Analysis of the Patient-Therapist Relationship in Dynamic Psychotherapy: An Experimental Study of Transference Interpretations

BackgroundMajor depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment in systematic reviews.Methods/Principal FindingsCochrane systematic review methodology with meta-analysis and trial sequential analysis of randomized trials comparing the effect of psychodynamic therapies versus ‘treatment as usual’ for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included six trials randomizing a total of 648 participants. Five trials assessed ‘interpersonal psychotherapy’ and only one trial assessed ‘psychodynamic psychotherapy’. All six trials had high risk of bias. Meta-analysis on all six trials showed that the psychodynamic interventions significantly reduced depressive symptoms on the 17-item Hamilton Rating Scale for Depression (mean difference −3.12 (95% confidence interval −4.39 to −1.86;P<0.00001), no heterogeneity) compared with ‘treatment as usual’. Trial sequential analysis confirmed this result.DiscussionWe did not find convincing evidence supporting or refuting the effect of interpersonal psychotherapy or psychodynamic therapy compared with ‘treatment as usual’ for patients with major depressive disorder. The potential beneficial effect seems small and effects on major outcomes are unknown. Randomized trials with low risk of systematic errors and low risk of random errors are needed.

show abstract

“…The notions of transference and counter-transference (raising awareness of the therapeutic relationship) [32].…”

Section: Methodsmentioning

confidence: 99%

The Effect of Interpersonal Psychotherapy and other Psychodynamic Therapies versus ‘Treatment as Usual’ in Patients with Major Depressive Disorder

et al. 2011

View full text Add to dashboard Cite

show abstract

“…The purpose of the First Experimental Study of Transference-interpretations [10, 17] was to measure the effects of Transference Work (TW) in dynamic psychotherapy. FEST was a randomized controlled trial where one hundred patients seeking psychotherapy for depression, anxiety, and personality disorders, where allocated to psychodynamic psychotherapy with low to moderate levels of TIs (the transference group; N = 52) or psychodynamic psychotherapy with no TIs, only RI’s (the comparison group; N = 48).…”

Section: Methodsmentioning

confidence: 99%

“…Contrary to expectation, no significant between-group differences were revealed in FEST. Moderator analyses showed that patients with a life-long pattern of poor relational functioning measured with the QOR [17] and/or patients with personality disorders profited more in therapy with TI than without TI [10, 17, 26]. This was especially true for women, while men responded better to therapy without TI compared to women [11].…”

Section: Methodsmentioning

confidence: 99%

Relational interventions in psychotherapy: development of a therapy process rating scale

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundIn psychodynamic psychotherapy, one of the therapists’ techniques is to intervene on and encourage exploration of the patients’ relationships with other people. The impact of these interventions and the response from the patient are probably dependent on certain characteristics of the context in which the interventions are given and the interventions themselves. To identify and analyze in-session effects of therapists’ techniques, process scales are used. The aim of the present study was to develop a simple, not resource consuming rating tool for in-session process to be used when therapists’ interventions focus on the patients’ relationships outside therapy.MethodsThe present study describes the development and use of a therapy process rating scale, the Relational Work Scale (RWS). The scale was constructed to identify, categorize and explore therapist interventions that focus on the patient’s relationships to family, friends, and colleges Relational Interventions and explore the impact on the in-session process. RWS was developed with sub scales rating timing, content, and valence of the relational interventions, as well as response from the patient. For the inter-rater reliability analyzes, transcribed segments (10 min) from 20 different patients were scored with RWS by two independent raters. Two clinical vignettes of relational work are included in the paper as examples of how to rate transcripts from therapy sessions with RWS.ResultsThe inter-rater agreement on the RWS items was good to excellent.ConclusionRelational Work Scale might be a potentially useful tool to identify relational interventions as well as explore the interaction of timing, category, and valence of relational work in psychotherapies. The therapist’s interventions on the patient’s relationships with people outside therapy and the following patient-therapist interaction might be explored.Trial registrationFirst Experimental Study of Transference-interpretations (FEST307/95)Registration number: ClinicalTrials.gov Identifier: NCT00423462.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1021-4) contains supplementary material, which is available to authorized users.

show abstract

“…Such patterns are presumed to reflect enduring inner psychological representations of self-other relations. The QORS has been used in a number of studies, with consistently satisfactory levels of rater reliability (Høglend et al, 2006;Piper & Duncan, 1999) and concurrent validity (Lindfors, Knekt, Virtala, & Haaramo, 2013). The interviewer considers behavioral manifestations, affect regulation, self-esteem regulation, and historical antecedents in the assessment of QOR.…”

Section: Quality Of Object Relationsmentioning

confidence: 99%

“…Higher scores are reflective of more mature levels of object relations. The QORS has been used in a number of studies, with consistently satisfactory levels of rater reliability (Høglend et al, 2006;Piper & Duncan, 1999) and concurrent validity (Lindfors, Knekt, Virtala, & Haaramo, 2013). QORS interviews for the ETP were conducted by trained clinicians (n = 5) who did not provide treatment to the participants.…”

Section: Quality Of Object Relationsmentioning

confidence: 99%

Improving self‐esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations

et al. 2019

View full text Add to dashboard Cite

Objective We aimed to investigate change in self‐esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients’ experience of therapeutic alliance and improvement in self‐esteem during treatment, including patients’ quality of object‐relations (QOR) as a possible moderator; and (b) the association between improvement in self‐esteem during treatment, and depressive symptoms 9 months later. Method Eighty patients with personality dysfunction, consecutively enrolled in a group‐oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow‐up. Results Especially for patients with lower QOR, alliance predicted self‐esteem change during treatment. In addition, change in self‐esteem during treatment predicted follow‐up depression severity, even when controlling for within‐treatment symptom change. Conclusions Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self‐esteem. Change in self‐esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction.

show abstract

Analysis of the Patient-Therapist Relationship in Dynamic Psychotherapy: An Experimental Study of Transference Interpretations

Cited by 159 publications

References 29 publications

The Effect of Interpersonal Psychotherapy and other Psychodynamic Therapies versus ‘Treatment as Usual’ in Patients with Major Depressive Disorder

The Effect of Interpersonal Psychotherapy and other Psychodynamic Therapies versus ‘Treatment as Usual’ in Patients with Major Depressive Disorder

Relational interventions in psychotherapy: development of a therapy process rating scale

Improving self‐esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations

Contact Info

Product

Resources

About