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1.
  • Falkenström, Fredrik, et al. (författare)
  • Development and Validation of a 6-item Working Alliance Questionnaire for Repeated Administrations During Psychotherapy
  • 2015
  • Ingår i: Psychological Assessment. - : American Psychological Association. - 1040-3590 .- 1939-134X. ; 27:1, s. 169-183
  • Tidskriftsartikel (refereegranskat)abstract
    • Recently, researchers have started to measure the working alliance repeatedly across sessions of psychotherapy, relating the working alliance to symptom change session by session. Responding to questionnaires after each session can become tedious, leading to careless responses and/or increasing levels of missing data. Therefore, assessment with the briefest possible instrument is desirable. Because previous research on the Working Alliance Inventory has found the separation of the Goal and Task factors problematic, the present study examined the psychometric properties of a 2-factor, 6-item working alliance measure, adapted from the Working Alliance Inventory, in 3 patient samples (ns = 1,095, 235, and 234). Results showed that a bifactor model fit the data well across the 3 samples, and the factor structure was stable across 10 sessions of primary care counseling/psychotherapy. Although the bifactor model with 1 general and 2 specific factors outperformed the 1-factor model in terms of model fit, dimensionality analyses based on the bifactor model results indicated that in practice the instrument is best treated as unidimensional. Results support the use of composite scores of all 6 items. The instrument was validated by replicating previous findings of session-by-session prediction of symptom reduction using the Autoregressive Latent Trajectory model. The 6-item working alliance scale, called the Session Alliance Inventory, is a promising alternative for researchers in search for a brief alliance measure to administer after every session.
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2.
  • Falkenström, Fredrik, et al. (författare)
  • Dynamic Models of Individual Change in Psychotherapy Process Research
  • 2017
  • Ingår i: Journal of Consulting and Clinical Psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-006X .- 1939-2117. ; 85:6, s. 537-549
  • 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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3.
  • Falkenström, Fredrik, et al. (författare)
  • Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of Depression
  • 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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4.
  • Falkenström, Fredrik, et al. (författare)
  • Reflective Functioning, Affect Consciousness, and Mindfulness : Are These Different Functions?
  • 2014
  • Ingår i: Psychoanalytic psychology. - : American Psychological Association (APA). - 0736-9735 .- 1939-1331. ; 31:1, s. 26-40
  • 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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5.
  • Falkenström, Fredrik (författare)
  • The Capacity for Self-Observation in Psychotherapy
  • 2012
  • 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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6.
  • Holmqvist Larsson, Mattias, 1977-, et al. (författare)
  • Alliance ruptures and repairs in psychotherapy in primary care
  • 2018
  • Ingår i: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 28:1, s. 123-136
  • 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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7.
  • Holmqvist Larsson, Mattias, 1977- (författare)
  • Rupture and Repair in the Working Alliance : Relation to Psychotherapy Outcome and Within-Session Interaction
  • 2019
  • 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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8.
  • Holmqvist Larsson, Mattias, 1977-, et al. (författare)
  • The Alliance and Rupture Observation Scale (AROS) : Development and validation of an alliance and rupture measure for repeated observations within psychotherapy sessions
  • 2019
  • Ingår i: Journal of Clinical Psychology. - : John Wiley & Sons. - 0021-9762 .- 1097-4679. ; 75:3, s. 404-417
  • 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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9.
  • Lindqvist, Karin, et al. (författare)
  • Multilevel Exploratory Factor Analysis of the Feeling Word Checklist-24
  • 2017
  • Ingår i: Assessment (Odessa, Fla.). - : SAGE PUBLICATIONS INC. - 1073-1911 .- 1552-3489. ; 24:7, s. 907-918
  • 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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10.
  • Möller, Clara, et al. (författare)
  • Mentalizing in Young Offenders
  • 2014
  • Ingår i: Psychoanalytic psychology. - : American Psychological Association (APA). - 0736-9735 .- 1939-1331. ; 31:1, s. 84-99
  • Tidskriftsartikel (refereegranskat)abstract
    • In order to prevent relapse into criminality, it is important to understand what precedes criminal behavior. Two earlier studies found deficits in mentalizing ability to be related to violent and criminal actions. Mentalizing refers to the ability to make human behavior predictable and meaningful by inferring mental states (thoughts, feelings, etc.) as explaining behavior. In this study, mentalizing ability was assessed by rating 42 Adult Attachment Interviews with young male offenders with the Reflective Functioning (RF) scale. In addition, specific mentalizing ability about their crimes was assessed, as well as psychopathy traits (Psychopathy Checklist, Screening Version [PCL: SV]) and alexithymia (Toronto Alexithymia Scale [TAS]). Results suggest impaired mentalizing in criminal offenders. Examples of anti- and prementalizing reasoning about crimes are presented. RF scores were not correlated with the PCL:SV or TAS.
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11.
  • Söderberg, Anna Karin, et al. (författare)
  • Emotional availability in psychotherapy : The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship
  • 2014
  • Ingår i: Psychotherapy Research. - : Informa UK Limited. - 1050-3307 .- 1468-4381. ; 24:1, s. 91-102
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to assess whether a modified version of the Emotional Availability Scales (EAS), created to assess interaction quality between parents and children, could be applied to psychotherapy sessions and whether emotional availability (EA), as assessed by the modified EAS-T, was associated with client- and therapist-rated working alliance. EAS-T was used to assess 42 sessions from 16 therapies. The therapies came from the LURIPP project, comparing IPT with BRT for depressed clients. The results showed that sessions could be reliably rated with EAS-T. Most rating scales had acceptable variance. The client's perception of task alliance was associated with several of the EA subscales (sensitivity, nonhostility, responsiveness) assessed over therapies, whereas the perception of bond was associated with Structure on EAS.
