| 1. |
- Falkenström, Fredrik, et al.
(författare)
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Therapeutic Alliance Predicts Symptomatic Improvement Session by Session
- 2013
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Ingår i: Journal of counseling psychology. - : American Psychological Association. - 0022-0167 .- 1939-2168. ; 60:3, s. 317-328
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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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| 2. |
- Falkenström, Fredrik, et al.
(författare)
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Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement
- 2014
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Ingår i: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 24:2, s. 146-159
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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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| 3. |
- Falkenström, Fredrik, et al.
(författare)
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Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials
- 2013
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Ingår i: Journal of Clinical Psychiatry. - : Physicians Postgraduate Press. - 0160-6689 .- 1555-2101. ; 74:5, s. 482-491
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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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| 4. |
- Falkenström, Fredrik
(författare)
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Does psychotherapy for young adults in routine practice show similar results as therapy in randomized clinical trials?
- 2010
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Ingår i: Psychotherapy Research. - : Routledge. - 1050-3307 .- 1468-4381. ; 20:2, s. 181-192
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Tidskriftsartikel (refereegranskat)abstract
- Previous research indicates that patients treated with psychotherapy in the community do not stay in treatment long enough to achieve clinically significant change. Because the average patient seeking treatment at a community center may not be as informed and motivated for change as the average patient participating in a research trial, the authors compared outcome among all patients presenting to a mental health clinic (n=416) and a subgroup of patients who started psychotherapy at the same clinic (n=101). Outcome was assessing using the Symptom Checklist-90, Inventory of Interpersonal Problems, and Global Assessment of Functioning. Results confirmed that outcome among all patients seeking the centre was worse than in an average clinical trial. However, patients who started psychotherapy after assessment achieved results comparable to those in RCT studies.
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| 5. |
- 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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| 6. |
- Falkenström, Fredrik
(författare)
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Studying mindfulness in experienced meditators: A quasi-experimental approach
- 2010
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Ingår i: PERSONALITY AND INDIVIDUAL DIFFERENCES. - : Elsevier BV. - 0191-8869. ; 48:3, s. 305-310
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Tidskriftsartikel (refereegranskat)abstract
- Self-report measures were used to study mindfulness and well-being in experienced meditators in a quasi-experimental intervention study. Seventy-six experienced meditators were studied, 48 who were participating in an intensive meditation retreat in the Vipassana (insight meditation) tradition and 28 who did not. Retreat participants had scheduled meditation practice from early morning to late at night, and were encouraged to practice mindfulness throughout the whole day. The Kentucky Inventory of Mindfulness Skills (KIMS) and the Five Facet Mindfulness Questionnaire (FFMQ) were used to measure mindfulness, and the General Population version of the Clinical Outcomes in Routine Evaluation (GP-CORE) was used to measure well-being. Correlation analyses in the pre-intervention data showed that self-reported mindfulness was strongly related to well-being, with the exception for the observe subscale of FFMQ, Only the acceptance subscales were associated with meditation experience. Mindfulness increased after the retreat, but the increase was not significantly larger for retreat participants than for the control group. However. well-being increased more in the retreat group than the control group, and increase in mindfulness was associated with increase in well-being across both groups. Results are discussed in relation to previous research and methodological aspects.
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| 7. |
- 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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| 8. |
- Kullgard, Niclas, et al.
(författare)
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Reflective functioning in patients with obsessive–compulsive disorder (OCD) – preliminary findings of a comparison between reflective functioning (RF) in general and OCD-specific reflective functioning
- 2013
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Ingår i: Psychoanalytic Psychotherapy. - : Routledge. - 0266-8734 .- 1474-9734. ; 27:2, s. 154-169
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Tidskriftsartikel (refereegranskat)abstract
- Several scales for rating the reflective function (RF) in different psychiatric syndromes (symptom-specific reflective function [SRF]) have been developed. In this study, the validity of a rating instrument for measuring obsessive–compulsive disorder (OCD)-specific RF (OCD-SRF) was assessed. The study was conducted at two outpatient psychiatric facilities. A total of 18 women and 12 men were interviewed with adult attachment interview and the OCD–SRF interview. The patients also rated their symptoms on a self-rating scale (Yale-Brown Obsessive–Compulsive Scale [Y-BOCS]). The results indicated that there was a significant difference between the levels of RF in general and SRF. No correlations between Y-BOCS and RF or SRF were found. Illustrations of ratings are presented. The difference between RF and SRF, the relationship between SRF and symptom checklists, and a relational perspective on symptoms in OCD were discussed.
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| 9. |
- Lilja, Josefine, et al.
(författare)
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Observing as an Essential Facet of Mindfulness : A Comparison of FFMQ Patterns in Meditating and Non-Meditating Individuals
- 2013
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Ingår i: Mindfulness. - : Springer. - 1868-8527 .- 1868-8535. ; 4:3, s. 203-212
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Tidskriftsartikel (refereegranskat)abstract
- One of the most comprehensive measures of mindfulness is the Five Facet Mindfulness Questionnaire (FFMQ) with five factors-Observing, Describing, Acting with awareness, Non-judging, and Non-reactivity. Hierarchical confirmatory factor analyses, however, have suggested that only four of the FFMQ factors (i.e. all except Observing) were components of "an overall mindfulness construct"-which is puzzling because Observing represents a core aspect of all definitions of mindfulness. The purpose of the present study was to approach this problem by a person-oriented approach, focusing on patterns on the FFMQ scales, rather than linear associations between them. Data on the FFMQ were collected on 817 individuals. Cluster analysis according to the LICUR procedure was used to group these participants in 13 clusters, according to their profiles of scores on the five FFMQ scales. Of the participants, 325 were categorized as meditators and 317 as non-meditators. To test hypotheses about the relation between Observing and mindfulness (which we assumed should be higher among meditators), the meditators/non-meditators categorization was cross-tabulated with the FFMQ clusters. The results showed that all clusters in which meditators were over-represented had high scores on Observing, and all clusters in which meditators were under-represented had low scores on Observing-which supports the hypothesis that mindfulness is related to high levels of Observing. The relationship between Observing and Non-judging, however, was found to be more complex than expected. The results are discussed in terms of mindfulness seen as a multidimensional skill, which may develop differently in various subgroups of individuals.
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| 10. |
- Möller, Clara, et al.
(författare)
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Mentalizing in Young Offenders
- 2014
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Ingår i: Psychoanalytic psychology. - : American Psychological Association (APA). - 0736-9735 .- 1939-1331. ; 31:1, s. 84-99
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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)
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Emotional availability in psychotherapy : The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship
- 2014
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Ingår i: Psychotherapy Research. - : Informa UK Limited. - 1050-3307 .- 1468-4381. ; 24:1, s. 91-102
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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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