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Psychotherapy patients in mental health care:: attachment styles, interpersonal problems and therapy experiences
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mona Wilhelmsson Göstas, School of Health and Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden, mona.vilhelmsson gostas@orebroll.se Attachment styles are relevant to psychotherapy since they highlight the way a person handles interpersonal and emotional stress. This thesis aimed to examine how psychotherapy patients in the public mental health care system report attachment styles related to interpersonal problems and diagnosis before and after psychotherapy and to examine problems and changes and psychotherapy contract and process from patients’ experiences of cognitive behavioural oriented therapy (CBT) and psychodynamic oriented psychotherapy (PDT).

The studies are based on data from patients admitted to psychotherapy within the public psychiatric services in Örebro County Council. Studies I and IV were quantitative and used self-reports to examine attachment styles and interpersonal problems before and after psychotherapy. Studies II and III were qualitative interview studies examining patients experiences of problems, changes and psychotherapy process. The patients were diagnosed with mood disorders, anxiety disorders, adjustment disorders and personality disorders and reported insecure avoidant and anxious attachment styles that correlated positively with interpersonal problems when they started therapy. Psychotherapy with CBT or PDT enabled them to turn attachment styles into more secure ones and decrease interpersonal problems Patients aged between 26 and 39, patients who attended 11-25 sessions and patients diagnosed with a personality disorder reported greater changes in secure related attachment than others. Patients described their problems as emotions that could not be regulated, as cognitive disabilities and as problematic behaviours that implied a self-centredness. During the course of psychotherapy, the patients gained abilities to handle their problems. The perceived self-centeredness changed which increased their participation in their life-context.

Similarities across the therapy orientations showed that the creation of a new context was essential to pay full attention to the patient’s problems, and that the working method and cooperation with the psychotherapist made up a whole. To make the therapy effective, it is important to build up confidence in cooperation and secure base functions like offering predictability and shaping interventions according to the needs of the patient and their ability to use them.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2014. , 91 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 103
Keyword [en]
attachment styles, interpersonal problems, psychotherapy, psychiatric patients, qualitative analysis
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-33935ISBN: 978-91-7529-014-0 (print)OAI: oai:DiVA.org:oru-33935DiVA: diva2:699019
Public defence
2014-05-09, Hörsal C2, Campus USÖ, (Universitetssjukhuset), Södra Grev Rosengatan, 703 62 Örebro, 08:35 (Swedish)
Opponent
Supervisors
Available from: 2014-02-26 Created: 2014-02-26 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Self-reported anxious- and avoidant-related attachment correlated to interpersonal problems by patients starting psychotherapy
Open this publication in new window or tab >>Self-reported anxious- and avoidant-related attachment correlated to interpersonal problems by patients starting psychotherapy
2012 (English)In: E-Journal of Applied Psychology, ISSN 1832-7931, E-ISSN 1832-7931, Vol. 8, no 1, 9-17 p.Article in journal (Refereed) Published
Abstract [en]

Attachment theory is an encompassing theory for understanding human reactions to life stressors, such as loss and separation and interpersonal problems are common reasons for seeking psychotherapy. Psychotherapy may be an opportunity to revise insecure attachment and handle interpersonal problems. This study examined attachment styles and interpersonal problems in a clinical sample of psychotherapy patients (n =168) at the start of psychotherapy. The main aim was to study how self-reported attachment styles, measured by the Attachment Style Questionnaire (ASQ), correlated with interpersonal problems measured using the Inventory of Interpersonal Problems (IIP). Avoidant-related  and anxious-related  attachment scales correlated positively to the total IIP scores. Inconsistent with findings in nonclinical samples, specific interpersonal problems in the dominant and affiliative parts of the IIP correlated positively to both the anxious-related and the avoidant-related attachment scales. The findings imply that a challenge for the therapist, at the start of psychotherapy, is to balance providing security with encouraging exploration of feelings, thoughts, and behaviour in the patient’s interpersonal problems in current relationships. Exploring individual profiles of attachment styles helps to clarify motives in expressed interpersonal problems.

 

 

Place, publisher, year, edition, pages
Hawthorn, Australia: Swinburne University of Technology, Faculty of Health, Arts and Design, 2012
Keyword
Attachment style, interpersonal problems, patients, psychiatry, psychotherapy
National Category
Medical and Health Sciences Psychiatry
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-27143 (URN)10.7790/ejap.v8i1.261 (DOI)
Available from: 2013-02-02 Created: 2013-01-30 Last updated: 2017-12-06Bibliographically approved
2. Increased participation in the life context: a qualitative study of clients' experiences of problems and changes after psychotherapy
Open this publication in new window or tab >>Increased participation in the life context: a qualitative study of clients' experiences of problems and changes after psychotherapy
2012 (English)In: European Journal of Psychotherapy, ISSN 1364-2537, E-ISSN 1469-5901, Vol. 14, no 4, 365-380 p.Article in journal (Refereed) Published
Abstract [en]

