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  • 1.
    Dennhag, Inga
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Learning psychotherapy: An effectiveness study of clients and therapists2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Many psychotherapy studies with trainees have been conducted, but few have investigated how effective baseline trainee-led psychotherapies are. Baseline trainee-led psychotherapies are often provided by a professional education, and the therapists are often young, untrained and inexperienced. The present study was conducted at the Clinical Psychology Program at Umeå University, in Sweden. The psychology students were in their fourth or fifth year of, in total, five years, and few had practiced therapy before. Clients, students and education providers are interested in the outcome of trainee-led psychotherapies because clients want an effective treatment, and students and the educators want the best education. In research, there is an interest in knowing more about training, how training influences clients’ benefits of therapy, and how training works in regular activity. In the present thesis, we investigate questions related to outcome and how different training factors affect outcome. The overall purpose of the present thesis was to examine 1) the effectiveness of trainee-led therapies in a psychology education setting and 2) if clients’ self-image patterns would predict the outcome 3) if different training conditions covary with treatment outcome 4) how novices develop in their professional characteristics and work involvement styles.

    Methods and Result The current thesis utilized data from the Swedish naturalistic study Effects of Student Therapies (EUT) at Umeå University. The EUT is a naturalistic psychotherapist research project, which comprises client data from 2003 to 2012. The present study included 235 clients. The mean age of the clients was 31 years (SD = 9.66), and 69% of the clients were women. The clients had mixed psychological symptoms and were well functioning. Psychological symptoms were measured by Symptom Check List 90 (SCL-90; Derogatis, Lipman, & Covi, 1973). The patients’ self-image was measured using the Structural Analysis of Social Behavior (SASB), the introject questionnaire (Benjamin, 1974). All therapists were students at the psychology program. In Paper III, 76 therapists participated. The therapists’ mean age was 28 years (SD = 5.55), and 71% of the therapists were women. Therapists’ professional characteristics and work involvement styles were measured by Development of Psychotherapists’ Common Core Questionnaire (DPCCQ; Orlinsky et al., 1999).

    Four specific objectives have been addressed. The first objective was to investigate the overall effectiveness of treatment. In Papers I and II, the effect sizes implicated that the therapy outcome was moderate. Paper I showed that 67% of the clients were in the dysfunctional domain before therapy compared to 34% after completed therapy. Further in Paper I, it was found that 42% of the clients had recovered or improved at the end of the therapy, but most of the clients remained unchanged (55%) and a few percent had deteriorated (3%). This result is in line with a Norwegian training study (Ryum, Stiles & Vogel, 2007) but less effective than effectiveness studies have shown with professional therapists (e.g. Hunsley & Lee, 2007). Paper II, where we used a subsample of Paper I’s clients, showed a similar result.

    The second objective was to investigate if clients’ self-image pattern (attachment group, disrupted attachment group, self-control and self-autonomy) predicted change in psychological symptoms (GSI: global severity index) and personality symptoms (PSI: personality symptom index). The disrupted attachment group or the clients’ negative self-image had the strongest relationship to outcome and explained 8% vs. 10% in outcome (PSI vs. GSI). Self-control explained a further 3% (GSI) and 4% (PSI) of the result, and self-autonomy added 1% in both GSI and PSI. The result indicates that clients with an increased negative self-image, higher self-control, and lower level of self-autonomy before therapy improve more in both psychological symptoms and personality symptoms than clients with a less negative self-image, lower self-control, and higher level of self-autonomy.

    The third objective was to explore if treatment duration (one or two semesters) and training condition (cognitive therapy and psychodynamic therapy) could affect basic psychotherapy outcome. Paper II demonstrated that clients in all training conditions, cognitive therapy two semesters (CT2), psychodynamic therapy one semester (PDT1) and psychodynamic therapy two semesters (PDT2), had significant changes in self-image patterns and symptoms, except for cognitive therapy one semester (CT1). Analyses using clinically significant change demonstrated that fewer clients in CT1 had recovered and reliably improved compared to the other training conditions (in CT1: 20- 23%, in PDT1: 27- 43%, in CT2: 49- 54% and in PDT2: 35- 41%). Two hierarchical multiple regression analyses demonstrated that clients’ pre-tests characteristics self-image pattern (affiliation: AFF) and psychological symptoms (global severity index: GSI) explained 34% of the results. Treatment duration and training condition demonstrated an interaction effect between duration and theoretical approach, explaining about 2%. The regression lines for self-image pattern AFF and psychological symptoms GSI showed that clients in CT2 and PDT1 improved more than clients receiving CT1 and PDT2.

