| 1. |
- Holmqvist Larsson, Mattias, 1977-, et al.
(författare)
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Alliance ruptures and repairs in psychotherapy in primary care
- 2018
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Ingår i: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 28:1, s. 123-136
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The association between alliance level and outcome in psychotherapy has been extensively studied. One way to expand this knowledge is to study alliance patterns. The main aims of this study were to examine how frequent alliance patterns with ruptures or rupture-repair episodes were in a naturalistic sample of psychotherapies in primary care, and if three alliance patterns (a Rupture pattern, a Repair pattern, and a No Rupture pattern) were differentially associated with treatment outcome.METHOD: The psychotherapies (N = 605) included a wide range of different treatment orientations and patient diagnoses. Alliance patterns were studied at session-to-session level, using patient-rated alliance scores. Outcome data were analyzed using longitudinal multilevel modeling with a slopes-as-outcomes model.RESULTS: The Repair pattern accounted for 14.7% (n = 89) of the treatments, 10.7% (n = 65) exhibited a Rupture pattern, and 74.5% (n = 451) contained no ruptures. The Rupture pattern was associated with inferior treatment outcomes. The Repair pattern was, in longer treatments, associated with better outcomes than the No Rupture pattern.CONCLUSIONS: The results support theory about the importance of ruptures in the therapeutic alliance and suggest that identification of alliance ruptures is important in alliance-outcome research, for feedback purposes in clinical practice, and in training of therapists.
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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. |
- Holmqvist Larsson, Mattias, 1977-, et al.
(författare)
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The Alliance and Rupture Observation Scale (AROS) : Development and validation of an alliance and rupture measure for repeated observations within psychotherapy sessions
- 2019
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Ingår i: Journal of Clinical Psychology. - : John Wiley & Sons. - 0021-9762 .- 1097-4679. ; 75:3, s. 404-417
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to test a new observer-rated instrument, the Alliance and Rupture Observation Scale (AROS). It was designed for repeated measurements of the alliance within sessions and to detect alliance ruptures.Method: Videotaped therapy sessions with depressed adults were analyzed. Reliability was mainly assessed as inter-rater reliability. Convergent, predictive, and discriminant validity of the AROS was assessed by comparing the instrument with both observer-rated and patient-rated measures.Results: The AROS exhibited excellent inter-rater reliability. Alliance levels measured with the AROS predicted patients’ ratings of the alliance in the same session and were highly correlated with another observer-rated alliance measure. Alliance patterns (rupture; repair; and no-rupture) based on AROS scores were significantly correlated with patients’ ratings of the alliance.Conclusions: Preliminary support for convergent and predictive validity was found. It is yet to be determined whether AROS scores are related to psychotherapy outcomes.
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| 4. |
- Alexandersson, Klas, et al.
(författare)
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Session-to-session effects of therapist adherence and facilitative conditions on symptom change in CBT and IPT for depression
- 2023
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Ingår i: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 33:1, s. 57-69
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of this study was to analyze the effect of adherence to both specific technique factors and facilitative condition variables (e.g., therapists' involvement, understanding and support) in Cognitive Behavior Therapy (CBT) and Interpersonal Psychotherapy (IPT). In addition, we were interested in whether the effect of therapist adherence would depend on the level of the working alliance. Method: Three sessions each from 74 patients diagnosed with Major Depressive Disorder who were randomized to 14 sessions of IPT or CBT were rated for adherence using a modified version of The Collaborative Study Psychotherapy Rating Scale-6 (CSPRS-6). Data was analyzed using Multilevel Modeling. Results: No effects of adherence to specific factors on outcome were found in neither CBT nor IPT. Facilitative conditions were associated with better outcome in CBT but not in IPT, even after adjustment for the quality of the working alliance. No interaction effects were found. Conclusions: Our findings highlight the importance of relational factors in CBT, but do not support the need for specific adherence to any of the two treatments. Possible explanations of the findings and directions for future research are discussed.
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| 5. |
- Andersson, Yvonne, et al.
(författare)
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Child Evacuations During World War II: This ShouldNot Happen Again
- 2019
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Ingår i: Journal of Loss and Trauma. - UK : Routledge. - 1532-5024 .- 1532-5032. ; 24:3, s. 213-225
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Tidskriftsartikel (refereegranskat)abstract
- There is little research about the long-term effects on childrenthat were separated from their parents and moved fromFinland to Sweden during World War II. The aim of this studywas to capture these now-lifelong reflections, and so questionnaireswere sent to 14 potential participants. Ten personsaged 7381 responded. The themes that emerged concernedpride over professional achievements, the pain of separation,and feelings of alienation and loneliness. The informantsemphasized the importance of sibling relationships. The conclusionwas that the participants, despite the hardships connectedwith the migration, had successfully lived a good lifein Sweden.ARTICLE HISTORYReceived 16 July 2018Accepted 11 May 2018KEYWORDSFinnish war children; childseparations; childevacuation; importance ofsibling relationsAt
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| 6. |
- Armelius, K., et al.
