to outcomes in 14 cases of publicly financed psychoanalysis. The method of prototype matching was adapted for personality assessment, and multiple outcome measures were applied. For the anaclitic cases, symptom reduction was accompanied by more mature integration of anaclitic and introjective personality dimensions, while the introjective cases showed symptom reduction without such improvement. This could indicate that sustainable change in latent mental structures is more difficult to achieve in introjective than in anaclitic patients. Further research is needed to validate these preliminary results.

  • 43.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Grünbaum, Camilla
    Jonasson, Britta
    Kempe, Helena
    Kusz, Milosz
    Linde, Solweig
    O'Nils, Karin Lundén
    Sjövall, Patrik
    Svenson, Minna
    Theve, Catharina
    Ulin, Lena
    Öhlin, Agneta
    Changes in the representations of mother and father among young adults in psychoanalytic psychotherapy2011In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 28, no 1, p. 95-116Article in journal (Refereed)
    Abstract [en]

    The present study explores the changes in young adult patients’ representations of their parents from prior to psychotherapy through long-term follow-up. Twenty-five women and 16 men from the Young Adult Psychotherapy Project (YAPP) were interviewed according to Sidney Blatt’s unstructured Object Relations Inventory prior to psychoanalytic psychotherapy, at termination and at the 1.5-year follow-up, comprising 123 interviews in all. Typologies of the 246 parental descriptions were constructed by means of ideal-type analysis for male and female patients separately, and for representations of mother and father separately. The analysis resulted in 5 to 7 ideal types of mother and father representations. Prior to psychotherapy, women’s representations of their fathers and men’s representations of their mothers seemed most problematic. As to the content, the most common descriptions of the parent were the emotionally or physically absent parent, and the parent with his or her own problems. In most cases, the descriptions of the parent changed over time in terms of belonging to different ideal-type clusters. There were important improvements in the quality of the descriptions, and the changes continued after termination of psychotherapy. However, most of the parental representations were negative in all three interviews. The possible explanations of these findings are discussed.

  • 44.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Hägertz, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Borg Ölander, Nadja
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Matching Patient and Therapist Anaclitic: Introjective Personality Configurations Matters for Psychotherapy Outcomes2018In: Journal of Contemporary Psychotherapy, ISSN 0022-0116, E-ISSN 1573-3564, Vol. 48, no 4, p. 241-251Article in journal (Refereed)
    Abstract [en]

    Decades of psychotherapy research suggest that patient–therapist match accounts for outcome beyond single patient or therapist variables. This study examines the associations between different patterns of patient–therapist matching (in terms of orientation on relatedness or self-definition) and outcomes at termination of psychoanalytic psychotherapy with young adults. Thirty-three patients and their therapists were classified as predominately anaclitic or introjective at baseline. Patients in the convergent patient–therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Moreover, convergent patient–therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or self-definition to their patients’ predominant personality configuration in order to enhance treatment outcomes.

  • 45.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Hägertz, Mikael
    Borg Ölander, Nadja
    Matching Patient and Therapist Anaclitic-Introjective Personality Configurations Matters for Psychotherapy Outcomes2018Conference paper (Other academic)
    Abstract [en]

    Aim: Decades of psychotherapy research suggest that patient-therapist match accounts for outcome beyond single patient or therapist variables. The therapist’s personality does influence the psychotherapeutic process. This study examines how the therapist’s personality configuration (orientation on relatedness and on self-definition) manifests itself early in the relationship to the patient. Furthermore, we examine the associations between different patterns of patient-therapist matching (convergent or complementary personality configurations) and outcomes at termination of psychotherapy with young adults. Method: Thirty-three patients and their therapists were interviewed at baseline. Prototype Matching of Anaclitic-Introjective Personality Configuration (PMAI) was applied to the interview material by two pairs of independent judges. Patients and their therapists were classified as predominately anaclitic or introjective at baseline (16 convergent and 17 complementary dyads). Outcome measures included Symptom Checklist-90-R and Differentiation-Relatedness scale at baseline and at termination. Results: Patients in the convergent patient-therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Convergent patient-therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. Different personality configurations could be actualized in the same therapist.Discussion: These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or on self-definition to their patients’ predominant personality configuration in order to enhance treatment outcome. Further and larger studies are needed to draw more far-reaching conclusions about the relations between patient-therapist personality match and the treatment efficacy.

  • 46.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Levander, Sonja
    Fostering change in personality configurations: Anaclitic and introjective patients in psychoanalysis2016In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 33, no 2, p. 217-242Article in journal (Refereed)
    Abstract [en]

    Treatment goals in psychoanalysis often include changes in underlying psychological structures. Different patterns of change have been demonstrated in anaclitic and introjective patients. In a series of 14 cases, we took a further step and examined changes in the anaclitic - introjective personality configurations following psychoanalysis, as well as patients' experiences of these changes. Clinical case formulations were based on repeated interviews and the application of prototype-matching methodology. Patients' experiences were explored by applying inductive thematic analysis. We found a development toward more mature levels of differentiation and individuation in the anaclitic group, whereas relatedness and intimacy remained problematic in some introjective cases. Patients described their experienced changes in terms of complementary personality configuration, but the introjective group described more benefits from psychoanalysis. Several patients expressed their ambivalence toward these changes and a feeling of loss of their former selves. Patients' view of their analysts and the analytic method were congruent with patients' primary personality configuration. To reactivate developmental processes, the psychoanalytic technique has to be adjusted to the anaclitic and introjective patients' different needs and defenses.

