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Forskningspresentationer

Vid föreningens Vetenskapliga program 18 november 2016 presenterades flera aktuella forskningsrapporter. Här kan du se presentationsbilder och en utförligare rapport från några av dem:

Presentationsbilder från föreläsningen:


Olavi Lindfors m fl: Jämförelse kort- och låntidspsykoterapi/analys i Finland

 

Andrzej Werbart: Empirisk psykoanalytisk process- och utfallsforskning är kliniskt relevant

 

Utförligare rapport
av Adrzej Werbarts forskningsprojekt: Empirisk psykoanalytisk process- och utfallsforskning är kliniskt relevant.

 

Forskning


Ett flertal forskningsprojekt bedrivs inom föreningen.
Korta sammanställningar av några av dessa projekt finns här.

 

Aleman, Kristian
Longitudinella studier av personlighetsdrag, prestationsbaserad självkänsla relaterat till utbrändhet.

Under många decennier i USA har man trott att olika program, terapier etc skulle höja självkänslan och leda till bättre hälsa hos folk som i sin tur skulle leda till färre sjukskrivningar, kriminalitet etc. Samtidigt var det också tänkt att människor med hög självkänsla skulle bidra med stabilare och bättre löner till samhället. I de senaste seriösa meta-analyser som gjorts där man evaluerar dessa fenomen i relation till objektiva fakta (t ex sjukskrivningar, löner, utbrändhet, psykiatriska diagnoser, arbetslöshet etc) visar det sig att ovanligt få fördelar faktiskt verifieras hos människor som på olika sätt skattas inneha hög självkänsla.
Utifrån amerikansk historia tror forskare att Kalvinism och meritokraci kan ha bidragit till att befolkningen måste bevisa sitt värde som individer i USA. Detta i sin tur kan leda till vad man skulle kunna översätta som "prestationsbaserad" självkänsla. Individen validerar sina olika egenskaper och kapaciteter i relation till, exempelvis, akademiska studier, hur man ter sig i sociala sammanhang, utseende, materialism, hög moral, och t o m status gör partner samt barn. Detta medför allvarliga konsekvenser, såsom; att man prioriterar bort vänner och landar i självupptagenhet (narcissism, även depression och ångesttillstånd) för att sträva efter självkänsla, svårigheter i inlärningsprocesser (vid hot om misslyckande vid kunskapsprövning, skyddar man sitt själv genom att undvika just den kunskap man är rädd att inte hantera), fysisk ohälsa tex hjärt- och kärlsjukdomar samt hjärnblödningar (pga förhöjt kortisolvärde vilket är ett stresshormon). Prestationsbaserad självkänsla transformeras ofta till ett slags missbruksbeteende där t ex relationer i sig inte fyller någon djupare mening, såvida den inte bekräftar det repetitiva strävandet efter självkänsla.
Just nu studerar vi, på avdelningen för klinisk neurovetenskap, sektionen för psykologi vid Karolinska sjukhuset, dessa strävanden efter självkänsla i relation till personlighetsdrag (Five Factor Model) samt till utbränningssyndrom (MBI) utifrån två kohorter (n= 1800). Resultat kommer att presenteras mellan 2011-2014.
 

Aleman, K, Hallsten, L., Rudman, A., & Gustavsson, P. (2011). Self-esteem strivings and its mediational role between neuroticism and burnout.

Aleman, K, Rudman, A., & Gustavsson, P. (2011). Performance-based self-esteem during university studies predicts educational outcome and occupational socialisation.

Eriksson, J.
Subjektivitet. En filosofisk undersökning av psykoanalysens ontologi, metodologi och etik.

I en tid som domineras av en naturvetenskaplig syn på människans psykiska liv har psykoanalysen som teori och klinisk behandlingsmetod blivit något av en anakronism som har svårt att legitimera sin existens och relevans. Syftet med mitt projekt är att filosofiskt profilera psykoanalysen genom att iscensätta en utförlig dialog mellan psykoanalysens grundtexter hos Freud och den transcendentala idealismens subjektsfilosofi. På så vis hoppas jag uppnå följande:
1. filosofiskt arbeta ut psykoanalysens ofta oartikulerade konception av vad det innebär att vara en psykisk varelse;
2. filosofiskt grunda psykoanalysens kliniska behandlingsmetod;
3. teckna psykoanalysens etiska grundhållning. Kort sagt: min förhoppning är att jag med hjälp av den transcendentala idealismens filosofi kring den mänskliga subjektiviteten skall lyckas arbete fram psykoanalysens ontologiska, metodologiska och etiska självförståelse. Därmed hoppas jag kunna reaktivera psykoanalysens radikalitet i dagens positivistiska klimat, ett klimat som kännetecknas av en bristande förståelse av det som gör människan till någonting annat än en psykofysisk entitet som är inlemmad i den naturliga ordningens kausalitet – hennes subjektivitet.