People use psychotherapy in different ways depending on how they perceive their problems and themselves. Exploring a person’s experiences of problems and changes after psychotherapy is important for evaluating outcomes of therapies. Based on descriptions from people with recent experiences of psychotherapy, the aim of this study was to gain a deeper understanding of the participants’ problems before psychotherapy and of changes after psychotherapy. Fourteen participants  selected based on variations in age, gender, marital status, occupation, number of sessions and psychotherapy orientation (CBT and PDT), were interviewed after completing psychotherapy. A qualitative content analysis of the transcribed interviews was performed. Problems before psychotherapy showed a relationship between the categories overwhelming emotions, cognitive problems and problematic behaviours. The theme self-centredness captured the latent content of being so absorbed by problems that these prevent participation in the life context.  Descriptions of changes were summarized in the categories emotions became balanced, cognitive functioning became evident and possibility to influence one’s behaviour, overlapping the two therapy orientations. The themes awareness of self-agency and tools to handle problems expressed the understanding of the descriptions of changes which made an optimal participation in the person’s life context possible. No differences between therapy groups were found.

 

Place, publisher, year, edition, pages
Oxon, United Kingdom: Routledge, 2012
Keyword
Affect theory, clients, interviews, psychotherapy, psychotherapy outcome, qualitative content analysis
National Category
Medical and Health Sciences Psychiatry
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-27256 (URN)10.1080/13642537.2012.734498 (DOI)2-s2.0-84869890186 (Scopus ID)
Available from: 2013-02-02 Created: 2013-02-02 Last updated: 2017-12-06Bibliographically approved
3. ’Hard work’ in a new context: clients’ experiences of psychotherapy
Open this publication in new window or tab >>’Hard work’ in a new context: clients’ experiences of psychotherapy
2013 (English)In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 12, no 3, 340-357 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe and gain an understanding of clients’ experiences of psychotherapy contracts and processes in cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (PDT). Fourteen participants were interviewed after ending their psychotherapy. To get information richness they were selected with as great a variation as possible in relation to their life context. Qualitative content analysis was used to analyze the descriptions and the significance of the descriptions. Similarities between the two therapy orientations emerged throughout the informants’ experiences. These similarities were expressed in the two themes The creation of a new context and The working method and the cooperation with the psychotherapist made up a whole. The psychotherapy process was described as “hard work” in a new context, markedly different from the ordinary social context. From the informants’ perspective, the creation of a new context offered a possibility to give full attention, together with the psychotherapist, to oneself and to the problems one was grappling with. A salient feature was the informant’s responsibility for agreements in the psychotherapy contract, especially in relation to the number of sessions and the creation of cooperation with the therapist. Irrespective of therapy orientation the therapeutic techniques were described as inextricably linked to the cooperation with the psychotherapist. An implication for practice and research from these findings is to give more weight to the influence of cooperation in psychotherapy techniques, irrespective of therapy orientation. Another implication is an awareness that the client’s knowledge of her/his difficulties, needs and desire for change, capacity to make an effort and to assume responsibility always have to be highlighted and have an impact on the psychotherapy contract and process.

 

 

Place, publisher, year, edition, pages
Sage Publications, 2013
Keyword
Cognitive behavioural therapy, patients’ experiences, psychodynamic psychotherapy, qualitative research
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-27260 (URN)10.1177/1473325011431649 (DOI)000319563700007 ()2-s2.0-84877322293 (Scopus ID)
Available from: 2013-02-02 Created: 2013-02-02 Last updated: 2017-12-06Bibliographically approved
4. Changes in attachment styles and interpersonal problems after different forms of psychotherapy
Open this publication in new window or tab >>Changes in attachment styles and interpersonal problems after different forms of psychotherapy
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Attachment theorists and researchers have argued that psychotherapy may be an opportunity to revise insecure attachment styles, enabling more flexibility in interpersonal relationships. Attachment theory was developed to understand human reactions to life stressors, such as loss and separation. The term attachment style reflects a person’s most typical internal working models to seek proximity in relationships. This study examines whether self-reported attachment styles measured by the Attachment Style Questionnaire (ASQ) changed after a course of either cognitive behavioural (CBT) or psychodynamic oriented psychotherapy (PDT) in a clinical sample of psychotherapy patients (n= 111). One aim was to examine changes related to differences in gender, age, diagnoses, therapy method and number of sessions. Another aim was to examine whether changes correlated with changes in interpersonal problems measured by the Inventory of Interpersonal Problems (IIP). Results showed an increase in security in attachment styles that correlated with a decrease in interpersonal problems. No differences between therapy methods were found. The age group 26 to 39 reported greater security and less avoidance compared to patients over 40. Patients who attended between 11 and 25 sessions scored higher as regards security compared to those with 1-10 sessions but there was no difference for those with more than 25 sessions. The study supports results from a few other studies that psychotherapy increases the attachment-related security of patients. As an increase in security is associated with a decrease in interpersonal problems, attachment styles can be perceived as mediating factors in psychotherapy outcome irrespective of psychotherapy orientation.

Keyword
Attachment styles, interpersonal problems, psychotherapy outcome, therapeutic alliance
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-34002 (URN)
Available from: 2014-02-28 Created: 2014-02-28 Last updated: 2017-10-17Bibliographically approved

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