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- Falkenström, Fredrik
(författare)
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The Capacity for Self-Observation in Psychotherapy
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The phenomena of self-awareness and self-observation are thought by many to be uniquely human qualities, and questions about how they develop have engaged philosophers and spiritual thinkers throughout history. More recently these issues have come to interest psychologists, psychotherapists, and researchers of diverse clinical psychology orientations as well. This dissertation explored conceptual issues and empirical measurement methods related to self-awareness and self-observation capacities. The four studies approached this from different angles: Study I used mainly qualitative methods to study post-treatment processes related to continuing clinical improvement after termination of long-term psychotherapeutic treatments. The main finding was that self-analysis seemed to be related to continued improvement after ending of therapy, but contrary to our hypothesis there was no difference between psychotherapy and the more intensive psychoanalysis in this regard. Study II tested the measurement of mindfulness by self report in a sample of experienced Buddhist meditators. The findings confirmed relationships between mindfulness and psychological well-being, but raised doubt about the instruments’ sensitivity to change. Study III compared different methods for measuring theoretically related concepts of self-observation: mindfulness, mentalization, and affect consciousness. This study showed surprisingly little common variance between affect consciousness and mentalization/mindfulness. Finally, the results of Study IV showed that in patients diagnosed with clinical depression, mentalization about depressive symptoms predicted aspects of the initial psychotherapy process better than mentalization about attachment. Taken together, these studies show the complexity of the phenomenon of self-observation and the corresponding complexity of research on it. The relationships between variables related to self-observation, their measurements, and their relationships to the psychotherapy process seem more complex than would be expected from current theories. A model for types of self-observation in the process of change in psychotherapy is tentatively proposed.
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| 2. |
- Holmqvist Larsson, Mattias, 1977-
(författare)
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Rupture and Repair in the Working Alliance : Relation to Psychotherapy Outcome and Within-Session Interaction
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ruptures and repairs are processes related to shifts in the collaborative relationship Cthe working allianceJ between patient and therapist in psychotherapy. Ta study ruptures and repairs is one way ta disentangle mechanisms that might underlie the association between the working alliance and psychotherapy outcome. The overarching aim af this thesis was ta analyze the clinical relevance af the rupture and repair concepts at different process levels. The same three alliance patterns were investigated in the three empirical studies: the rupture pattern, the repair pattern, and the no-rupture/stable pattern. The analyses af the alliance patterns moved fromwhole treatments ta session segments. In Study I ruptures were found ta be associated with worse outcomes than treatments without ruptures. Repairs were, in longer therapies, shown ta be related ta better outcomes than norupture treatments. In Study Il it was found that the three alliance patterns could be discerned within sessions. Ruptures and repairs within sessions were found ta be associated with patient-ratings af the working alliance. In Study 111 the alliance patterns were found ta be related ta different interaction patterns within sessions. In these analyses, importont patient contributions ta repairs af ruptures were found.
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| 3. |
- Möller, Clara, 1982-
(författare)
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Mentalizing : Competence and process
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mentalizing means making sense of oneself and others in terms of mental states, such as thoughts and feelings. The Reflective Functioning (RF) scale is the golden standard in measuring mentalizing. This thesis aimed to explore the concept of mentalizing and its operationalization RF in different contexts and what RF means in human interaction. The first part of the thesis focused on capturing the applicability of RF in difficult situations of adulthood. The concept of mentalizing was studied as a trait capacity (in young criminal offenders and in mothers who reflected upon their relations to their children and upon limit setting in relation to their children). Findings in the first study indicated that mentalizing might be considered to function as a buffer against committing criminal acts. The second study showed that limit setting RF was more predictive of the mothers’ behavior, measured as emotional availability in interaction with their children, than their general RF concerning the child. In the second part of the thesis, mentalizing was investigated in therapy sessions and analyzed as a state and interactional phenomenon. In study III, therapist interventions were studied and found to be related to the degree of mentalizing that occurred in patient statements, implying that interventions that demanded mentalizing predicted higher levels of RF in patient statements. In study IV, a new instrument to investigate dyadic mentalizing (i. e. both patient and therapist together) was tested. In one of the cases studied, higher dyadic RF predicted patient rated symptom relief in the next session, indicating that dyadic RF might be a mechanism of change. In conclusion, the studies of this thesis suggest that mentalizing can be meaningfully viewed both as an individual competence and as an interactional phenomenon and that RF seems to be highly context- and relationship-specific.