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12.
  • Alexandersson, Klas, et al. (författare)
  • Session-to-session effects of therapist adherence and facilitative conditions on symptom change in CBT and IPT for depression
  • 2023
  • Ingår i: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 33:1, s. 57-69
  • 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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13.
  • Andersson, Hedvig, et al. (författare)
  • Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study
  • 2024
  • Ingår i: Child and Adolescent Psychiatry and Mental Health. - : BMC. - 1753-2000. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundNonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence.MethodsTwenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis.ResultsThree main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later.ConclusionsHealthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.
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14.
  • Andersson, Yvonne, et al. (författare)
  • Child Evacuations During World War II: This ShouldNot Happen Again
  • 2019
  • Ingår i: Journal of Loss and Trauma. - UK : Routledge. - 1532-5024 .- 1532-5032. ; 24:3, s. 213-225
  • 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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15.
  • Armelius, K., et al. (författare)
  • Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender
  • 2003
  • Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 44:2, s. 69-77
  • 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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16.
  • Back, Malin, et al. (författare)
  • Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy : results from a naturalistic study
  • 2020
  • Ingår i: Journal of Eating Disorders. - : BioMed Central. - 2050-2974. ; 8:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease.Methods: Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9).Results: Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session.Conclusions: IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.
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17.
  • Baranowska, Izabella, et al. (författare)
  • Sensory ataxic neuropathy in golden retriever dogs is caused by a deletion in the mitochondrial tRNATyr gene
  • 2009
  • Ingår i: PLoS Genetics. - : Public Library of Science (PLoS). - 1553-7390 .- 1553-7404. ; 5:5, s. e1000499-
  • Tidskriftsartikel (refereegranskat)abstract
    • Sensory ataxic neuropathy (SAN) is a recently identified neurological disorder in golden retrievers. Pedigree analysis revealed that all affected dogs belong to one maternal lineage, and a statistical analysis showed that the disorder has a mitochondrial origin. A one base pair deletion in the mitochondrial tRNA(Tyr) gene was identified at position 5304 in affected dogs after re-sequencing the complete mitochondrial genome of seven individuals. The deletion was not found among dogs representing 18 different breeds or in six wolves, ruling out this as a common polymorphism. The mutation could be traced back to a common ancestor of all affected dogs that lived in the 1970s. We used a quantitative oligonucleotide ligation assay to establish the degree of heteroplasmy in blood and tissue samples from affected dogs and controls. Affected dogs and their first to fourth degree relatives had 0-11% wild-type (wt) sequence, while more distant relatives ranged between 5% and 60% wt sequence and all unrelated golden retrievers had 100% wt sequence. Northern blot analysis showed that tRNA(Tyr) had a 10-fold lower steady-state level in affected dogs compared with controls. Four out of five affected dogs showed decreases in mitochondrial ATP production rates and respiratory chain enzyme activities together with morphological alterations in muscle tissue, resembling the changes reported in human mitochondrial pathology. Altogether, these results provide conclusive evidence that the deletion in the mitochondrial tRNA(Tyr) gene is the causative mutation for SAN.
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18.
  • Bäck, Malin, et al. (författare)
  • Interpersonal psychotherapy for eating disorders with co-morbid depression : A pilot study
  • 2017
  • Ingår i: European Journal of Psychotherapy. - : Routledge. - 1364-2537 .- 1469-5901. ; 19:4, s. 378-395
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Patients with eating disorders (ED) often suffer from co-morbid depression, which may complicate the ED treatment. Previous studies have found that ED interventions seem to have limited capacity to reduce depressive symptoms. Several studies of interpersonal psychotherapy (IPT), have found that when patients have been treated for depression, co-morbid symptoms have diminished. As depression and EDs are commonly co-occurring conditions, this pilot study aimed to examine the effect of an IPT treatment for these conditions, with the focus on the depressive symptoms.Method: In this multi-centre study, 16 patients with EDs and co-occurring major depression received 16 weeks of depression-focused IPT.Results: Significant improvements with substantial effect sizes were found for both depression (d = 1.48) and ED (d =.93). Symptom reduction in the two syndromes were strongly correlated (r = .625, p = .004). Patients with a restrictive ED did not improve on either depression or ED symptoms.Conclusion: These findings point to the usefulness of IPT for concurrent depression and ED with a bingeing/purging symptomatology. Working with negative affect and problem-solving related to current interpersonal problems may alleviate general psychological distress among these patients.
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19.
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20.