Hau, S & Jacobsson, G.

I psykoterapiforskning görs vanligtvis utfallsforskning för att undersöka terapiers effektstyrkor. Bara en liten del av förändringsvarians anses bero på t ex specifika terapeutiska teknik. Oklar är vilka förändringsprocesser som sker inom terapeuten och dess betydelse för psykoterapiers framgång.
I en forskargrupp på Psykologiska institutionen, Stockholms universitet bedriver Stephan Hau och Gunnel Jacobsson forskning kring hur en psykoterapeutisk självbild skapas. Vilka "ingredienser" finns med när en grundläggande identitet som terapeut utvecklas?
Att utbildas till psykoterapeut anses vara en komplex process i vilken  "klinisk kompetens" tillskrivs en stor betydelse. Hur förmedlas dessa kompetenser som oftast beskrivs som implicit kunskap? Väsentliga delar av denna tysta kunskap står inte i läroböcker men förmedlas genom handledning eller kliniska diskussioner. Tar psykolog- och psykoterapeututbildningarna tillräcklig hänsyn till förmedling av den kliniska kompetensen och hur ser konsistensen ut mellan de teoretiska och praktiska utbildningsdelarna?

Björn Salomonsson
Spädbarnsproblem – en behandlingsstudie

Att vara spädbarnsmamma är ofta fantastiskt. Men ibland tillstöter bekymmer. Barnet skriker, sover dåligt, vill inte äta eller verkar inte knyta an så bra. Ibland är mamma nedstämd eller ängslig. Allt detta färgar hur hon upplever att vara mamma. Kanske präglar det också hur babyn upplever tillvaron. På landets BVC:n görs stora insatser för att stödja mammor. Ibland behövs en extra terapeutisk insats. Många metoder finns, bland annat en utvecklad av en svensk barnpsykoanalytiker, Johan Norman. Metoden, ”mother-infant-psychoanalytic treatment” (MIP), har i en ”RCT” jämförts med vanlig BVC-behandling. RCT betyder Randomized Controlled Trial och innebär att mammorna och barnen, efter en ingående intervju och givet samtycke, lottas till endera MIP eller BVC.

Resultaten presenterades vid en disputation vid Karolinska Institutet i april 2010. MIP-behandlingarna bedrevs av analytiker knutna till Psykoanalytikernas Spädbarnsmottagning i Stockholm. De varade ungefär 20 sessioner under några månaders tid, medan BVC-behandlingarna följde vanliga svenska rutiner. Uppföljningsintervjun av de 80 mammorna och barnen efter ½ år visade följande: MIP gav signifikant bättre effekter på mammans depression och känslighet för barnens signaler liksom på hur deras relation tedde sig. Nästan signifikanta effekter på mammans stress visades till förmån för MIP. Kvalitativa bedömningar hade gjorts innan behandlingarna startade. Barnen indelades i dem som tedde sig påverkade av de aktuella problemen (skrikighet, problem med mat, sömn, anknytning, etc.) resp. dem som verkade opåverkade trots mammans oro. Mammorna indelades i dem som anade en egen roll i problemet (”Participators”) samt dem som kände sig övergivna och snarare sökte hjälp och praktiska råd (”Abandoned”). När man jämförde dessa gruppers resultat visade det sig att de påverkade barnen fick signifikant bättre resultat av MIP än av BVC. Samma gällde ”Participator”-mammagruppen.

Studien visade alltså att en relativt kort psykoterapeutisk insats för mor och baby kan ge gynnsamma resultat ½ år senare. Speciellt tycks påverkade spädbarn samt mammor som anar sin roll i problemet ha nytta av denna behandling.