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| 4. |
- Uckelstam, Carl-Johan, 1983-
(författare)
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Looking into the Future : How to Use Advanced Statistical Methods for Predicting Psychotherapy Outcomes in Routine Care
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychotherapy research has shifted from mainly focusing on the average effects of different treatments to concentrating more on questions related to the individual patient. When research attention shifts, it can give rise to the implementation of new statistical methods that, in turn, can illuminate new challenges that must be addressed.The aim of the thesis was to study how traditional methods for predicting certain psychotherapy outcomes have been conducted in the past, and how more advanced statistical methods might be used to enhance knowledge of how to predict these outcomes today.Three studies were performed: Paper I focused on how Multi Level Modeling (MLM) can be used to study certain aspects of the relationship between working alliance and treatment outcome. In Paper II, Latent Profile Analysis (LPA) and item-level analysis were used to give nuance to the relationship between psychological distress at baseline and change rate during treatment. Finally, in Paper III, Machine Learning (ML) was used to detect dropout patients in the early phase of treatment by exploring complex patterns of symptom distress during the early phase of treatment.The thesis showed how different goals of scientific exploration can be studied in the context of routine care with the use of these statistical frameworks and discussed some of the challenges and opportunities worth noting when entering this line of research.
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| 5. |
- Åkerman, Anna-Karin E., 1969-
(författare)
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Relationally focused specialized foster care : Relational experiences and changes in mental health and adaptive functioning
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Foster care is a relatively common arrangement when parents are unable to meet the needs of their children. Specialized foster care is sometimes applied in cases when problems are more serious and complex. More knowledge is needed about the effects of such specialized foster care.Aims: To explore trajectories of change associated with specialized foster care in a treatment model with a relational and mentalization-based orientation, and to develop the understanding of foster children’s and their foster parents’ experiences of their relationship living in a treatment foster family.Methods: Children and young people between the ages of 5 and 20 years who received treatment within a specialized foster care model, Treatment By Foster care (TBF), participated in this study. Longitudinal data collected in a naturalistic setting were analyzed quantitatively. In Studies 1 and 2, the number of participants at baseline varied for different instruments between 76 – 105. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure how psychiatric symptoms change from the perspectives of the foster children, the foster parents, and teachers. The Adaptive Behavior Assessment System – second edition (ABAS-II) was used to measure adaptive functioning from the foster parents’ perspective. Self-ratings by the children and young people of their emotional and social problems were measured with the Beck Youth Inventories of Emotional and Social Impairment (BYI). Data about experiences of the relationship between child and foster parent were collected through repeated individual short interviews/speeches with both children and their foster parents according to Five Minute Speech Sample (FMSS) (n = 14). Interviews/speeches were analyzed using Thematic Analysis (TA).Results: The ratings of foster parents and foster children differed. The analyses showed a significant reduction in psychiatric symptoms, emotional and social problems according to the self-ratings by the children and young people. According to foster parents and teachers, psychiatric symptoms did not decrease. The baseline ratings of adaptive functioning by foster parents showed that adaptive functioning was considerably below peers from the Swedish non-clinical norm group. Adaptive functioning did improve but not enough to approach or catch up with peers.Analysis of the interviews/speeches generated three main themes containing seven subthemes. Main themes were: No 'real' family, A co-created relationship, and Time. Participants related to a norm for what a 'real' family is and seemed to presuppose that the biological family is the 'real' family. A co-created relationship related to No 'real' family as an answer or a solution. The challenges in the foster family constellation could be overcome by a mutual ambition to build a relationship and by liking each other. Time appeared as a common theme and both as an opportunity and a threat to the relationship. Despite the fact that no interview question concerned the duration of the relationship, the participants described their relationship based on how long they had known each other.Conclusions: According to the foster children’s and young people’s self-ratings, their mental health improved, and their social problems decreased. It is likely that the TBF-model contributed to this improved psychological well-being, although causal relationships could not be established without any comparison group. However, the model did not seem to contribute to the foster parents experiencing improvement in the foster children’s psychological well-being or adaptive functioning.Based on the results of this thesis, it may be effective to place children and young people in specialized foster care with a relational and mentalization-oriented focus, but the results are not clear-cut. Practice and policies should take greater account of the time aspect in foster care, and work with the aim of increasing clarity and security, and thereby enabling a more stable upbringing for some of society’s most vulnerable children. Also, this may make foster parents want to continue their mission.More studies are needed to gain knowledge about how specialized foster care should be applied. Future studies also need to focus on creating knowledge about which aspects of the treatment are decisive.
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