A systematic review of the association between interpretations and immediate, intermediate, and distal outcomes.

Abstract

Interpretations are a hallmark of psychodynamic treatment and a method used in other theoretical orientations as well. Therapists use interpretations to increase patients' insight concerning unconscious and preconscious elements in their lives, with the ultimate aim to reduce mental pain and suffering and improve mental health. This systematic review focuses on the association between the therapists' use and accuracy of interpretation and immediate (within-session), intermediate (between-session), and distal (endof-treatment) outcomes. This synthesis of the research literature is based on 18 independent samples of 1,011 total patients in individual psychotherapy. The results suggest that the use and accuracy of interpretations were associated, in half the studies, with patient disclosure of emotions and increased insight at the immediate, moment-to-moment enfolding of the session. At the intermediate postsession outcome, the use of interpretations was associated with a stronger alliance and greater depth, in half the studies. At the end of treatment, however, while there is some evidence for a positive effect of the use of interpretations on treatment success, there are also neutral effects and even evidence that interpretations have the potential to be harmful in some particular situations. The article concludes with training implications and therapeutic practices based on the integration of clinical experience and research evidence. Clinical Impact StatementQuestion: Does a synthesis of the literature support the utility of providing interpretations for improving immediate, intermediate, and distal outcomes in adult psychotherapy? Findings: In many of the studies, the use and accuracy of interpretation were related to various positive outcomes. Meaning: The use of interpretations, especially those that accurately capture the origins of the patient's suffering, contributes to adaptive therapeutic in-session processes and to better treatment outcome, although potential adverse effects of interpretations have also been documented. Next Steps: More studies are needed to determine the type of interpretations that should be used and the optimal, responsive way of delivering them to individual patients, based on their strengths, characteristics, and needs.

Skills and methods that work in psychotherapy: Observations and conclusions from the special issue.

“…• Attend to patients' quality of object relations when using interpretations. Patients with poorer object relations tend to benefit more from interpretations compared to patients with high quality of object relations (Zilcha-Mano et al, 2023).…”

“…• Inaccurate interpretations and a high dose of transference interpretations can be harmful. Because transference interpretations can make patients feel attacked, accused, and misunderstood, they are considered "high-risk, high-gain" methods (Zilcha-Mano et al, 2023).…”