Björn Salomonsson & Majlis Winberg Salomonsson
Tiden läker alla sår? – en uppföljning av spädbarnsstudien

I spädbarnsstudien fann man förändringar vad gällde modern och mor-barnrelationen. Det var däremot svårare att mäta eventuella förändringar hos barnet. Dessutom kan man anta att mätinstrumenten är mer tillförlitliga för äldre barn än för spädbarn. Eventuella skillnader mellan barn i MIP-gruppen och BVC-gruppen går därför troligen att visa först när barnet är äldre. I denna studie avser vi att träffa mammorna och barnen när barnen är 4½ år gamla. Då medelvärdet för barnens ålder vid behandlingsstart var 5 mån. har det i genomsnitt gått 4 år sedan behandlingarna startade. Nu har barnen flera uttrycksmöjligheter och ett tillräckligt stort ordförråd för att kunna delta vid undersökningar och testningar där instruktioner och språket är av betydelse. Dessutom kan man förvänta att de flesta barn nu kan skiljas från mamman och själva kommunicera med intervjuaren i ett separat rum.

Projektet syftar bl. a. till att besvara frågan hur behandlingarna MIP och BVC i tidiga småbarnsåren har påverkat den fortsatta utvecklingen hos mammor och barn.

Barnen bedöms i socialt, kognitivt och emotionellt avseende utifrån:
   • Mammans skattning av barnets funktion
   • Daghemspersonalens skattning av barnets funktion
   • Intervjuarens bedömning av barnets funktion

Mammorna bedöms utifrån
   • Anknytningsmönstret till barnet
   • Självskattad depression, stress och psykiska symptom

Mor-barn-samspelet bedöms utifrån ett videoinspelat samspel mellan mor-barn

Intervjun innefattar gemensamt möte med mor-barn, videoinspelat samspel samt enskilda intervjuer med modern respektive barnet. Datainsamlingen beräknas pågå oktober 2009 till juni 2012.

Sandell, R.
The Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP)

The purpose of the Stockholm Outcome of Psychotherapy and Psychoanalysis Project (STOPPP) is to follow-up and evaluate the long-term effects of psychoalysis in comparison with long-term psychodynamic psychotherapy. The patient sample consists of approx. 700 persons being subsidized for, at the longest, three years in psychoanalysis or psychotherapy or on the respective waitinglists for such subsidization. All have been referred by analysts or licensed psychotherapists after assessments of their need of, and suitability for, either kind of treatment. Outcome has been assessed in terms of symptoms, social relations, morale or existential attitudes, general health, health care consumption, working capacity etc., by qualitative interviews, self-report inventories, questionnaires, and/or official records.

Sandell, R. & Clinton, D.
"Vilken psykoterapi för vem? En studie av interaktionseffekter i psykoterapi".

Previous research has been unable to establish the relative efficacy of different methods of psychotherapy. This is difficult to explain given the extensive variation in therapy effect that is regularly found between patients receiving identical forms of treatment. Two hypotheses have been put forward to account for this paradox. Firstly, that there exists a common core of variables that characterise different methods of psychotherapy, thereby rendering distinctive therapeutic techniques relatively meaningless; and secondly, that significant interaction effects between person and treatment variables mask differential outcomes for divergent forms of psychotherapy. These hypotheses are reviewed and it is concluded that serious methodological shortcomings have characterised the limited amount of research in this field. The present research builds on previous work on the development of a valid and reliable measure of relevant interaction effects in psychotherapy. The aim of the present study is the prospective evaluation of interac-tion effects in psychotherapy. Using a randomised controlled design 180 patients are offered psychodynamic psychotherapy (PDT), cognitive therapy (CT), or cognitive behavioural therapy (CBT). Randomisation takes place in two steps. In the first step the group is split in two, where one group goes onto continued randomisation, and the other group is allowed free choice of psychotherapy method. In the second step method of treatment is randomly allocated to the former group. Psychotherapy is conducted in accordance with treatment manuals by supervised professional psychotherapists. Assessments take place at the start of treatment and subsequently after 6, 12, 24, 36 and 60 months. In order to increase the relevance of the study for both therapists and the health service, therapist participation in the study is coupled to a three year part-time university course in psychotherapy research.

Szecsödy, I.
"AHMOS-projektet" (Amsterdam, Helsinki, Milan, Oslo, Stockholm), en multicenter baserad psykoanalytisk process och effektforskning studie.

