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When Is Transference Work Useful in Psychodynamic Psychotherapy? A Review of Empirical Research

Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

The technical use of transference interpretations in psychoanalysis and psychodynamic psychotherapy has been debated extensively over a period of 100 years. More than 8,000 papers and book chapters have discussed the concept of transference. Up to year 2000, ten studies of brief dynamic psychotherapy had explored the association between dosage levels of transference interpretations and therapy outcome. Six studies reported negative correlations, and one initial study by Malan reported a positive correlation, between frequency of transference interpretations and outcome. All of the studies have more or less faulty designs. In this chapter, we present a study of immediate effects of transference interpretation Gabbard (Harvard Rev Psychiatry 1994;2:59–69) and a recent large-scale dismantling randomized clinical trial specifically designed to study long-term effects of transference interpretation Høglend (Am J Psychiatry 2006;163:1,739–46), Høglend (Am J Psychiatry 2008;165:763–71).

Keywords

  • In-session outcome
  • long-term outcome
  • mediators
  • moderators
  • psychodynamic psychotherapy
  • transference work

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Correspondence to Per Høglend M.D., Ph.D. .

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Appendix 23.1

Appendix 23.1

The Insight Scale. This dimension covers cognitive and emotional understanding of the main dynamics of inner conflicts, the related interpersonal patterns and repetitive behaviors, and connection to past experiences. Ability to understand and describe own vulnerability, reactions to stress, and coping abilities.

100
91
Unusual ability to describe genuinely personal wishes, fears, defences, and the related behavior and connections to earlier (childhood) experiences. High awareness of own vulnerability, attitudes, and interpersonal patterns, secondary gains. Open and curious about and reflects on the multiple levels and meanings of experience. Realistic judgment of self and others
90
81
Can account for inner conflicts, the related problems and repetitive behaviors, and connections to earlier experience. Aware of own vulnerability and reactions to stress. A tolerant and realistic sense of self and others in interpersonal disputes. May feel disillusionment but no bitterness or hopelessness
80
71
Can account for most important inner conflicts, related problems and repetitive behavior patterns, and personal attitudes. Connections to earlier experience may partly be forgotten. Aware of own vulnerability, stress reactions, and coping abilities. May blame self or others too much in interpersonal disputes but reflects freely and observes own reactions and learns from it (integration). Generally curious and tolerant. Realistic expectations about the future
70
61
Recognizes but cannot clearly describe the complex association between past experience, inner conflicts and present problems, and repetitive patterns. Reasonably aware of own vulnerability and strength and reactions to stress. Tendency to blame self or others too much in disputes. Occasionally, behavior and attitude may be unrecognized, but reflects and observes self in other areas
60
51
Understanding of inner conflicts and associations to past and present experience and behavior is somewhat unclear, or less emotionally integrated, or “learned.” Inadequate judgment of self and others but ability to observe and reflect with time. Vulnerability and stress reactions sometimes a surprise. Some defensive, unrecognized attitudes and behaviors. Rigid views of rights and wrongs. May look for superficial solutions. Recognizes symptoms as sign of disturbance
50
41
Superficial “learned” or misleading ideas of inner conflicts and past and present experience. Distortions of judgment of self versus others also when no disputes. Painful feelings accompanied by harsh self-blame or incorrectly ascribed to external factors. Little or no reflection on personal motives, unaware of important aspects of attitudes and behaviors (fundamentalism). May deny symptoms as sign of disturbance. Excessive pessimism or optimism
40
31
Does not recognize associations between behavior and internal dynamic components. Severely distorted perceptions/judgment of self or others. Disavows painful personal reactions. Can describe internal experiences but in a stereotyped, confusing, or misleading way. Denies signs of mental disturbance
30
21
Great difficulty describing internal experiences. Does not acknowledge associations between internal experiences and own behavior. Severe distortions/delusional ideas may be present
20
11
Disorganized or fragmented mental functioning. Breakdown of reality testing. Need outside assistance
10 Continuously disorganized in need of constant assistance for days

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Høglend, P., Gabbard, G.O., Gabbard, G.O. (2012). When Is Transference Work Useful in Psychodynamic Psychotherapy? A Review of Empirical Research. In: Levy, R., Ablon, J., Kächele, H. (eds) Psychodynamic Psychotherapy Research. Current Clinical Psychiatry. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-792-1_26

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