| 1. |
- Falkenström, Fredrik, et al.
(författare)
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Dynamic Models of Individual Change in Psychotherapy Process Research
- 2017
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Ingår i: Journal of Consulting and Clinical Psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-006X .- 1939-2117. ; 85:6, s. 537-549
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Tidskriftsartikel (refereegranskat)abstract
- Objective: There is a need for rigorous methods to study the mechanisms that lead to individual-level change (i.e., process-outcome research). We argue that panel data (i.e., longitudinal study of a number of individuals) methods have 3 major advantages for psychotherapy researchers: (1) enabling microanalytic study of psychotherapeutic processes in a clinically intuitive way, (2) modeling lagged associations over time to ensure direction of causality, and (3) isolating within-patient changes over time from between-patient differences, thereby protecting against confounding influences because of the effects of unobserved stable attributes of individuals. However, dynamic panel data methods present a complex set of analytical challenges. We focus on 2 particular issues: (1) how long-term trajectories in the variables of interest over the study period should be handled, and (2) how the use of a lagged dependent variable as a predictor in regression-based dynamic panel models induces endogeneity (i.e., violation of independence between predictor and model error term) that must be taken into account in order to appropriately isolate within-and between-person effects. Method: An example from a study of working alliance in psychotherapy in primary care in Sweden is used to illustrate some of these analytic decisions and their impact on parameter estimates. Results: Estimates were strongly influenced by the way linear trajectories were handled; that is, whether variables were "detrended" or not. Conclusions: The issue of when detrending should be done is discussed, and recommendations for research are provided. What is the public health significance of this article? This article provides recommendations on how to study psychotherapy processes using dynamic panel data models to strengthen causal inferences. Accurate estimates of what drives individual development in psychotherapy are needed to generate recommendations on what therapists should focus on in therapy. Using the alliance-outcome association as an example, we show that estimated effect sizes may vary greatly depending on which modeling approach is used, with the decision on whether to remove time-trends from the outcome variable making the largest difference.
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| 2. |
- Falkenström, Fredrik, et al.
(författare)
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Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of Depression
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aims: Despite considerable clinical attention to the concept of mentalization in psychotherapy, research on mentalization and the psychotherapy process is virtually absent. Using data from two ongoing randomized controlled trials of psychotherapy for depression, we studied mentalization in 45 patients diagnosed with DSM-IV Major Depressive Disorder. The initial psychotherapy process was hypothesized to be experienced as more difficult with patients showing lower capacity for mentalization because of their difficulty understanding behavior in terms of mental states.Methods: Mentalization was measured as Reflective Functioning (RF) on the Adult Attachment Interview, conducted before therapy start. Additionally, a measure of Depression-Specific Reflective Functioning (DSRF) measuring mentalization about depressive symptoms was tested. Psychotherapy process was measured by the Working Alliance Inventory – Short form (WAI-S) and the Feeling Checklist (FC), which were completed after each session by both therapist and patient.Results: Pre-treatment RF on the AAI was on average low (M = 3.1), but variation in RF did not predict any aspect of the initial (first four sessions) psychotherapy process. Higher DSRF predicted better working alliance and more positive feelings as rated by the patient. RF on the AAI did not predict any process measure significantly.Discussion: The low RF in depression replicates two previous studies, and may help explaining why maternal depression is a risk factor for infant developmental problems. If the results for DSRF are replicated, this measure might be used for identifying patients who are not easy candidates for psychotherapy.
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| 3. |
- Falkenström, Fredrik, et al.
(författare)
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Reflective Functioning, Affect Consciousness, and Mindfulness : Are These Different Functions?
- 2014
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Ingår i: Psychoanalytic psychology. - : American Psychological Association (APA). - 0736-9735 .- 1939-1331. ; 31:1, s. 26-40
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Tidskriftsartikel (refereegranskat)abstract
- Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed that purportedly measure these concepts, but little is known about their interrelationships. We discuss conceptual overlaps and distinctions between these three concepts, and present results from a preliminary empirical study comparing their measures. To study the relationships between these concepts, data from a group of psychotherapy students (N = 46) was used. Mentalization operationalized as Reflective Functioning (RF) was rated on transcripts of a brief version of the Adult Attachment Interview; the Five Facet Mindfulness Questionnaire (FFMQ) was used to measure mindfulness; and the Affect Consciousness Interview-Self/Other version (ACI-S/O) to measure affect consciousness. There was a small but statistically significant relationship between RF and FFMQ, but surprisingly no relationship between AC-S/O and RF or FFMQ. A post hoc analysis showed a relationship between consciousness of others' affects and a reduced version of the RF scale. Results confirm that mentalization and mindfulness share some common variance, but contrary to expectations, affect consciousness seems to be more different from RF and mindfulness than expected. A possible explanation for the counterintuitive finding of no relationship between RF and affect consciousness is that the high end of the affect consciousness scale measures a mature capacity for mentalized affectivity, while RF is largely a buffer against trauma and adversity. Low or absent findings for the FFMQ are explained more in terms of different methods variance.
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| 4. |
- 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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| 5. |
- Lindqvist, Karin, et al.