Syftet med projektet är att kunna urskilja och visa hur de för psykoanalysen specifika faktorer inverkar på process och utfall. Målsättningen är att vid de olika centra insamla och strukturera information från psykoanalytiker och analysander och använda bedömningsinstrument på ett liknande sätt innan, under och efter avslutad behandling för att kunna jämföra iakttagelserna om processen med iakttagelser av effekten. Ett fokus är att följa huruvida och hur analysandens "reflekterande funktion" förändras i samband med behandlingen.

Szecsödy, I.
Hur påverkar psykoanalytisk utbildning de utbildades kompetens och praxis - en deskriptiv, explorerande, hypotesskapande undersökning.

Den Internationella Psykoanalytiska Föreningens styrelse gav ett uppdrag till Committee on Psychoanalytic Education (COMPSED) att planera och genomföra ett studium om huruvida och hur påverkar psykoanalytisk utbildning (som bedrivs enligt något skilda modeller vid olika Psykoanalytiska Institut) sättet man utövar psykoanalytisk praxis. En sådan undersökning skulle vara den första i sitt slag och ansågs: "potentially extremely important because it asked an intriguing question: does analytic training effect analytic practice and other parameters of an analytic career?" En anledning att frågan ställs är, att man på olika håll i världen använder sig av olika utbildningsmodeller och som man tycks är mera beredd att försvara än kritiskt granska. Svenska Psykoanalytiska Institutet beslöt att försöka genomföra en förberedande pilotundersökning och söker intresserade att medverka i den.

Andrzej Werbart & Sonja Levander
Private theories of pathogenesis and cure: Patients in psychoanalysis and their analysts (PSA), 1997–2011.

Background: Concerning official psychoanalytic theories of therapeutic action, the current situation is characterized by the abundance of pluralism and lack of integration. Both patients in different kinds of treatment and their clinicians develop implicit, private theories of pathogenesis and cure.
Aim: To investigate vicissitudes of implicit ideas of how psychoanalysis might be of help with the analysands’ psychological problems, and how concordance and discordance between the participants interacts with the process of change.
Method: This prospective longitudinal study includs the total of 7 analyses. The Private Theories Interviews (PTI) with analysands and their psychoanalysts are conducted at the start of psychoanalysis, and then 6 months, 1.5 years, 3years, and 4.5 years after the first interview, at termination of the analysis, and 1.5 years post- termination. Transcripts are investigated by means of a serial case study methodology and inductive thematic analysis.
Results: Both utopian ideas and ideas of more attainable cure were found in both parties. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process in both participants in more than half of the cases. Utopian ideas often created feelings of incompatibility between the analyst and the analysand. The abandonment of these ideas was related to more positive experienced outcome of psychoanalysis. Furthermore, we found personality differences in analysands’ response to specific dimensions of the analytic process.
Conclusions: The study suggests that the psychoanalytic process might profit from the analyst’s observance of incongruities between the parties’ ideas and openness to work them through.
Financial support: The Bertil Wennborg Foundation and the Research Advisory Board, International Psychoanalytical Association.

Andrzej Werbart, David Forsström, et al.
Psychoanalysis in Public Service Setting (PPSS): Outcomes and individual patterns of change
Institute of Psychotherapy, Stockholm, and Department of Psychology, Stockholm University
1998–2012

Background: There are only few studies of psychoanalysis in public service settings.
Aim: To examine individual differences in outcome of psychoanalysis in a public setting.
Method: 26 patients in psychoanalysis and their 10 analysts at the Institute of Psychotherapy are included. Outcome measures included Symptom Checklist –90, Self-Rated Health, SASB, Sense of Coherence and socio-demographic data. The patients were interviewd at termination and 2-year follow-up sing the Change After Psychotherapy Interview (CHAP).
Results: Outcome data from a series of psychoanalyses conducted in a specialized public service setting are explored in-depth. Outcome data collected by different self-rating and expert-rating instruments are compared. In serial case studies we track the individual patterns of change in order to better understand how the patients benefited from psychoanalysis.
Financial support: The Research Advisory Board, International Psychoanalytical Association.

Andrzej Werbart, Lena Johansson, Peter Lilliengren, Björn Philips (doctoral project), et al.
Young Adult Psychotherapy Project (YAPP), 1998–2009.