  • Degner, Jürgen, 1964-, et al. (författare)
  • Placerad utanför sitt sammanhang : en uppföljningsstudie av 46 institutionsplacerade ungdomars privata och formella relationer
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • When young people are placed in residential treatment centres (RTCs), it is important that facility staff involve parents and other social network members (PSMs) (private relations) in the residential treatment program. This involvement process depends on both PSMs’ willingness and capability to take part in the youths’ treatment, as well as the residential staffs’ attitude towards promoting this process. The overall aim of the dissertation is to explore obstacles to and opportunities for involving PSMs in the youths’ treatment process. One key question is to investigate how the youths describe their parents’ emotional attitude, and support from other significant members of their network. At times of tension between youth and family, other formal relations with professional and non-professional support persons could serve as mediators between the youth and his or her family of origin. Accordingly, the aim is to investigate whether, and if so how, these support persons are included in the treatment process. Further, a positive treatment alliance between residential staff and the youth (resident) is important for the treatment outcome. Two further issues are to explore how the residents view the staffs’ personal involvement with the resident, and, from a gender perspective, to investigate the residents’ descriptions of the treatment received at the facility. Semi structured interviews, including a social network map and a Feeling word checklist, were conducted with 46 youths (23 girls/23 boys) placed at 10 different state RTCs run by the Swedish National Board of Institutional Care (SiS). The residents were interviewed three times, at approximately one-year intervals. This thesis is based on material from the first and second interview with the residents. Interviews were also conducted on one occasion with 23 support persons. Paper I deals with the PSMs’ involvement in the residents’ treatment process. Paper II explores obstacles to and opportunities for establishing a therapeutic alliance between key staff members and residents in a one year perspective. Papers III and IV investigate the residents’ (paper III) and support persons’ (paper IV) views of possibilities for the support persons to take part in the treatment program. Finally, Paper V aims, from a gender perspective, to study the residents’ descriptions of their psychosocial problems, their need for help, and their experiences of the help received from the staff at the facility. The main results show that the majority of the youths describe their parents as having a negative emotional attitude, with a desolate or family-oriented social network system. At the first interview the residents described the key staff members as mainly having little personal involvement, but this staff involvement had increased, according to the residents, by the one-year follow-up. Obstacles to and possibilities for involving PSMs as well as support persons is mainly related to staffs’ encouraging, or not encouraging attitude, attitudes of social welfare agency personnel (regarding support persons), and PSMs’ capability and willingness to participate in the program. With regard to gender, data indicate that there is reason to nuance the proposition of girls being more relationship oriented, and boys autonomous – at least in treatment settings – since, for example, the boys in the study to the same extent as the girls desired more trustful conversations with the staff. The importance of making an inventory of the youths’ social network and focusing on support persons’ involvement in the treatment program is discussed.
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21.
  • Ekeblad, Annika (författare)
  • A Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder : Predictors of process and outcome
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Interpersonal Psychotherapy (IPT) and Cognitive Behavioral Therapy (CBT) are both evidence-based treatments for Major Depressive Disorder (MDD). Several head-to-head comparisons between these methods have been made, most of them in the US. There is a need for more trials in different treatment settings. This thesis is based on a randomized controlled trial of CBT and IPT for MDD in a community-based psychiatric outpatient clinic. In the trial, treatment outcome and mentalization change was compared between the methods. In addition, the significance of pre-treatment mentalization for subsequent alliance and outcome was analyzed. Ninety-six patients, about half of them with personality disorders, were randomized to 14 sessions of CBT or IPT. The hypothesis was that IPT would not be inferior to CBT which was confirmed. CBT had a significantly higher drop-out rate. Initial capacity for mentalization predicted alliance and outcome in both IPT and CBT. The level of mentalization was changed in IPT but not in CBT
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22.
  • Ekeblad, Annika, et al. (författare)
  • Change in reflective functioning in interpersonal psychotherapy and cognitive behavioral therapy for major depressive disorder
  • 2023
  • Ingår i: Psychotherapy Research. - : Routledge; Taylor & Francis. - 1050-3307 .- 1468-4381. ; 33:3, s. 342-349
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). Methods In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. Results The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. Conclusions IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction.
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23.
  • Ekeblad, Annika, et al. (författare)
  • Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic
  • 2016
  • Ingår i: Depression and anxiety (Print). - : WILEY-BLACKWELL. - 1091-4269 .- 1520-6394. ; 33:12, s. 1090-1098
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.
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24.
  • Ekeblad, Annika, et al. (författare)
  • Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression
  • 2016
  • Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 84:1, s. 67-78
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Although considerable attention has been paid to the concept of mentalization in psychotherapy, there is little research on mentalization as predictor of psychotherapy process and outcome. Using data from a randomized controlled trial of cognitive-behavioral therapy and interpersonal psychotherapy for depression, we studied mentalization in 85 outpatients with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders. It was hypothesized that patients showing lower capacity for mentalization would experience poorer quality of alliance and worse outcome. Method: Depressive symptoms were measured each session using the Beck Depression Inventory-II. Mentalization was measured as reflective functioning (RF) on a slightly shortened version of the Adult Attachment Interview. A measure of depression-specific reflective functioning (DSRF), measuring mentalization about depressive symptoms, was also used. The Working Alliance Inventory-Short Form Revised was completed after each session by both therapist and patient. Longitudinal multilevel modeling was used to analyze data. Results: The patients had on average very low RF (M = 2.62, SD = 1.22). Lower pretreatment RF/DSRF predicted significantly lower therapist-rated working alliance during treatment. RF did not affect patient-rated alliance, but lower DSRF predicted lower patient-rated alliance across treatment. Patients with higher RF/DSRF had better outcomes on self-rated depression. Conclusions: The findings showed lower than normal capacity for mentalization in patients with MDD. Lower RF/DSRF predicted worse treatment outcome. More research is needed to understand how RF affects psychotherapy response and how RF is affected after recovery from depression.
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25.
