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Insight seems to be a key mechanism of change in dynamic psychotherapy. Our results bridge the gap between clinical theory and empirical research.

We know that psychotherapy works, but the processes and mechanisms underlying therapeutic change are still largely unknown. The study of mediators and moderators of change in psychotherapy is one way to improve our understanding of mechanisms operating in psychotherapy. Consensus is slowly building on how to define both mediators and moderators of change, while there is still a controversy on strategic issues, e.g., criteria for demonstrating causality. The rationales for mediator research are discussed, as well as some of the major obstacles inherent in this research area. Finally, we present some strategic considerations for future research.

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The present study focuses on whether there is a sustained difference in treatment response to transference interventions between women and men. Data from the First Experimental Study of Transference Interpretations were used. One hundred patients were randomized to receive dynamic psychotherapy in 1 year with either a moderate level of transference intervention or no transference intervention. Follow-ups were 1 year and 3 years after treatment termination. The two primary outcome measures were the Psychodynamic Functioning Scales (PFS) and Inventory of Interpersonal Problems-Circumplex Version. Change was assessed using linear mixed models. In the moderator analyses, using the primary outcome measure (PFS) and controlling for the effect of the level of relational functioning (Quality of Object Relations Scale), women and men differed significantly in their response to transference intervention. The average relational functioning female patients showed a significant positive long-term effect of transference intervention.