    The fourth objective was to examine how novice therapists in psychotherapy training develop in professional characteristics and work involvement styles (healing and stressful work involvement styles). The study was longitudinal and therapists were measured at session 2, 8, 16, 22 and endpoint. Mixed model analyses of the Development of Psychotherapists’ Common Core Questionnaire (DPCCQ) (when controlled for therapists’ age and gender) showed that the therapists’ professional characteristics and work involvement styles changed positively over time in training, except for in-session feelings of anxiety and boredom. The therapists increased most in technical expertise and less in basic relational skill. The result also indicated that the students changed linearly over time.

    Conclusion The present studies draw attention to the moderate outcome for clients in trainee-led psychotherapy. The novices appear to need time to increase in effectiveness possibly due to the high load of technical training in the beginning of the therapy. However, when exploring different training durations and training conditions, the contexts are shown to influence the outcome. In addition, clients with a more negative self-image pattern, with higher levels of self-control and lower levels of self-autonomy had better outcome, a finding with prognostic value. Finally, the training of students improves both a healing and a stressful involvement style, but in-session feelings of anxiety and boredom are more resistant to change.

  • 2.
    Dennhag, Inga
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Makt och psykoterapi2017Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Status och makt påverkar hur vi pratar och förhåller oss till varandra. Några kända makthierarkier handlar om kön, klass, etnicitet, ålder och funktionsnedsättning. Dessa utspelar sig i alla relationella sammanhang – även i psykoterapi.

    Relationen mellan klient och terapeut är inte jämlik. Terapeuten har mer makt utifrån sin utbildning och anställning, medan klienten ofta är i kris eller har svårigheter och är i behov av den hjälp som terapeuten kan erbjuda. Vilka former av makt kan gestalta sig i samtalet och hur kan makten påverka psykoterapin?

    Den här boken vill bidra till ökad förståelse för vad makt är, hur den yttrar sig i psykoterapi och hur makt kan utjämnas. Vinsterna med maktutjämning är många. Det kan stärka alliansen och samarbetet mellan klient och terapeut, göra terapeuten mer träffsäker i sina bedömningar, vara en hjälp i att anpassa behandlingsupplägget – och därmed bidra till färre avhopp och ett bättre utfall av terapin.

    Författaren undersöker och ger kunskap om jämställdhet, mångfald, fördomar och normer. Här finns också fördjupande kapitel om genus/kön, sexualitet, allians, språk och kommunikation, samt fallexempel med maktanalyser. De teoretiska verktyg som genomsyrar innehållet är kulturpsykologi, intersektionalitet och normkritik. Författaren visar också hur dessa perspektiv kan införlivas i en fallkonceptualisering i KBT med maktperspektiv. Till varje kapitel finns reflektionsfrågor och övningar som hjälper läsaren att öka sin medvetenhet om makt och att omsätta kunskapen i praktisk handling.

    Boken vänder sig till psykolog- och psykoterapistuderande samt till yrkesverksamma psykologer, psykoterapeuter, psykiatri- och vårdpersonal.

  • 3.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Baseline training in cognitive and psychodynamic psychotherapy during a psychologist training program: Exploring client outcomes in therapies of one or two semesters2012In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 22, no 5, p. 515-526Article in journal (Refereed)
    Abstract [en]

    This effectiveness study explored the outcomes of 187 clients seen by 187 students undergoing baseline training in psychotherapy. Clients reduced their symptoms (SCL-90) and increased their positive self-image (SASB introject) during the therapy. Multiple regression analyses showed no differences between the cognitive and the psychodynamic training approaches and no differences between one and two semesters duration of the therapies. However, 2 - 3% of variance in end states was accounted for by the interaction between the variables, indicating a moderating effect of duration in the two approaches. Outcomes for clients in the cognitive training approach were significantly better with two semesters than with one semester, while there was no such difference in the psychodynamic approach. Consequences for baseline training are discussed.

  • 4.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Connolly Gibbons, Mary Beth
    Center for Psychotherapy Research, Department of Psyhiatry, University of Pennsylvania, Philadelphuia, USA.
    Barber, Jacques P.
    Center for Psychotherapy Research, Department of Psyhiatry, University of Pennsylvania, Philadelphuia, USA.
    Gallop, Robert
    Statistics and Applied Mrthematics, West Chester University, West Chester, USA.
    Crits-Christoph, Paul
    Center for Psychotherapy Research, Department of Psyhiatry, University of Pennsylvania, Philadelphuia, USA.
    How many treatment sessions and patients are needed to create a stable score of adherence and competence in the treatment of cocaine dependence?2012In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 22, no 4, p. 475-488Article in journal (Refereed)
    Abstract [en]

    The study utilized a generalizability theory analysis of adherence and competence ratings to evaluate the number of sessions and patients needed to yield dependable scores at the patient and therapist levels. Independent judges' ratings of supportive expressive therapy (n = 94), cognitive therapy (n = 103), and individual drug counseling (n = 98) were obtained on tapes of sessions from the NIDA Collaborative Cocaine Treatment Study. Generalizability coefficients revealed that, for all three treatments, ratings made on approximately five to 10 sessions per patient are needed to achieve sufficient dependability at the patient level. At the therapist level, four to 14 patients need to be evaluated (depending on the modality), to yield dependable scores. Many studies today use fewer numbers.

