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  • 1. Aafjes-van Doorn, Katie
    et al.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Cooper, Angela
    McDonald, James
    Falkenström, Fredrik
    Patients’ Affective Processes Within Initial Experiential Dynamic Therapy Sessions2017In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 54, no 2, p. 175-183Article in journal (Refereed)
    Abstract [en]

    Research has indicated that patients’ in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients’ in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients’ adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients’ immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients’ in-session adaptive affect experiencing.

  • 2. Abbass, Allan
    et al.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Town, Joel
    On Paolo Migione's "What Does Brief Mean?"2014In: Journal of the American Psychoanalytic Association, ISSN 0003-0651, E-ISSN 1941-2460, Vol. 62, no 5, p. NP18-NP22Article in journal (Refereed)
  • 3. Abbass, Allan
    et al.
    Town, Joel
    Ogrodniczuk, John
    Joffres, Michel
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Intensive Short-Term Dynamic Psychotherapy Trial Therapy Effectiveness and Role of Unlocking the Unconscious2017In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 205, no 6, p. 453-457Article in journal (Refereed)
    Abstract [en]

    This study examined the effects of trial therapy interviews using intensive short-term dynamic psychotherapy with 500 mixed sample, tertiary center patients. Furthermore, we investigated whether the effect of trial therapy was larger for patients who had a major unlocking of the unconscious during the interview compared with those who did not. Outcome measures were the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP), measured at baseline and at 1-month follow-up. Significant outcome effects were observed for both the BSI and the IIP with small to moderate preeffect/posteffect sizes, Cohen's d = 0.52 and 0.23, respectively. Treatment effects were greater in patientswho had a major unlocking of the unconscious comparedwith thosewho did not. The trial therapy interview appears to be beneficial, and its effects may relate to certain therapeutic processes. Further controlled research is warranted.

  • 4. Bergsten, Katja
    Lindert, Patrik (Contributor)
    Pettersson, Kristoffer (Contributor)
    Hellquist, Linda (Contributor)
    Almebäck, Lasse (Contributor)
    Affektfokuserad psykodynamisk terapi: teori, empiri och praktik2015Collection (editor) (Other academic)
  • 5. Hesslow, Thomas
    et al.
    Nilsson, Maja
    Johansson, R.
    Färdig, S.
    Jansson, A.
    Jonsson, L.
    Karlsson, J.
    Hesser, H.
    Ljótsson, B.
    Frederick, R.J.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Linköpings universitet & Karolinska Institutet.
    Internet-delivered psychodynamic psychotherapy in the treatment of social anxiety disorder2015In: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii), Linköping: Linköping University Press , 2015, p. 12-12Conference paper (Other academic)
    Abstract [en]

    Social anxiety disorder is one of the most common mental health disorders. Effective treatments exist, but limited access and high costs causes many sufferers to remain untreated. As not all patients accept the CBTmodel of psychopathology, alternative treatments are desirable. We conducted two studies to help establish the efficacy of a psychodynamic model of guided self-help (IPDT). In the first study (N=72) participants were randomized to either ten weeks of IPDT or a waiting list control condition. Mixed-effects models revealed a significant difference at post-treatment in favor of the treatment condition on the primary outcome measure, LSAS-SR, with a large effect size. Rates of remission were comparable to recent face-to-face trials, and improvements were maintained at 6- and 12-month follow-ups. The second study was a pilot preference study where the control group in study 1 chose either IPDT (N=23) or ICBT (N=13). Both treatments led to moderate improvements. Notably, both groups suffered an exacerbation of interpersonal symptoms at 6-month follow-up. In summary, the results suggest that IPDT is effective in the treatment of social anxiety, with effect sizes in the same range as ICBT and face-to-face psychotherapy.