  • Falkenström, Fredrik, et al. (författare)
  • Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials
  • 2013
  • Ingår i: Journal of Clinical Psychiatry. - : Physicians Postgraduate Press. - 0160-6689 .- 1555-2101. ; 74:5, s. 482-491
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE:Clinical trials sometimes have the same therapists deliver more than 1 psychotherapy, ostensibly to control for therapist effects. This "crossed therapist" design makes controlling for therapist allegiance imperative, as therapists may prefer one treatment they deliver to the other(s). Research has established a strong relationship between principal investigators' allegiances and treatment outcome. Study therapists' allegiances probably also influence outcome, yet this moderating factor on outcome has never been studied.DATA SOURCES:English language abstracts in PsycINFO and MEDLINE from January 1985 to December 2011 were searched for keywords psychotherapy and randomized trial.STUDY SELECTION:The search yielded 990 abstracts that were searched manually. Trials using the same therapists in more than 1 condition were included.DATA EXTRACTION:Thirty-nine studies fulfilled inclusion criteria. Meta-regression analyses assessed the influence of researchers' allegiance on treatment outcome, testing the hypothesis that studies poorly controlling for therapist allegiance would show stronger influence of researcher allegiance on outcome. A single-item measure assessed researchers' reported attempts to control for therapist allegiance.RESULTS:Only 1 of 39 studies (3%) measured therapist treatment allegiance. Another 5 (13%) mentioned controlling for, without formally assessing, therapist allegiance. Most publications (67%) did not even mention therapist allegiance. In studies not controlling for therapist allegiance, researcher allegiance strongly influenced outcome, whereas studies reporting control for therapist allegiance showed no differential researcher allegiance. Researchers with cognitive-behavioral therapy allegiance described controlling for therapist allegiance less frequently than other researchers.CONCLUSIONS:The crossed therapist design is subject to bias due to differential psychotherapist allegiance. Worrisome results suggest that researchers strongly allied to a treatment may ignore therapist allegiance, potentially skewing outcomes. All clinical trials, and especially crossed therapist designs, should measure psychotherapist allegiance to evaluate this possible bias.
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26.
  • Falkenström, Fredrik, et al. (författare)
  • Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory-Short Form Revised
  • 2015
  • Ingår i: Assessment (Odessa, Fla.). - : SAGE PUBLICATIONS INC. - 1073-1911 .- 1552-3489. ; 22:5, s. 581-593
  • Tidskriftsartikel (refereegranskat)abstract
    • The working alliance concerns the quality of collaboration between patient and therapist in psychotherapy. One of the most widely used scales for measuring the working alliance is the Working Alliance Inventory (WAI). For the patient-rated version, the short form developed by Hatcher and Gillaspy (WAI-SR) has shown the best psychometric properties. In two confirmatory factor analyses of the WAI-SR, approximate fit indices were within commonly accepted norms, but the likelihood ratio chi-square test showed significant ill-fit. The present study used Bayesian structural equations modeling with zero mean and small variance priors to test the factor structure of the WAI-SR in three different samples (one American and two Swedish; N = 235, 634, and 234). Results indicated that maximum likelihood confirmatory factor analysis showed poor model fit because of the assumption of exactly zero residual correlations. When residual correlations were estimated using small variance priors, model fit was excellent. A two-factor model had the best psychometric properties. Strong measurement invariance was shown between the two Swedish samples and weak factorial invariance between the Swedish and American samples. The most important limitation concerns the limited knowledge on when the assumption of residual correlations being small enough to be considered trivial is violated.
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27.
  • Falkenström, Fredrik, et al. (författare)
  • How Much Therapy Is Enough? : Comparing Dose-Effect and Good-Enough Models in Two Different Settings
  • 2016
  • Ingår i: Psychotherapy. - : American Psychological Association (APA). - 0033-3204 .- 1939-1536. ; 53:1, s. 130-139
  • Tidskriftsartikel (refereegranskat)abstract
    • The Dose-Effect model holds that longer therapy leads to better outcome, although increasing treatment length will yield diminishing returns, as additional sessions lead to progressively less change in a negatively accelerating fashion. In contrast, the Good-Enough-Level (GEL) model proposes that patients, therapists, or patients-with-therapists decide on ending treatment when treatment outcome is satisfactory, meaning that patients who change faster will have shorter treatments. If true, this means that aggregating among patients with different treatment lengths would yield biased results. Most previous research has shown that symptom change rate depends on treatment length, but all of these studies used data from University counseling centers in the United States. There is a need to test if previous results hold in different settings. Two datasets from Swedish community-based primary care (n = 640) and psychiatric care (n = 284) were used. Patients made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel models indicated better fit for a model in which treatment length moderated symptom change rate. In the primary care sample, patients in longer treatments achieved more symptom change from pre- to posttreatment, despite having slower rate of improvement. The most important aspect of the GEL model was supported, and no evidence was found for a negatively accelerating Dose-Effect curve. Results cannot be generalized beyond about 12 sessions, due to scarcity of data for longer treatments.
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28.
  • Falkenström, Fredrik, et al. (författare)
  • Improvement of the Working Alliance in One Treatment Session Predicts Improvement of Depressive Symptoms by the Next Session
  • 2016
  • Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 84:8, s. 738-751
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Developments in working alliance theory posit that the therapist's attention to fluctuations in the alliance throughout treatment is crucial. Accordingly, researchers have begun studying the alliance as a time-varying mechanism of change rather than as a static moderator. However, most studies to date suffer from bias owing to the nonindependence of error term and predictors (endogeneity). Method: Patients with major depressive disorder (N = 84) from a randomized trial comparing cognitive-behavioral therapy with interpersonal psychotherapy filled out the Beck Depression Inventory-II before each session. After each session, patients and therapists filled out the Working Alliance Inventory short forms. Data were analyzed using the generalized method of moments for dynamic panel data, a method commonly applied in econometrics to eliminate endogeneity bias. Results: Improvement of the alliance predicted significant reduction of depressive symptoms by the next session (patient rating: b = -4.35, SE = 1.96, p = .026, 95% confidence interval [CI] [-8.19, -0.51]; therapist rating: b = -4.92, SE = 1.84, p = .008, 95% CI [-8.53, -1.31]). In addition, there was a significant delayed effect on the session after the next (patient rating: b = -3.25, SE = 1.20, p = .007, 95% CI [-5.61, -0.89]; therapist rating: b = -5.44, SE = 1.92, p = .005, 95% CI [-9.20, -1.68]). Conclusion: If the quality of patient-therapist alliance is improved in a given treatment session, depressive symptoms will likely decrease by the next session. The most important limitation of this study is its relatively small sample size.