  • 5.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Connolly Gibson, Mary Beth
    Center for Psychotherapy research, University of Pennsylvania, Philadelphia, USA.
    Barber, Jacques P.
    Center for Psychotherapy research, University of Pennsylvania, Philadelphia, USA.
    Gallop, Robert
    Statistics and Applied Mathematics, West Chester University, West Chester, USA.
    Crits-Christoph, Paul
    Center for Psychotherapy research, University of Pennsylvania, Philadelphia, USA.
    Do supervisors and independent judges agree on evaluations of therapist adherence and competence in the treatment of cocaine dependence?2012In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 22, no 6, p. 720-730Article in journal (Refereed)
  • 6.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Henje, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Parental caregiver burden and recovery of adolescent anorexia nervosa after multi-family therapy2019In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, p. 1-17Article in journal (Refereed)
    Abstract [en]

    This study investigated whether parental caregiving burden changed during adjunct multi-family therapy of adolescent anorexia nervosa and eating disorders not otherwise specified (EDNOS) and whether caregiver burden at baseline and changes in caregiver burden during treatment were associated with treatment outcome.

    Twenty-four females, 13 to 16 years old, and their parents, participated in the study. Caregiver burden was measured with the Eating Disorders Symptom Impact Scale, by mothers (n = 23) and fathers (n = 22). Treatment outcome was measured by adolescent body mass index, level of global functioning and self-rated eating disorder symptoms by the Eating Disorders Examination Questionnaire 4.0.

    All patient outcomes improved and overall caregiver burden decreased significantly during treatment. When broken down in aspects of caregiver burden the decrease in parental perceived isolation, was found to be associated with improvement of BMI and Children's Global Assessment Scale. When analyzing fathers and mothers separately, we found that maternal feelings of guilt and paternal perceived burden of dysregulated behaviors at base-line were correlated to treatment outcome. Future studies are needed to clarify the role of caregiver burden as a potential mediator of treatment results.

  • 7.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Steinvall, Anders
    Umeå University, Faculty of Arts, Department of language studies.
    Hakelind, Camilla
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Deutschmann, Mats
    School of Humanities, Education and Social Sciences, Örebro University, Sweden.
    Exploring gender stereotypes about interpersonal behavior and personality factors using digital matched-guise techniques2019In: Social behavior and personality, ISSN 0301-2212, E-ISSN 1179-6391, Vol. 47, no 8, article id e8150Article in journal (Refereed)
    Abstract [en]

    The current study explores gender stereotypes among Swedish university students (n=101) studying a course in psychology, using a matched-guise experimental design. The gender identity of a speaker in a dialogue, manifested by voice, was digitally manipulated to sound male or female. Responses to the recordings indicated that an actor with a male voice was rated significantly less conscientious, agreeable, extraverted, and open to experience than the same actor with a female voice. On social behavior, there was a tendency for the actor with a male voice to be rated as more hostile than the same actor with a female voice. The study suggests that stereotype effects rather than real behavioral differences may have an impact on perceived gender differences.

  • 8.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Ybrandt, Helene
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Novice psychotherapists’ development in professional characteristics and work involvement styles in trainingManuscript (preprint) (Other academic)
    Abstract [en]

    Information about how psychotherapists develop their professional characteristics and work involvement styles during training is scant; in addition, awareness of the need to find answers to how psychotherapy training can best be organized is increasing. This study investigated novice therapists’ development of healing and stressful work involvement in baseline psychotherapy education in Sweden. Undergraduate students (n = 76) provided information longitudinally by responding to the Development of Psychotherapists Common Core Questionnaire (DPCCQ). The results demonstrated that therapists’ healing and stressful work involvement, current therapeutic skills, perceived difficulties, and constructive coping strategies changed positively and linearly. Technical expertise changed the most, having a large effect, and relational skills developed moderately. Surprisingly, in-session feelings of anxiety and boredom did not change. The process of positive and linear development of in-session feelings is important in psychotherapy education. The question becomes how the training should address trainees’ personal issues or countertransference that might affect in-session feelings.