(författare)
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Multilevel Exploratory Factor Analysis of the Feeling Word Checklist-24
- 2017
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Ingår i: Assessment (Odessa, Fla.). - : SAGE PUBLICATIONS INC. - 1073-1911 .- 1552-3489. ; 24:7, s. 907-918
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Tidskriftsartikel (refereegranskat)abstract
- Emotional reactions are a vital part of the therapeutic relationship. The Feeling Word Checklist-24 (FWC-24) is an instrument asking the clinician (or the patient) to report to what degree he or she has experienced various feelings during a therapeutic interaction. The aim of this study was to assess the factor structure of the clinician-rated FWC-24 when taking dependencies in the data into account. The sample was deliberately heterogeneous and consisted of 4,443 ratings made by 101 psychotherapists working with different psychotherapy methods in relation to 191 patients of different ages, genders, and with different primary diagnoses. A random intercept-only model revealed large intraclass correlation coefficients at the therapist level, indicating that a multilevel analysis was warranted. A two-level exploratory factor analysis with therapists as the between level and patients plus sessions as the within level was conducted. The items from FWC-24 were found to be best represented by four factors on the between level and four factors on the within level. The factor structures were largely similar on the two levels and were labeled Engaged, Inadequate, Relaxed, and Moved. The different factors explained different amounts of variance on different levels, indicating that some factors are more therapist dependent and some more patient dependent.
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| 6. |
- Berg, A.L., et al.
(författare)
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Affect-Focused Body Psychotherapy in Patients With Generalized Anxiety Disorder : Evaluation of an Integrative Method
- 2009
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Ingår i: Journal of Psychotherapy Integration. - : American Psychological Association (APA). - 1053-0479 .- 1573-3696. ; 19:1, s. 67-85
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the long-term effects of affect-focused body psychotherapy (ABP) for patients with generalized anxiety disorder (GAD). A group of 61 consecutive patients, 21-55 years old, were randomized to ABP and psychiatric treatment as usual (TAU). The patients were assessed before treatment and followed up 1 and 2 years after inclusion. The ABP patients received one session of treatment per week during 1 year. Three self-report questionnaires were administered; Symptom Checklist-90, Beck Anxiety Inventory, and the WHO (Ten) Well-Being Index. In both groups, there was a significant improvement. On termination, the ABP group had improved significantly more on the SCL-90 Global Symptom Index than the TAU group, whereas the differences were short of significance on the other two scales. The integration of bodily techniques with a focus on affects in a psychodynamically informed treatment seems to be a viable treatment alternative for patients with GAD.
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| 7. |
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| 8. |
- Blomberg, J, et al.
(författare)
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Long-term outcome of long-term psychoanalytically oriented therapies : First findings of the Stockholm outcome of psychotherapy and psychoanalysis study
- 2001
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Ingår i: Psychotherapy Research. - 1050-3307 .- 1468-4381. ; 11:4, s. 361-382
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Tidskriftsartikel (refereegranskat)abstract
- The scarcity of findings on the effectiveness of psychodynamic long-term psychotherapy and psychoanalysis is a problem, at least in countries where these treatments are the general treatment of choice. In this study, a sample of 105 patients in various stages before, during, and after treatment was drawn froth a population of 1,200 patients who had received or were on a waiting list for public subsidized long-term psychoanalytically oriented psychotherapy or psychoanalysis. The average duration was 40 months for the psychotherapies and 51 months for the psychoanalyses. All patients completed a questionnaire, including the Symptom Checklist-90 (SCL-90), Sense of Coherence Scale (SOCS), and Social Adjustment Scale (SAS), on 3 occasions with 12-month intervals. Using a partly within- and between-subjects design, group means were regressed on an ordinal time scale covering 7 stages in the treatment process: before, early during, during, late during, soon after, after, and late after treatment. The slopes indicated small to moderate effect sizes (d = 0.4-0.6) for psychotherapy and moderate to very large effect sizes (d = 0.4-1.5) for psychoanalysis. The largest effect sizes were on the SCL-90 and the lowest on the SAS for both groups. The proportions of patients with more "healthy" scores compared, with the worst scoring 10% in a nonclinical norm group increased from roughly 30% to 55% in the psychotherapy group and from 10% to 75% in the psychoanalysis group. The results underscore the importance of long-terns follow-up when evaluation of long-term treatments is concerned.
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| 9. |
- Bragesjo, M., et al.
(författare)
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The credibility of psychodynamic, cognitive and cognitive-behavioural psychotherapy in a randomly selected sample of the general public
- 2004
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Ingår i: Psychology and Psychotherapy. - : Wiley. - 1476-0835 .- 2044-8341. ; 77:3, s. 297-307
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To examine the credibility of psychodynamic, cognitive and cognitive-behavioural psychotherapy in the general population. Methods: A random sample (N = 121) of individuals from the county of Östergötland in Sweden between 20 and 60 years of age rated written descriptions of the three forms of psychotherapy. Results: A clear majority of respondents rated cognitive and cognitive-behavioural therapies as more credible than psychodynamic therapy, although the latter was rated as the most credible form of psychotherapy among those who had previous experience of treatment for psychological distress. Conclusions: Each form of psychotherapy appears to have its own 'market segment' with a high degree of credibility to those within that segment.
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| 10. |
- Carlsson, Jan, et al.
(författare)
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Searching for recognition : The professional development of psychodynamic psychotherapists during training and the first few years after it
- 2011
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Ingår i: Psychotherapy Research. - : Informa UK Limited. - 1050-3307 .- 1468-4381. ; 21:2, s. 141-153
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to investigate the development of psychotherapists' professional self during training and the first few years after it. Constant comparison analysis was conducted on interviews with former students (N = 18) at a training institute for psychoanalytic psychotherapy. The resulting core category osearching for recognitiono indicated that participants' ambition during the studied time period was to reach high status by becoming psychotherapists. During training, this was expressed by the category oattachment to preformed professional self,o meaning that students wanted their preconceptions about therapy to be acknowledged by teachers. After training, participants experienced achieved recognition and, as a result, a sense of freedom to use their own judgment.
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