Background: The evidence base in psychotherapy research can be enriched adopting a naturalistic stance and taking the patients’ view into account.
Aim: To study psychoanalytic psychotherapy with young adults from the viewpoints of outcome and patients’ ideas of cure, and how these two aspects are related to each other.
Method: 134 patients were included. Measures included Symptom Checklist –90, Self-Rated Health, GAF, IIP, SASB, Differentiation-Relatedness Scale and Helping Alliance. Ideas of cure were explored using the Private Theories Interview. Qualitative methods included ideal-type analysis and grounded theory.
Results: The patients were considerably more troubled than Swedish norm groups at intake. The patients showed improvement on all outcome measures at termination. The largest positive changes were with respect to the patients’ overall health and functioning. A majority of the patients had ideas of cure that were in line with psychoanalytic psychotherapy. Patients who terminated therapy prematurely were significantly closer to the ‘distancing’ pole regarding ideas of cure, while completers closer the ‘approaching’ pole. Tentative theoretical models of therapeutic action were construted, starting from the patients’ and the therapists’ perspective. The patients and therapists both stress the importance of establishing a special kind of relationship enabling the patients to talk openly about their inner experiences. However, both parties had incompatible, implicit theories regarding what the problem in therapy was and what was needed to change it.
Conclusions: The introductory sessions seem to be of vital importance in helping patients to engage in a potentially beneficial therapy.
Financial support: Söderström-Königska Nursing Home Foundation and the Bank of Sweden, Tercentenary Foundation.

Andrzej Werbart & Gunnel lacobsson
Young Adult’s Own Thinking, Understanding, and Managing of Everyday Life (YOUTH), 2000-2006.

YOUTH is a study of private explanatory systems and personal strategies, created by young adults (aged 18-25; non-clinical population) in confrontation with strains and challenges on the threshold of adulthood.

   • Part 1: Using case study methodology, both successful and non-adaptive strategies are
     investigated, as well as differences between women’s and man’s private theories about
     their difficulties and ways of managing strains and challenges in life. The material includes
     PTI-interviews with 24 young adults, as well as interviews, questionnaires, and rating scales
     used in YAPP. Data is collected at 3 points of time: at the baseline, 1.5 and 3 years later.
   • Part 2: A survey in a representative random sample of young adults in Stockholm (N=630).
     In this part of the research programme a Private Theories Questionnaire was constructed
     and tested.
   • Part 3: A pilot study of private theories constructed by young adults in narratives collected
     online on the Net.
One doctoral dissertation, one international publication, and 5 publications and reports in Swedish.

Andrzej Werbart, Camilla von Below et al.
Depression among young men and women in psychotherapy: patient perspective on own problems, medication and psychotherapy in relation to outcome, 2005-2009.

Background: Growing incidence of mental ill-health and depression among young adults, and women in particular, is reported in Sweden.
Aim: The first aim was a longitudinal follow-up of young adult psychotherapy patients with diagnoses within the depression spectrum. The the second aim was to explore patients’ experiences of overcoming depression.
Method: The material consisted of data collected in YAPP. Of the 87 diagnosed cases in YAPP, 23 patients (26%) had pre-treatment Mood Disorder diagnosis. Both quantitaive and qualitative methods were used.
Results: At termination, 45% 16 of patients still had a diagnosis of Mood Disorder, while 1.5 years later 20% had this diagnosis. The percentage of patients on medication remained unchanged. The patients significantly improved at termination and at 1.5 years follow-up in respect of self-reported symptoms, self-rated health, positive and negative aspects of self-concept, and the differentiation-relatedness of self and object representations.
Grounded theory analysis resulted in 15 distinct categories, organized into five general domains: experiences of positive change, in-therapy contributions to positive change, extra-therapeutic contributions to positive change, obstacles in therapy and negative experienced outcomes. Exploration of interplay between these domains resulted in a process model for the way out of depression. The positive changes experienced extended beyond symptom relief. The patients emphasised finding out how they wanted to live and how they started forming their lives in that direction. Obstacles in therapy interplayed with the experience of being stuck in depression.
Discussion: These findings are related to age-specific challenges on the threshold of adulthood.
Financial support: Bank of Sweden, Tercentenary Foundation, the Centre for Health Care Science, and the Clas Groschinsky Memorial Fund.