  • 47.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Levander, Sonja
    Vicissitudes of ideas of cure in analysands and their analysts: A longitudinal interview study2011In: International Journal of Psychoanalysis, ISSN 0020-7578, E-ISSN 1745-8315, Vol. 92, no 6, p. 1455-1481Article in journal (Refereed)
    Abstract [en]

    This longitudinal prospective study focuses on analysands’ and analysts’ implicit ideas of how psychoanalysis might help analysands’ psychological problems. Seven analysands and their analysts were periodically interviewed. Single ideas of cure from 75 interviews were inductively categorized. Nine distinct types of cures emerged, representing the wished-for goals of psychoanalysis, as well as the actions to achieve the wished-for changes. Each category might comprise more or less utopian ideas of wished-for cure as well as ideas of an attainable, more limited cure, or combinations of these. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process for more than half the analysands and analysts. The abandonment of these ideas was related to the experienced outcome of psychoanalysis. The relation between the theories of one analysand and her analyst is explored in depth in a case study with special emphasis on the analytic process. The study suggests that the psychoanalytic process might profit from the analyst’s observance of such incongruities and an openness to work through them.

  • 48.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Levander, Sonja
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fostering change in personality configurations: anaclitic and introjective patients in psychoanalysis2015In: Book of Abstracts: Society for Psychotherapy Research 46th Annual International Meeting June 24 - 27, 2015 Philadelphia, Pennsylvania, U.S.A., 2015, p. 56-56Conference paper (Other academic)
    Abstract [en]

    Aim: Treatment goals in psychoanalysis often include changes in underlying psychological structures. Different patterns of change have been demonstrated in anaclitic and introjective patients. This study takes a further step and examines changes in the anaclitic-introjective personality configurations following psychoanalysis, as well as patients’ experiences of these changes in a series of 14 cases. Method: Outcome measures included SCL-90, SASB and SOC pretreatment, at termination and at 2-year follow-up. Personality assessments were based on repeated interviews and applying prototype-matching methodology. Patients’ experiences were explored by applying inductive thematic analysis. Results: We found a moderate increase in the other polarity, with more mature and integrated expressions of relatedness and self-definition, while still maintaining the basic personality configuration. These changes were more pronounced in the anaclitic group. On the group level, the patients improved on all self-report measures, with outcomes comparable to meta-analytic data, and the improvements continued after termination. However, outcomes on the self-report measures were more favorable in the introjective group. Patients described their experienced changes in terms of complementary personality configuration, but the introjective group described more benefits from psychoanalysis. Several patients expressed their ambivalence to these changes and a feeling of loss of their former selves. The patients’ view of their analysts and the analytic method were congruent with the patients’ primary personality configuration. Discussion: In order to reactivate developmental processes, the psychoanalytic technique has to be adjusted to the anaclitic and introjective patients’ different needs and defenses.

  • 49.
    Werbart, Andrzej
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm Cty Council, Stockholm.
    Levin, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology. holm Cty Council, Outpatient Psychiat Clin West, Stockholm.
    Andersson, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sandell, Rolf
    Everyday Evidence: Outcomes of Psychotherapies in Swedish Public Health Services2013In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 50, no 1, p. 119-130Article in journal (Refereed)
    Abstract [en]

    This naturalistic study presents outcomes for three therapy types practiced in psychiatric public health care in Sweden. Data were collected over a 3-year period at 13 outpatient psychiatric care services participating in the online Quality Assurance of Psychotherapy in Sweden (OAPS) system. Of the 1,498 registered patients, 14% never started psychotherapy, 17% dropped out from treatment, and 36% dropped out from data collection. Outcome measures included symptom severity, quality of life, and self-rated health. Outcomes were studied for 180 patients who received cognitive behavioral, psychodynamic, or integrative/eclectic therapy after control for dropout representativity. Among treatment completers, patients with different pretreatment characteristics seem to have received different treatments. Patients showed significant improvements, and all therapy types had generally good outcomes in terms of symptom reduction and clinical recovery. Overall, the psychotherapy delivered by the Swedish public health services included in this study is beneficial for the majority of patients who complete treatment. Multilevel regression modeling revealed no significant effect for therapy type for three different outcome measures. Neither did treatment duration have any significant effect. The analysis did not demonstrate any significant therapist effects on the three outcome measures. The results must be interpreted with caution, as there was large attrition and incomplete data, nonrandom assignment to treatment, no treatment integrity control, and lack of long-term follow-up.

  • 50.
    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.

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