  • 9.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Ybrandt, Helene
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Trainee Psychotherapists' Development in Self-Rated Professional Qualities in Training2013In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 50, no 2, p. 158-166Article in journal (Refereed)
    Abstract [en]

    This study investigated changes in trainees’ self-rated experience as a therapist over the course of one practicum treatment case in basic psychotherapy education in Sweden. Undergraduate students (n = 76) provided longitudinal information on their healing involvement and stressful work involvement. The results of the Development of Psychotherapists Common Core Questionnaire (DPCCQ) demonstrated that trainees’ basic relational skills, technical skills, perceived difficulties, and constructive coping strategies changed linearly, with an increasing slope. Technical expertise changed the most, and relational skills developed moderately. In-session feelings of anxiety and boredom did not change. The individualized reliable change scores show that the process during training is different for different students. Most students did not change at all, and some students even changed negatively. Investigation of how pedagogic variables affect therapists’ development is necessary to support the professional growth of trainees in their involvement with different types of psychotherapy.

  • 10.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Ybrandt, Helene
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Utbildningsterapeuters utveckling av allians och terapeutförmågor: en longitudinell studie2015In: Tidskriften psykoterapi, ISSN 2001-5836, no 3, p. 38-41Article in journal (Other (popular science, discussion, etc.))
  • 11.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Ybrandt, Helene
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Kerstin
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Self-image pattern as predictors of change and outcome of trainee-led psychotherapy2011In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 21, no 2, p. 201-209Article in journal (Refereed)
    Abstract [en]

    This study investigated the outcome of undergraduate trainee-led psychotherapy and how different self-image patterns explain symptom change. Pre- and post-treatment data from 235 Swedish outpatients were used. Clients were assessed with Symptom Checklist-90 (SCL-90) and the Structural Analysis of Social Behavior (SASB). Outcome effect size was moderate and in line with earlier studies on trainees. Clinical significant change showed that 42% of all clients were recovered or improved after 18 sessions in either training condition PDT or CBT. Regression analysis showed that a more negative self-image and higher levels of self-control before treatment predicted improvement in both psychiatric symptoms and personality factors. A negative self-image, when observed before treatment, can be understood as an increased motivation for change.

  • 12.
    Dennhag, Inga
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Ybrandt, Helene
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundström, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    The relationship between clients' personality traits, working alliance and therapy2017In: Current Issues in Personality Psychology, ISSN 2353-4192, Vol. 5Article in journal (Refereed)
    Abstract [en]

    Objectives: This study investigated the relationships between client personality traits, and changes in those traits after cognitive behavioral or psychodynamic short-term therapy, and clients' perceived working alliances with their therapists and their clinical outcomes at a university training clinic in Sweden.

    Design: This was a longitudinal study, with the measures collected at pre- and post-therapy.

    Methods: The sample consisted of 138 clients with moderate psychological symptoms. Personality traits were measured using the Health-Relevant Personality Inventory, a health-relevant instrument that measures five factors.

    Results: The results showed that Antagonism, Impulsivity, Hedonic Capacity, and Negative Affectivity improved significantly during therapy, while Alexithymia did not. Pre-therapy personality traits were not related to perceived working alliances (as measured by the Working Alliance Inventory) or therapeutic outcomes (as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure). Post-therapy personality traits negative affectivity, hedonic capacity and alexithymia were related to working alliance, and changes in personality traits were predictive of therapy outcome. The change in Hedonic Capacity and Negative Affectivity explained about 20% of the variance in post-therapy symptoms after controlling for pre-therapy symptoms.

    Conclusions: The results suggest that therapeutic foci on hedonism (extraversion) and negative affectivity (neuroticism) could be important for working alliance formation and symptom reduction in therapy. Future research should examine whether changes in clients' negative affectivity or hedonic capacity mediates the relation between perceived working alliance quality and clinical outcome in training and other psychotherapeutic contexts.

  • 13.
    Svartvatten, Natalie
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Segerlund, Mattias
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Dennhag, Inga
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    A content analysis of client e-mails in guided internet-based cognitive behavior therapy for depression2015In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 2, p. 121-127Article in journal (Refereed)
    Abstract [en]

    The relationship between what a client writes when communicating with an online therapist and treatment outcome in internet-based cognitive behavior therapy (ICBT) is largely unknown. The aim of this study was to address if written correspondence from the client to the therapist correlates with outcome and treatment completion. A total of 29 participants with mild to moderate depression were included from an ongoing randomized controlled trial targeting depression. Content analysis involving ten categories was performed on all emails and module responses sent by the participants to their internet therapist. A total of 3756 meaning units were identified and coded. Significant positive correlations were found between change in depression and statements in the two categories “observing positive consequences” (r = .49) and “alliance” (r = .42). Treatment module completion correlated with seven categories. The result suggests that text dealing with alliance and observing positive consequences can be used as indicators of how the treatment is progressing. This study suggests that written correspondence from an online client can be divided into ten categories and the frequency of those can be used by internet therapists to individualize treatment and perhaps make ICBT more effective.

1 - 13 of 13
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