  • 6. Johansson, Robert
    et al.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Allt starkare forskningsstöd för Intensive Short-Term Dynamic Psychotherapy2015In: Psykologtidningen, ISSN 0280-9702, no 6, p. 28-31Article, review/survey (Other academic)
    Abstract [sv]

    Intensive Short-term Dynamic Psychotherapy, ISTDP, har god effekt för en bred patientgrupp. Men det finns behov av fler RCT-studier av hög kvalitet och vid fler diagnoser. Här ger psykologerna och forskarna Robert Johansson och Peter Lilliengren en beskrivning av ISTDP och redovisar det nuvarande forskningsläget på området.

  • 7.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Exploring therapeutic action in psychoanalytic psychotherapy: Attachment to therapist and change2014Doctoral 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. 

  • 8.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Falkenström, Fredrik
    Sandell, Rolf
    Risholm Mothander, Pia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults2015In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 62, no 1, p. 1-13Article in journal (Refereed)
    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.

  • 9.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Johansson, Robert
    Lindqvist, Karin
    Mechler, Jakob
    Andersson, Gerhard
    Efficacy of Experiential Dynamic Therapy for Psychiatric Conditions: a Meta-Analysis of Randomized Controlled Trials2016In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 53, no 1, p. 90-104Article in journal (Refereed)
    Abstract [en]

    Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic psychotherapy (STPP) that emphasizes patients’ in-session affective processing. To evaluate the efficacy of EDT for psychiatric conditions, we conducted a meta-analysis of randomized controlled trials. Twenty-eight studies published between 1978 and 2014 were included, encompassing 1,782 adult patients with mood, anxiety, personality, or mixed disorders. Across targeted outcome domains, medium-size between-groups effects (Cohen’s ds ranging from 0.39 to 0.65) favored EDT over inactive controls at posttreatment and in symptom measures at follow-up. We found no differences between EDT and active treatments (e.g., medication, cognitive–behavioral therapy, manualized supportive therapy) at posttreatment, but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect sizes, EDT was associated with large improvements in general psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09) and with small to moderate gains in the areas of interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant effects suggested continued improvement between posttreatment and follow-up. Heterogeneity in pre–post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating contemporary versions of EDT in specific psychiatric conditions are warranted.

  • 10.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Johansson, Robert
    Town, Joel M.
    Kisely, Steve
    Abbass, Allan
    Intensive Short-Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process-outcome study2017In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 24, no 6, p. 1313-1321Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to evaluate the clinical- and cost-effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for generalized anxiety disorder (GAD). We further aimed to examine if a key clinical process within the ISTDP framework, termed the level of mobilization of unprocessed complex emotions (MUCE), was related to outcome. The sample consisted of 215 adult patients (60.9% female) with GAD and comorbid conditions treated in a tertiary mental health outpatient setting. The patients were provided an average of 8.3 sessions of ISTDP delivered by 38 therapists. The level of MUCE in treatment was assessed from videotaped sessions by a rater blind to treatment outcome. Year-by-year healthcare costs were derived independently from government databases. Multilevel growth models indicated significant decreases in psychiatric symptoms and interpersonal problems during treatment. These gains were corroborated by reductions in healthcare costs that continued for 4years post-treatment reaching normal population means. Further, we found that the in-treatment level of MUCE was associated with larger treatment effects, underlining the significance of emotional experiencing and processing in the treatment of GAD. We conclude that ISTDP appears to reduce symptoms and costs associated with GAD and that the ISTDP framework may be useful for understanding key therapeutic processes in this challenging clinical population. Controlled studies of ISTDP for GAD are warranted.

  • 11.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults2010In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 47, no 4, p. 570-585Article in journal (Refereed)
    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.

  • 12.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Risholm Mothander, Pia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ekström, August
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sjögren, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ögren, Marie-Louise
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Patient attachment to therapist rating scale: development and psychometric properties2014In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 2, p. 184-201Article in journal (Refereed)
    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.

  • 13.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    A model of therapeutic action grounded in the patients’ view of curative and hindering factors in psychoanalytic psychotherapy2005In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 42, no 3, p. 324-339Article in journal (Refereed)
    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.

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