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29.
  • Falkenström, Fredrik, Professor, 1972-, et al. (författare)
  • Patient Attachment and Reflective Functioning as Predictors for Therapist In-Session Feelings
  • 2024
  • Ingår i: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 71:3, s. 190-201
  • Tidskriftsartikel (refereegranskat)abstract
    • Therapists' in-session feelings in psychotherapy can be seen as indications of the development of the therapeutic relationship and the therapeutic process. To manage them appropriately, it is important to know to what extent they may be influenced by patients' pretreatment characteristics. This study aims to improve the understanding of therapists' emotional reactions in the psychotherapeutic setting by investigating if patients' pretreatment mentalization ability and attachment style predicted therapist in-session feelings. In a sample of 87 therapy dyads treated with interpersonal psychotherapy and cognitive behavioral therapy for depression, patient attachment was measured using self-reported Experiences in Close Relationships (ECR) and mentalization using Reflective Functioning (RF). ECR and RF were hypothesized to predict therapist feelings measured by the Feeling Word Checklist-24 at different treatment phases over the full course of treatment. Treatment method, patient age, gender, and pretreatment depression were evaluated as potential confounders. Multilevel modeling was used to analyze the data. Lower RF in patients predicted more negative therapist feelings in the mid- to late-treatment phases and less positive feelings in the late-treatment phase. Self-reported attachment anxiety or avoidance did not predict therapist feelings. Findings indicate that patients' ability to mentalize is important to consider when conducting psychotherapy, as it can influence therapists' feelings in the therapeutic process. Limitations of the present study's approach are discussed, and directions for future research are considered.
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30.
  • Falkenström, Fredrik, et al. (författare)
  • Review of organizational effects on the outcome of mental health treatments
  • 2018
  • Ingår i: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 28:1, s. 76-90
  • Forskningsöversikt (refereegranskat)abstract
    • OBJECTIVE: As there are theoretical, clinical, and "common sense" reasons to expect a relationship between organizational factors and outcome in clinics providing psychotherapy and other mental health treatments, a review of empirical research in this area was undertaken with the aim of finding empirical evidence for organizational effects.METHODS: A structured search for studies on organizational differences in patient mental health outcomes was performed using EBSCO host, Cochrane Library Database, and the Health Systems Evidence database at McMasters University. Finished studies published in English were included if they presented data from more than one mental health service and used change in symptom, level of functioning, or quality of life as outcome.RESULTS: The search yielded not more than 19 studies fulfilling inclusion criteria. All studies showed some evidence for organization effects, and there was some evidence for organizational climate and culture explaining differences in outcome.CONCLUSION: Given that mental health treatments are likely to be especially susceptive to organizational effects, it is remarkable that not more research has been devoted to this. Clearly, more research is needed to study the consequences of work organization for the outcome of psychotherapy. Methodological issues in organizational studies are discussed.
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31.
  • Falkenström, Fredrik, et al. (författare)
  • Therapeutic Alliance Predicts Symptomatic Improvement Session by Session
  • 2013
  • Ingår i: Journal of counseling psychology. - : American Psychological Association. - 0022-0167 .- 1939-2168. ; 60:3, s. 317-328
  • Tidskriftsartikel (refereegranskat)abstract
    • The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic improvements. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analyses do not necessarily mean that improving the alliance with a given patient will improve outcome (i.e., a within-patient effect). In a sample of 646 patients (76% women, 24% men) in primary care psychotherapy, the effect of working alliance on next session symptom level was analyzed using multilevel models. The Clinical Outcomes in Routine Evaluation–Outcome Measure was used to measure symptom level, and the patient version of the Working Alliance Inventory–Short form revised (Hatcher & Gillaspy, 2006) was used to measure alliance. There was evidence for a reciprocal causal model, in which the alliance predicted subsequent change in symptoms while prior symptom change also affected the alliance. The alliance effect varied considerably between patients. This variation was partially explained by patients with personality problems showing stronger alliance effect. These results indicate that the alliance is not just a by-product of prior symptomatic improvements, even though improvement in symptoms is likely to enhance the alliance. Results also point to the importance of therapists paying attention to ruptures and repair of the therapy alliance. Generalization of results may be limited to relatively brief primary care psychotherapy.
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32.
