This article presents a qualitative research interview method informed by psychoanalysis, which can collect data beyond the subjective report of the participants. The method has been used to study acquisition of psychodynamic understanding and therapy technique among student therapists in psychology. Within the psychodynamic tradition, the subjective report of every person is viewed as potentially distorted by defense processes. Moreover, relational patterns in an interaction are viewed as significant data about the intrapsychic object relations of a person provided that the person is placed in a projective situation. Since common qualitative interview methods focus primarily on verbal data, such psychodynamic assumptions represent a methodological challenge. To collect a wider scope of data than merely the subjective report, a research interview has been developed based on a certain degree of projection, a psychoanalytic listening perspective, and the use of emotional expression in the interview relation as data. Subsequently, relational scenarios and incidences of defense processes in the research participants are inferred.

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Objective: Mentalization-based treatment (MBT) is an evidence-based long-term treatment for borderline personality disorder (BPD). Alliance is central for effective psychotherapies. Few studies have addressed aspects of working alliance in BPD evidencebased treatments. This study aimed to investigate alliance development in MBT therapies with different clinical outcomes. Method: The sample included 155 patients in an MBT programme. Clinical outcomes were based on Global Assessment of Functioning (GAF). The sample was divided in two subgroups according to GAF levels at the end of treatment (cut-off = 60). Working alliance was assessed by patient report (Working Alliance Inventory, subscales, Goals, Bonds and Tasks) and assessed repeatedly over 36 months. The method for statistical analyses was linear mixed models. Results: Initial levels of Goals, Bonds, and Tasks did not differ by subgroup, but change over time differed significantly by subgroup. In the good outcome subgroup, ratings of Goals, Bonds, and especially Tasks increased significantly over time. In the poor outcome subgroup, paranoid PD was associated with poorer alliance development over time. Conclusions: Good outcome therapies were characterized by a process where the working alliance grew over time. Results encourage an explicit focus on tasks in therapy particularly for patients with high levels of mistrust.

This study investigates whether fathers’ adverse childhood experiences (ACE) and attachment style reported during pregnancy predict fathers’ perception of child behavior assessed 12 months postpartum, expressed by the Parenting Stress Index (PSI), Child Domain. Prospective fathers (N = 835) were recruited to “The Little in Norway (LiN) study” (Moe & Smith) at nine well‐baby clinics in Norway, with data collection composed of five time points during pregnancy and two time points postpartum (6 and 12 months). The main analyses included linear regression, path‐analysis modeling, and intraclass correlation based on mixed effects modeling. First, linear regression analyses showed that neither fathers’ ACE nor attachment style significantly predicted perceived child behavior postpartum directly. Furthermore, path analyses showed that ACE and less secure attachment style (especially avoidant attachment) measured early in pregnancy strongly predicted negatively perceived child behavior, mediated by fathers’ mental health symptoms during pregnancy and partner disharmony postpartum. Second, intraclass correlation analyses showed that fathers’ perceived child behavior showed substantial stability between 6 and 12 months postpartum. Family interventions beginning in pregnancy may be most beneficial given that fathers’ early experiences and perceptions of attachment in pregnancy were associated with later partner disharmony and stress.

Defining outcome represents a key challenge for psychotherapy theory, research and practice.The present paper uses a case study of a client with anorexia nervosa to contribute to thedevelopment of conceptual understanding of the nature of paradoxical outcome. In this case,different sources of outcome data offered different answers to the question of whether or not the therapy had been successful. Qualitative thematic analysis of therapy transcriptions was carried out, using Interpretative Phenomenological Analysis (IPA). Both the process of change that occurred in this case, and the conflicting outcome indicators, could be explained in terms of a model of affect elaboration. These findings are discussed in terms of the need for caution when interpreting results from outcome measures in psychotherapy research and practice.

Client self-report symptom measures are widely used in counselling and psychotherapy research and practice to track client progress and evaluate outcome. A growing body of evidence indicates differences between selfreport assessments and information collected through other sources. This paper considers a range of theoretical and empirical perspectives on this issue, including the concept of illusory mental health. Particular emphasis is given to the relevance of single-case research as a means of identifying different patterns of paradoxical outcome. Implications for practice and research are discussed. Paradoxe Ergebnisse in der Psychotherapie: theoretische Perspektiven, Forschungsagenda und Auswirkungen auf die PraxisZusammenfassung: In der Beratungs-und Psychotherapieforschung und -praxis werden häufig Maßnahmen zur Selbstberichterstattung des Klienten eingesetzt, um den Fortschritt des Klienten in der Therapie zu verfolgen und das Ergebnis zu bewerten. Eine wachsende Zahl von Beweisen weist auf Unterschiede zwischen Selbstberichtsbewertungen und Informationen hin, die aus anderen Quellen gesammelt wurden. Dieser Artikel betrachtet eine Reihe von theoretischen und empirischen Perspektiven zu diesem Thema, einschließlich des Konzepts der illusorischen psychischen Gesundheit. Besonderes Augenmerk wird auf die Relevanz der Einzelfallforschung als Mittel zur Identifizierung verschiedener Muster paradoxer Ergebnisse gelegt. Implikationen für die Praxis und die Forschung werden diskutiert.

Listening and exploring divergences in private theories of cure mattered for the creation of a viable working alliance directed at the patient's efforts to live their life.

A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.