Andrzej Werbart, Camilla von Below, Annika Lindgren, Vendela Palmstierna, et al.
Patients’ view of helpful and hindering factors in psychoterapy in relation to longitudinal outcomes: Post-termination changes, 2007–2010.

Background and aim: There is a need of long-term follow-up of the effects of psychotherapy, as well as appplying the patient perspective on process and outcome.
Mathods: The material consists of quantitative and qualitative data collected in YAPP.
Results: All outcome measures changed significantly from intake to follow-up. Lower therapist-rated alliance predicted greater change in psychiatric suffering for patients reporting more psychiatric symptoms at intake. A qualitative study of changes in parental representations showed that most common descriptions of the parent were the emotionally or physically absent parent, and the parent with his or her own problems. Dissatisfied patients lacked confidence in their relationship to the therapist, felt unable to express their own feelings, lacked direction in therapy and wanted more response from the therapist. They felt abandoned by an insufficiently flexible therapist, a therapy lacking intensity, and links missing between therapy and everyday life. In the most successful therapies, helpful factors in therapy and in life reinforced each other in a positive feedback loop. In a growth-promoting and secure relationship the patients and the therapists could overcome obstacles to their collaboration. The patients obtained support in close relationships, could cope with strains in life and continued to apply therapeutic experiences after termination. The therapists experienced the therapeutic work in a strikingly similar way.
Conclusions: The long-term effectiveness of psychoanalytic psychotherapy for young adults was supported. Hypotheses were generated about the benefits of a therapist listening to the patient’s ideas and making interpretative interventions focusing on obstacles to the therapeutic work.
Financial support: Secretariate for Research and Development, Stockholm County Council.

Andrzej Werbart, and Peter Lilliengren (doctoral project)
Therapists’ view of helpful and hindering factors in psychoterapy with young adults, 2007–2010.

Background: Studying experienced therapists’ implicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations.
Aim and method: 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. The material consists of data collected in YAPP. Grounded theory methodology was used to construct a tentative model of therapeutic action based on the therapists’ implicit knowledge.
Results: 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.
Discussion: 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.
Financial support: Clas Groschinsky Memorial Fund and the Centre for Health Care Science, Karolinska Institutet.

 

 

Andrzej Werbart, Alexandra Billinghurst, Johan Schubert, et al.
Quality Assurance of Psychotherapy in Sweden (QAPS), 2007-2009.

Background: There is a need for various sources of evidence and research methods in order to build an empirical knowledge base applicable to routine psychotherapy practice.
Aim: To describe, follow up and evaluate the effectiveness of psychotherapy in public services in a standardized way.
Method: QAPS is a core battery of well-established theory-neutral instruments with on-line data entry. The patient questionnaire consists of socio-demographic data and the self-rating scales SRH, SCL-90, QOLI, HAQ and CSQ-8, and is administrated at the beginning, during and at the end of psychotherapy, and twice as follow-up. The psychotherapists fill in the questionnaire at the beginning and end of psychotherapy.
Results: QAPS is running from 2007. At present, 15 psychiatric, psychotherapeutic units and GP-units are involved in the project and the data base includes more than 1.500 patients and 320 therapists. QAPS offers great possibilities to extract different types of information from the database. This can be done by the psychotherapists regarding their patients, by the units as regards all patients at the unit there or the entire material. Questions which may be answered include: who is in psychotherapy, what types and forms of psychotherapy are practiced, how does the group of patients – and the treatment they get – change over time, what is the outcome of the various psychotherapies and how does it differ between treatments?
Discussion: First experiences from the implementation of the system in routine psychiatric care underline the clinical usefulness of monitoring patient progress and feedback to therapists.
Financial support: Stockholm County Council.

Andrzej Werbart, Lars Levin and Mo Wang
Which psychotherapy suits whom? A naturalistic study of interaction effects in psychotherapy in public servrice settings,. 2010-2012.