  • Falkenström, Fredrik, 1972-, et al. (författare)
  • Therapist in-session feelings predict change in depressive symptoms in interpersonal and brief relational psychotherapy
  • 2022
  • Ingår i: Psychotherapy Research. - : Taylor & Francis Group. - 1050-3307 .- 1468-4381. ; 32:5, s. 571-584
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Brief Relational Therapy (BRT) includes the idea that the therapists use their in-session feelings in meta-communications about the therapy relationship to facilitate resolution of alliance ruptures. The current study aimed to explore the effect of therapist feelings on patient depressive symptoms in BRT compared to Interpersonal Psychotherapy (IPT). Methods: The effects of therapist feelings were studied in 40 patients randomized to 16 sessions of IPT or BRT, using the Feeling Word Checklist-24, the Patient Health Questionnaire-9 and the Working Alliance Inventory. Data was analyzed using dynamic structural equation modeling. Results: Negative therapist feelings predicted increase and positive feelings decrease in next-session PHQ-9 via the alliance and the patients' engaged feelings, in both treatments. The direct effect of negative therapist feelings on PHQ-9 differed significantly between BRT and IPT, with more negative feelings predicting a decrease in PHQ-9 in BRT but not in IPT. Conclusion: Negative therapist feelings may cause increase/less decrease and positive feelings more decrease in depressive symptoms via disruptions in the alliance. In BRT, if the alliance is unaffected by negative therapist feelings, the patient's depressive symptoms may improve. Findings need replication in a larger sample.
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33.
  • Falkenström, Fredrik, et al. (författare)
  • Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement
  • 2014
  • Ingår i: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 24:2, s. 146-159
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Although the working alliance as been found to be a robust predictor of psychotherapy outcome, critics have questioned the causal status of this effect. Specifically, the effect of the alliance may be confounded with the effect of prior symptom improvement. The objective of the present study was to test this possibility. Method: A large dataset from primary care psychotherapy was used to study relationships between alliance and outcome using piecewise multilevel path analysis. Results: Initial symptom level and symptom change up to session three predicted the alliance at session three. Working alliance significantly predicted symptom change rate from session three to termination, even while controlling for several possible confounds. Conclusions: The alliance predicts outcome over and above the effect of prior symptom improvement, supporting a reciprocal influence model of the relationship between alliance and symptom change.
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34.
  • Frankenberg, Sofia Johnson, et al. (författare)
  • In Earlier Days Everyone Could Discipline Children, Now They Have Rights' : Caregiving Dilemmas of Guidance and Control in Urban Tanzania
  • 2014
  • Ingår i: Journal of Community and Applied Social Phychology. - : Wiley. - 1052-9284 .- 1099-1298. ; 24:3, s. 191-204
  • Tidskriftsartikel (refereegranskat)abstract
    • Caregiving practices in Tanzania are potentially affected by socio-demographic change such as urbanization and globalization. The aim of this study is to explore adult caregivers' discourses regarding the responsibility of caregiving, related to guidance and control of children in Tanzania. Data was collected in focus group discussions with parents and grandparents in an urban area of Tanzania. The analysis found two interpretative repertoires: guidance and control as a community matter and guidance and control as a family matter. These repertoires are related to responsibility and to an ideological dilemma regarding parental authority and individual's rights. The findings are discussed in relation to the tendency to polarize between ideologically traditional versus modern societies. This illustrates how lived ideology of caregiving responsibility is historically and socially situated, in the local context and how the spread of Children's Rights ideology needs to be understood in this context.
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35.
  • Frankl, My, 1968- (författare)
  • Psychotherapy for Substance Use Disorders – the importance of affects
  • 2017
  • 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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36.
  • Fransson, Mari, 1978- (författare)
  • Attachment and the Development of Personality and Social Functioning
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • According to attachment theory, the establishment of an attachment bond to a caregiver not only provides the infant with protection from danger, but also many other resources presumably beneficial to the child’s general psychological development. Although there is substantial empirical support for a link between attachment security and social functioning in childhood and adolescence, less is known about whether childhood attachment contributes to social functioning beyond adolescence. Similarly, attachment has been found predictive of broad aspects of a person’s functioning, but few attempts have been made to link attachment to the currently dominating perspective on personality, the Five Factor Model (FFM). Results in Study I partially supported our expectations, by showing prospective links from middle childhood security to various aspects of social functioning in young adulthood. Further, security contributed to developmental change in social functioning from middle childhood to young adulthood. In Study II, middle childhood security was found to predict some of the FFM personality traits (primarily extraversion and openness) concurrently and prospectively, partially supporting our expectations. The third aim of this thesis was to address whether attachment disorganization, which has usually been found predictive of maladaptive phenomena, may predict also other, non-pathological outcomes. In Study II, we found that higher levels of disorganization in young adulthood were concurrently associated with more openness and lower conscientiousness. Furthermore, in Study III disorganization was shown to be concurrently associated with more New Age spirituality and more absorption in adulthood. In addition, absorption was, in accordance with our expectations, found to statistically mediate the link between disorganization and New Age spirituality. Hence, these findings supported our assumption that disorganization might be expressed in other life domains besides specifically maladaptive ones. Taken together, we suggest that attachment spreads its influence to a broad set of life domains through its continuous influence on general psychological components such as cognitive representations and self-regulation abilities. However, the modest strength of our results indicates that attachment is only one among several factors involved in the development of social functioning, personality traits, and spirituality.
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37.
  • Gidhagen, Ylva, 1951-, et al. (författare)
  • Attachment style among outpatients with substance use disorders in psychological treatment
  • 2018
  • Ingår i: Psychology and Psychotherapy. - : Wiley. - 1476-0835 .- 2044-8341. ; 91:4, s. 490-508
  • 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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38.