(författare)
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Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender
- 2003
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 44:2, s. 69-77
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Tidskriftsartikel (refereegranskat)abstract
- The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff members and patients rated their self-images using the Structural Analysis of Social Behavior (SASB). Male staff seemed less influenced by the patient, with their feelings relating mainly to aspects of their own self-image, while the feelings of the female staff were more related to the patient's self-image. The patient's diagnosis was less important for a staff member's feelings than that member's self-image. Generally, the relation between feelings and self-image was stronger for negative feelings. The results point to the importance of understanding more about the influence of staff members' self-structure on their negative feelings toward their patients and how this relates to both the staff member's and patient's gender.
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| 7. |
- Frankl, My, 1968-
(författare)
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Psychotherapy for Substance Use Disorders – the importance of affects
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options.The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia.In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design.In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking.Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition.
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| 8. |
- Gidhagen, Ylva, 1951-, et al.
(författare)
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Attachment style among outpatients with substance use disorders in psychological treatment
- 2018
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Ingår i: Psychology and Psychotherapy. - : Wiley. - 1476-0835 .- 2044-8341. ; 91:4, s. 490-508
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment.Design and Methods In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation.Results An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end.Conclusions This study shows significant relations between patients' attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style.
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| 9. |
- Holmqvist, Rolf, 1948-, et al.
(författare)
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Associations between psychiatric patients' self-image, staff feelings towards them, and treatment outcome
- 2004
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Ingår i: Psychiatry Research. - : Elsevier BV. - 0165-1781 .- 1872-7123. ; 128:1, s. 89-102
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Tidskriftsartikel (refereegranskat)abstract
- Interpersonal theory, as well as relational models of psychoanalytic and cognitive therapy, posits the importance for positive treatment outcome of the therapist's becoming emotionally involved in the patient's interpersonal patterns. Using the same data as in this study, we have previously found associations between psychiatric patients' self-image and the staff's feelings towards them, and differential associations between staff feelings and outcome for different diagnostic groups. The purpose of the present study was to analyze potential connections between patients' self-image, staff feelings, and outcome. Twice a year, staff at small psychiatric units reported their feelings towards 63 psychotic and 21 borderline patients who had rated their self-image at the beginning of the treatment using the Structural Analysis of Social Behavior (SASB) introject and parent images. Feelings reported on the two first occasions at the beginning of the treatment were used. Outcome was assessed after 5 years. Correlation analyses found different associations between patient self-image and staff feelings for patients with favorable and less favorable outcome. The results indicated for psychotic patients associations between positive outcome and less distant staff feelings connected with the patient's freedom-giving introject, less unfree staff feelings connected with a negative image of mother and less positive feelings connected with a positive image of father. For the borderline patients, positive outcome was associated with the fact that a negative image of mother did not evoke helpful staff feelings, a positive image of the patient himself or herself did not evoke helpful staff feelings and a controlling image of father-evoked distant feelings. © 2004 Elsevier Ireland Ltd. All rights reserved.
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| 10. |
- Holmqvist, Rolf, 1948-
(författare)
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Associations between staff feelings toward patients and treatment outcome at psychiatric treatment homes
- 2000
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Ingår i: Journal of Nervous and Mental Disease. - : Ovid Technologies (Wolters Kluwer Health). - 0022-3018 .- 1539-736X. ; 188:6, s. 366-371
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents, as part of a national Swedish research project, a study of associations between staff feelings toward patients and treatment outcome at 23 small psychiatric inpatient units. The outcome was measured with a composite scale based on structured interviews. Staff feelings were reported on a feeling checklist. Few and scattered correlations were found between staff feelings and treatment outcome when the whole group of patients was analyzed together. More meaningful patterns were found when data for psychotic and borderline patients were analyzed separately. For psychotic patients, positive outcome was associated with low levels of negative feelings throughout treatment. For borderline patients, positive outcome was associated with negative feelings at the beginning of treatment, followed by strong positive feelings in the later part. Staff feelings were more strongly associated with outcome for borderline patients than for psychotic patients. Patients with different structural diagnoses need different kinds of staff 'feeling milieus'.
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