Background: Defining empirically supported treatments exclusively in terms of randomized controlled trials has numerous limitations.
Aim: This naturalistic study presents patient pre-treatment characteristics and compares outcomes for three psychotherapy types practised in psychiatric routine care. Further comparisons include patients who did not start psychotherapy after the initial assessment and patients who started their treatment, patients who discontinued and those who remained in treatment, as well as patient-initiated and therapist-initiated dropout.
Method: Data were collected over a 3-year period at 13 outpatient psychiatric care services participating in the online Quality Assurance of Psychotherapy in Sweden (QAPS) system. Of the 1,498 registered patients, 14% never started psychotherapy, 17% dropped out from treatment and 36% dropped out from data collection. Outcomes were studied for 180 patients who received CBT, PDT or integrative/eclectic psychotherapy.
Results: There were no significant differences in psychological pre-treatment distress between these three groups, and patients showed significant post-treatment improvements. There were no statistically significant differences in effectiveness between psychotherapy types. In ongoing studies, early predictors of non-starting and dicontinuation of treatment are identified, using advanced statistical methods.
Conclusions: Overall, the psychotherapy delivered by the Swedish public health services included in this study is effective for the majority of patients who complete treatment. The theoretically different psychotherapy approaches had equivalent outcomes. The observed variation in improvement size and type depended on the outcome measure, indicating that most patients may experience reduced symptoms through brief psychotherapy, but not necessarily an increased life satisfaction to the same extent.
Financial support: Stockholm County Council, Secretariate for Research and Development.

Peter Lilliengren (doctoral project) and Andrzej Werbart
Attachment to Therapist and Long-Term Changes after Psychoanalytic Psychotherapy with Young Adults, 2011–2014.

Background: According to Bowlby, the therapist ideally functions as an attachment figure for the patient, enabling safe affective exploration and corrective emotional experience in the therapeutic relationship. If a secure attachment is developed (Mallinckrodt, 2010) the patient is expected to experience the therapist as (i) a “secure base”, (ii) as “stronger and wiser”, (iii) as a “safe haven”, and the patient would also (iv) seek proximity to the therapist in times of distress and (v) experience separation anxiety in relation to breaks and termination. Further, insecure attachment to the therapist would be expected to be characterized by either deactivation (attachment behaviors and/or feelings are denied or generally toned down) or hyper activation (attachment behaviors and/or feelings are heightened or exaggerated).
Aim: To explore the mediating role of patients’ attachment to their therapists for the long-term outcome.
Method: In a first step, an observer rating scale for patient attachment to therapist is developed and used on interview material from YAPP. The aim of the scale is to enable measurement of patient attachment to therapist for studying mediation in long-term outcome in psychoanalytic psychotherapy with young adults.
Results: The scale is under construction.
Financial support: Vårstavi Foundation and Department of Psychology, Stockholm University.

Andrzej Werbart and Sverker Sikström, Lars-Göran Lundh, David Arvidsson
Quantifying semantic contents in therapy sessions in relation to treatment outcomes: Development of a new computational methodology in psychotherapy research, 2010–2014.

Background: Therapy sessions and outcome measures are to a large extent based on the verbal communication. Common methods for measuring and quantifying semantic content are based on pre-defined word-lists, ordered according to some theoretically anchored assumptions. Lack of theory-free computational methods has hampered scientific investigation of semantics as the cornerstone of the therapeutic process and outcome.
Aim: To develop and evaluate a new computational methodology for quantitative studies of the semantic content in therapy sessions and to relate the semantic content to outcomes.
Method: This large-scale program focuses on theory-free computational methods for collecting and analyzing semantic content of online-stored records of therapy sessions. It will results in a software program for analysis of the semantic in-therapy content, including summary and categorizing of the sessions, and prediction of various outcome variables.
Results: In a pilot study, young adults in psychotherapy were compared with an age-matched, non-clinical sample at three time points. Verbatim transcripts of descriptions of the self and parents were quantified in a semantic space constructed by Latent Semantic Analysis. In the psychotherapy group, all representations changed from baseline to follow-up, whereas no comparable changes could be observed in the comparison group. The semantic space method supports the hypothesis that long-term psychodynamic psychotherapy contributes to sustained change of affective-cognitive schemas of self and others.
Implementation: The proposed method will be implemented in clinical settings, where the intention is to enable monitoring and providing online feedback of the therapeutic progress.
Financial support: Applications for grants.

 

Spaf:s skriftserie

Spaf:s skriftserie har utkommit med elva nummer, det senaste "Depression i vår tid".

Spas skriftserie

Spas skriftserie gavs ut med tre nummer mellan 2004 och 2007.

Scandinavian Review

Huvudsyftet för The Scandinavian Psychoanalytic Review är att belysa utvecklingen av psykoanalys i Skandinavien och internationellt.

 

 

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