  • Gidhagen, Ylva, et al. (författare)
  • Outcome of psychological treatment of patients with substance use disorders in routine care
  • 2017
  • Ingår i: Journal of Substance Use. - Cardiff, Wales, UK : Taylor & Francis. - 1465-9891 .- 1475-9942. ; 22:3, s. 343-352
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: More knowledge is needed about outcome of treatments in routine care for patients with substance use disorders (SUDs). These patients often suffer from psychological distress in addition to SUDs. Objectives: To evaluate the effects of community-based psychological treatment on SUD patients’ psychosocial problems, as well as on their substance use. Design: All patients who were referred or self-referred for psychological treatment to a social worker or a psychotherapist at three outpatient treatment centers for SUD patients were asked to participate in the study. Methods: Ratings at treatment start and end were obtained on Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM, n = 100), Alcohol Use Disorders Identification Test - Consumption (AUDIT-C, n = 49), and Drug Use Disorders Identification Test - Consumption (DUDIT-C, n = 27). Results: CORE-OM mean scores were significantly improved. In total 14% of the patients were recovered, 10% improved, and 5% deteriorated. Both AUDIT-C and DUDIT-C mean scores were significantly improved for patients with alcohol use and patients using illicit drugs, respectively. Conclusions: Routine psychological treatment had positive effects on psychological distress as well as on reduction of substance use. A substantial number of patients remained however unchanged, particularly regarding psychological distress. More studies with larger patient groups are needed to develop treatment for SUD patients in routine care.
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39.
  • Gradin Franzén, Anna (författare)
  • Disciplining Freedom : Treatment Dilemmas and Subjectivity at a Detention Home for Young Men
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This ethnographic study explores treatment practices and staff-resident interaction at a detention home for young men, drawing on video recorded conversations and interviews. It investigates ideological dilemmas inherent in the institutional setting and how these produce complex subject positions to uptake, negotiate or refuse. Study I explores a core treatment dilemma: coercion vs. freedom, involving the dual institutional goal of coercing residents into norm abiding behavior and of producing individuals who behave "properly" out of their own free will. It focuses on staff members’ talk about token economy, illuminating rhetorical resources deployed to avoid the troubled subject position of a disciplinarian. Study II investigates disciplinary humor, illuminating how humor is used both to impose and disrupt social order. It shows how staff members and youths skillfully deploy humor in negotiating local hierarchies related to authority, generation, and age. Humor was also found to be a useful way of navigating ideological dilemmas. Study III explores behavior modification practices, focusing on how selfassessment practices can be conceptualized as responsibilization that emphasizes self-regulation. It documents the participants’ engagement in strategic deployment of specific subject position relations, “young boy”-caregiver rather than delinquent-disciplinarian. In brief, the thesis shows that subject positions are essentially co-constructed, and how positions related to age are highly relevant in this institutional setting. Paradoxical aspects of subject positions provide discursive resources that can be deployed to navigate ideological dilemmas such as that of coercion vs. freedom, but also to handle issues of authenticity.
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40.
  • Gradin Franzen, Anna, et al. (författare)
  • From punishment to rewards? : Treatment dilemmas at a youth detention home
  • 2014
  • Ingår i: Punishment & Society. - : SAGE Publications. - 1462-4745 .- 1741-3095. ; 16:5, s. 542-559
  • Tidskriftsartikel (refereegranskat)abstract
    • The present article analyses staff members' discourses on the treatment method token economy, as it is implemented at a detention home for young men. The study draws on interviews with eight staff members and on participant observations at the detention home. Using discursive psychology, the analysis centers on the staff members' own constructions of token economy as well as paradoxes and dilemmas that appear in their talk. Two paradoxes were found: (1) paradox of transparency and interpretation; token economy is objective and transparent, but requires interpretative work over time; and (2) paradox of rewards and punishments; tokens are rewards, but they can be zeroed' or withdrawn in order to limit undesirable behavior. Further, the analysis showed that both paradoxes invoke a principal ideological dilemma of control - freedom, which staff members attempt to resolve by positioning the young men as responsible for their own actions and themselves as subordinate parties in the outcome of objective' token economy practices.
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41.
  • Hartzell, Monica, 1953- (författare)
  • The First Meeting at Child and Adolescent Psychiatry
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Children and parents who visited child and adolescent psychiatry (CAP) for the first time were interviewed in the presence of their therapists about the first meeting. The interview was intended to make the attendants describe in their own words what the meeting was like for them. The interview was repeated after six months to get complementary information. Research assistants, reflectors, helped the interviewer to prevent from bias and to hold on to the theme. The grounded theory approach was utilised in papers I, II, and III, and qualitative content analysis was used in paper IV. Children appreciated the therapist being in an active as well as in a more passive but alert position, moving between asking adjusted questions and including the parents. The therapists’ skill of listening was also important to them. For the parents, it was important what happened between their child and the therapists. They questioned their own role and presence. Also, they focused on the plan for the meeting and for the coming process. Certain things that happened in the dialogue were useful after the meeting. The results indicate that what was helpful was connected to family therapy matters rather than psychiatric ones. The therapists balanced between a psychiatric and a family therapeutic position, and it was a dilemma for them how to best fulfil their assignment in the organisation as they perceived it. Two competing discourses were found in the first meeting; Structuring, which stood for structure, planning and expertise, while Collaboration represented negotiations of how to work together, empowerment and emotional aspects. The Structuring discourse tended to dominate. Both discourses consisted of valuable elements that needed to be included to ensure that the atmosphere would not be too strict or too flexible. The findings are tentative because of the lack of studies to compare to, and because of the few interviews made.      
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42.
  • Holmqvist, Rolf, 1948-, et al. (författare)
  • Associations between psychiatric patients' self-image, staff feelings towards them, and treatment outcome
  • 2004
  • Ingår i: Psychiatry Research. - : Elsevier BV. - 0165-1781 .- 1872-7123. ; 128:1, s. 89-102
  • 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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43.
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44.
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45.
