Therapists' Inadequate Feelings and Long-Term Effect of Transference Work

Dahl, Hanne–Sofie Johnsen; Ulberg, Randi; Friis, Svein; Perry, J. Christopher; Høglend, Per

doi:10.1159/000444647

Cited by 9 publications

(13 citation statements)

References 11 publications

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“…Lindqvist et al (2017) found that all psychometric studies on the FWC have found at least one factor reflecting positive feelings of engagement and interest, and at least one reflecting negative feelings of disengagement and/or frustration. Variants of these, such as the dimensions used in the current study, have in turn shown to demonstrate meaningful associations with long-term patient outcomes (Dahl et al, 2014(Dahl et al, , 2016(Dahl et al, , 2017 thus providing evidence for the external and construct validity of the CT dimensions measured via the FWC 58.…”

Section: Methodsmentioning

confidence: 52%

“…The items of the FWC-58 have shown to be reliably differentiated as four distinct dimensions: Confident, Inadequate, Parental and Disengaged feelings (Dahl et al, 2012). In turn, these factors have been shown to interact with patient pathology in contributing to the long-term effects of treatment (Dahl et al, 2014(Dahl et al, , 2016(Dahl et al, , 2017. For example, increased levels of therapists' Inadequate and Disengaged CT were more detrimental for patients when treated with TW, than without TW, particularly so for patients with a history of relational problems.…”

Section: Introductionmentioning

confidence: 99%

“…For example, increased levels of therapists' Inadequate and Disengaged CT were more detrimental for patients when treated with TW, than without TW, particularly so for patients with a history of relational problems. Patients with more relational pathology seem extra vulnerable to their therapist experiencing negative affect when they work explicitly with the therapeutic relationship (Dahl et al, 2016(Dahl et al, , 2017.…”

Section: Introductionmentioning

confidence: 99%

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Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

Nissen‐Lie

Dahl

Høglend

2020

Psychotherapy Research

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Objective: Recently, studies have reported systematic relationships between the therapists' emotional response/ countertransference (CT) during therapy and a variety of patient characteristics, speaking to the communicative potential of CT. Within an RCT assessing the role of transference work (TW) in psychodynamic therapy, we investigated whether therapist CT was related to patients' pre-treatment interpersonal problems, degree of personality pathology and motivation for psychodynamic therapy. Secondly, we explored if these relationships depended on whether the therapists used TW or not in sessions. Method: One hundred outpatients were treated with psychodynamic psychotherapy (with or without TW) for one year. Their therapists' emotional reactions after sessions (CT) were assessed with the Feeling Word Checklist-58 (FWC-58). Results: Four subscales of the FWC-58; Inadequate, Confident, Disengaged and Parental feelings were differentially predicted by patient characteristics. Some of the associations depended on treatment condition such that degree of PD pathology was associated with therapists feeling more inadequate in the non-TW-group. Patients' motivation for treatment was associated with less disturbing CT feelings, such as Inadequate and Disengaged CT (the latter especially in the TW group), and feeling more Confident CT. Conclusion: Patient factors predict therapists' emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy. Trial registration: ClinicalTrials.gov identifier: NCT00423462.

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Section: Methodsmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

Nissen‐Lie

Dahl

Høglend

2020

Psychotherapy Research

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“…Studies of psychotherapy with relationally disturbed patients have indicated high sensitivity towards therapists' countertransference reactions or behaviours. Negative therapist feelings of disengagement or inadequacy are associated with poorer outcomes, and therapists' anxiety or negative reactions may contribute to a poorer working alliance (Dahl et al, 2016(Dahl et al, , 2017Nissen-Lie et al, 2015). Moreover, too great a degree of self-confidence or self-concern may not facilitate alliance (Heinonen & Nissen-Lie, 2020;Nissen-Lie et al, 2010).…”

Section: Main Findingsmentioning

confidence: 99%

Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder

Folmo

Stänicke

Johansen

et al. 2020

Psychotherapy Research

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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.

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“…Balancing processes through difficult emotional situations requires skilled therapists [66]. Therapists' negative countertransference feelings are commonly encountered in treatment of patients with PD [67][68][69][70] and in the extraordinary, pandemic situation, such complicated reactions involving both patient and therapist would be understandable. A recent publication addresses the dialogue between therapists and patients in mentalizationbased treatment during the pandemic [26].…”

Section: Maintaining Alliancementioning

confidence: 99%

Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of treatment experiences among patients referred to treatment

Kvarstein

Zahl

Stänicke

et al. 2021

Nordic Journal of Psychiatry

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Background: The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementation of treatment modifications was required for patients typically characterized by insecure attachment and vulnerability to separation. Aim: To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD. Design: A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs. Results: The response-rate was 12% (N ¼ 133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly telephone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations. Conclusion:The survey confirms a radical modification from comprehensive group-based PD programs to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable concern about treatment progress.

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Therapists' Inadequate Feelings and Long-Term Effect of Transference Work

Cited by 9 publications

References 11 publications

Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder

Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of treatment experiences among patients referred to treatment

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