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Exploring therapeutic action in psychoanalytic psychotherapy: Attachment to therapist and change
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore therapeutic action in psychoanalytic psychotherapy from different perspectives (patient, therapist, observer), using different methodological approaches (qualitative and quantitative). Study I explores patients’ views of therapeutic action with grounded theory methodology. The results indicated that talking openly in a safe therapeutic relationship led to new relational experiences and expanding self-awareness. Hindering factors included difficulties “opening up” and experiencing something missing in treatment. Study II investigates experienced therapists’ views of therapeutic action. The development of a close and trusting relationship was perceived as the core curative factor. Patients’ fear of closeness hindered treatment from the therapists’ perspective. Study III involves the development and psychometric examination of a new rating scale for patient-therapist attachment (Patient Attachment to Therapist Rating Scale; PAT-RS). Inter-rater reliability was good for three of the subscales (Security, Deactivation, Disorganization), but poor for one (Hyperactivation). Patterns of correlations with other measures suggest construct validity for the reliable subscales. Study IV examines the relationships between secure attachment to therapist, alliance, and outcome. Linear mixed-effects models, controlling for therapist effects, treatment length and patient-rated alliance, indicated that secure attachment to therapist relates to outcome. Further, the unique variance associated with secure attachment to therapist predicted continued gains in functioning during follow-up. The results of this thesis suggest that the development of a secure attachment to the therapist is a central mechanism of therapeutic change. The results are discussed in relation to established notions of therapeutic action in psychoanalytic psychotherapy. Two tentative process models that may be useful for clinical practice and future research are proposed. 

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University , 2014. , 73 p.
Keyword [en]
Therapeutic action, mechanisms of change, psychoanalytic, psychodynamic, psychotherapy, young adults, attachment to therapist, therapeutic alliance, process, outcome, grounded theory, linear mixed models
National Category
Applied Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-106501ISBN: 978-91-7447-988-1OAI: oai:DiVA.org:su-106501DiVA: diva2:753745
Public defence
2014-11-21, David Magnussonsalen (U31), Frescati hagväg 8, Stocksholm, 13:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Epub ahead of print.

Available from: 2014-10-30 Created: 2014-08-08 Last updated: 2014-11-21Bibliographically approved
List of papers
1. A model of therapeutic action grounded in the patients’ view of curative and hindering factors in psychoanalytic psychotherapy
Open this publication in new window or tab >>A model of therapeutic action grounded in the patients’ view of curative and hindering factors in psychoanalytic psychotherapy
2005 (English)In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 42, no 3, 324-339 p.Article in journal (Refereed) Published
Abstract [en]

The patients’ view of curative and hindering factors in psychoanalytic psychotherapy was explored, starting from conducting the Private Theories Interview with 22 young adult patients at termination of their therapies. A tentative theoretical model of therapeutic action was constructed using grounded theory methodology.Talking About Oneself, Having a Special Place and Relationship, and Exploring Together With the Therapist were perceived as curative factors by the patients, leading to therapeutic impacts such as New Relational Experiences and Expanding Self-Awareness. Hindering aspects included experiencing that Talking Is Difficult and that Something Was Missing in therapy, interacting with negative impacts such as Self-Knowledge Is Not Enough and Experiencing Mismatch. Methodological issues, the question of common versus specific factors, and implications for clinical practice are discussed.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2005
Keyword
psychoanalytic psychotherapy, patients’ view, curative and hindering factors, therapeutic action, grounded theory [I]t
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-106286 (URN)10.1037/0033-3204.42.3.324 (DOI)
Available from: 2014-07-31 Created: 2014-07-31 Last updated: 2014-10-09Bibliographically approved
2. Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults
Open this publication in new window or tab >>Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults
2010 (English)In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 47, no 4, 570-585 p.Article in journal (Refereed) Published
Abstract [en]

Studying experienced therapists' implicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations. In this study, 16 therapists' views of curative factors, hindering factors, and outcome were explored in 22 interviews conducted at termination of individual psychoanalytic psychotherapy with young adults. Grounded theory methodology was used to construct a tentative model of therapeutic action based on the therapists' implicit knowledge. The results indicated that developing a close, safe and trusting relationship was viewed as the core curative factor in interaction with the patient making positive experiences outside the therapy setting and the therapist challenging and developing the patient's thinking about the self. The therapeutic process was experienced as a joint activity resulting in the patient becoming a subject and acquiring an increasing capacity to think and process problems. The patient's fear about close relationships was seen as hindering treatment and leading to core problems remaining. The model is discussed in relation to major theories of therapeutic action in the psychoanalytic discourse and previous research focusing on young adults' view of curative and hindering factors in psychotherapy. Implications for practice and further research are suggested.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2010
Keyword
psychoanalytic psychotherapy, therapeutic action, young adults, curative and hindering factors, grounded theory
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-106287 (URN)10.1037/a0021179 (DOI)
Available from: 2014-07-31 Created: 2014-07-31 Last updated: 2014-10-09Bibliographically approved
3. Patient attachment to therapist rating scale: development and psychometric properties
Open this publication in new window or tab >>Patient attachment to therapist rating scale: development and psychometric properties
Show others...
2014 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 2, 184-201 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To report on the development and initial psychometric properties of a new rating scale for patent-therapist attachment. Method: Seventy interviews from the Young Adult Psychotherapy Project (YAPP) were rated. Results: Excellent internal consistency (Cronbach's > .90) was observed for all four subscales (Security, Deactivation, Hyperactivation, and Disorganization). Three subscales showed good inter-rater reliability (ICC > .60), while one (Hyperactivation) had poor (ICC < .40). Correlations with measures of alliance, mental representations, and symptom distress support the construct validity of the reliable subscales. Exploratory factor analysis indicated three underlying factors explaining 82% of the variance. Conclusions: The Patient Attachment to Therapist Rating Scale is a promising approach for assessing the quality of attachment to therapist from patient narratives. Future development should focus on improving the discrimination of the insecure subscales.

Keyword
attachment to therapist, rating scale, reliability, construct validity
National Category
Psychology
Identifiers
urn:nbn:se:su:diva-101475 (URN)10.1080/10503307.2013.867462 (DOI)000330690800006 ()
Note

AuthorCount:6;

Available from: 2014-03-13 Created: 2014-03-10 Last updated: 2014-10-09Bibliographically approved
4. Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults
Open this publication in new window or tab >>Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults
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2015 (English)In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 62, no 1, 1-13 p.Article in journal (Refereed) Published
Abstract [en]

Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning whereas the alliance predicted deterioration when both variables were modeled together. While limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of post-treatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

Keyword
attachment to therapist, therapeutic alliance, outcome, psychoanalytic, psychodynamic, psychotherapy, young adults
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-106500 (URN)10.1037/cou0000044 (DOI)000348049200001 ()
Available from: 2014-08-08 Created: 2014-08-08 Last updated: 2015-02-16Bibliographically approved

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