  • Holmqvist, Rolf, 1948- (författare)
  • Associations between staff feelings toward patients and treatment outcome at psychiatric treatment homes
  • 2000
  • Ingår i: Journal of Nervous and Mental Disease. - : Ovid Technologies (Wolters Kluwer Health). - 0022-3018 .- 1539-736X. ; 188:6, s. 366-371
  • 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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46.
  • Holmqvist, Rolf, 1948-, et al. (författare)
  • Burnout and psychiatric staff's feelings towards patients
  • 2006
  • Ingår i: Psychiatry Research. - : Elsevier BV. - 0165-1781 .- 1872-7123. ; 145:2-3, s. 207-213
  • Tidskriftsartikel (refereegranskat)abstract
    • The concept of burnout describes a number of destructive aspects in work relationships. In this study, the relations between psychiatric staff members' feelings towards their patients and burnout were analyzed. Staff feelings were measured with a feeling checklist, and burnout with BM (Burnout Measure) and MBI (Maslach's Burnout Inventory). The staff at 28 treatment units rated their feelings towards the patients as a group. The results indicated that high burnout was associated with negative feelings and low levels of burnout with positive feelings towards patients. The correlation patterns for the different measures of burnout were somewhat different. BM had the strongest correlations with unhelpful and rejecting feelings towards patients, whereas Personal accomplishment, one dimension of MBI, was most strongly correlated with accepting and close feelings. The results were interpreted as opening for the question whether negative staff feelings towards patients most profitably can be seen as an aspect of burnout or whether these two phenomena should be distinguished clinically and theoretically. © 2006 Elsevier Ireland Ltd. All rights reserved.
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47.
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48.
  • Holmqvist, Rolf, 1948- (författare)
  • Change in self-image and PTSD symptoms in short-term therapies with traumatized refugees
  • 2006
  • Ingår i: Psychoanalytic Psychotherapy. - : Informa UK Limited. - 0266-8734 .- 1474-9734. ; 20:4, s. 251-265
  • Tidskriftsartikel (refereegranskat)abstract
    • In this study, an attempt was made to evaluate changes in the self-image of traumatized refugees receiving short-term psychotherapy. Fourteen clients with war and torture experiences were followed during and after trauma-focused therapies with self-rating instruments. Outcome was measured with SCL-90, measuring overall psychiatric symptoms, and with PTSS-10, measuring Post-traumatic Stress Disorder (PTSD) symptoms. Self-image was measured with Structural Analysis of Social Behavior (SASB). The analyses showed considerable remission of both general psychiatric and PTSD-related symptoms, but more moderate changes in self-image aspects. The positive aspect of the self-image was virtually non-related to the symptom measures and did not change after the termination of the therapy, the negative aspect of the self-image was more strongly related to the symptoms and changed mainly on the last measurement occasion, 15 months after the therapy end. When clients with good and poor outcome were compared, it was found that those with good outcome had higher initial levels on both the positive and the negative aspects of the self-images. This was tentatively interpreted as indicating that clients who had invested more energy in their self-image were better able to utilize the therapy. Different development in the self-image for these two groups indicated that for some clients, the treatment process might have entailed too much strain.
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49.
  • Holmqvist, Rolf, et al. (författare)
  • Client and therapist agreement about the clients problemsAssociations with treatment alliance and outcome
  • 2016
  • Ingår i: Psychotherapy Research. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 1050-3307 .- 1468-4381. ; 26:4, s. 399-409
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: A shared understanding of the patients symptoms and problems is seen by most theories as a crucial aspect of the collaboration in therapy, presumably influencing alliance and outcome. The empirical ground for this argument is not solid, however. Several studies have found weak associations between a common view of the patients problems and outcome. The purpose of the present study was to analyze whether agreement in the understanding of the patients depression and anxiety problems was important for alliance and outcome. Method: The study used data from a practice-based study using the CORE system with 846 patients who received psychological treatment in primary care. Results: The analyses indicated that although patients who were assessed by their therapists as having depression and anxiety problems scored higher on these subscales than other patients, about half of the patients reported such problems when the therapists did not, and vice versa. Agreement was not associated with better alliance or outcome. Conclusions: Productive collaboration in psychotherapy may be based on other factors than agreement about symptoms.
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50.
  • Holmqvist, Rolf, 1948-, et al. (författare)
  • Countertransference feelings and the psychiatric staff's self-image
  • 2000
  • Ingår i: Journal of Clinical Psychology. - 0021-9762 .- 1097-4679. ; 56:4, s. 475-490
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper presents a study of associations between psychiatric staff's habitual feelings towards their patients and the staff's self-image. At 22 psychiatric treatment homes for psychotic and other severely disturbed patients, 163 male and female staff recurrently rated their feelings towards the individual patients on a feeling checklist. At the beginning of the study period, they also rated different aspects of their self-image (the introject and the mother and father images) using Structural Analysis of Social Behavior (SASB). Over time and over patient, correlations between the individual staff ratings on the feeling checklist and ratings on the SASB were studied for all staff and for male and female staff separately. The analyses showed a number of associations between the staff's feelings and aspects of their self-image. Staff who habitually tended to feel helpful and autonomous towards their patients had a more positive image of mother, whereas staff who tended to feel more rejecting, unhelpful, and controlled had a combination of negative images of mother and father and a protecting introject. Some notable differences between male and female staff were found. Overall, self-image accounted for larger proportions of the male staff's feelings than of the female staff's. Negative feelings for male staff were associated more-with a critical father image, whereas for female staff these feelings were associated more with an image of the father as a freedom giving. (C) 2000 John Wiley and Sons, Inc.
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