Andrzej Werbart Foto: Psykologiska institutionen/HD

Andrzej Werbart

Affilierad professor

Visa sidan på svenska
Works at Department of Psychology
Telephone 08-16 33 99
Visiting address Frescati Hagväg 14
Room 325
Postal address Psykologiska institutionen 106 91 Stockholm

About me

I share my professional time between clinical practice (psychoanalysis and psychotherapy with children and adults), teaching, supervision and research. Between 1998 and 2009 I was Research Director at the former Institute of Psychotherapy, Stockholm County Council. In my research projects at the Institute I involved psychotherapists as participants in the data collection process, different kinds of assessments and some data analysis.


I am supervising theses on different levels, from Psychology III through masters to PhD level, including a 5-year Psychologist programme and a Psychotherapist programme.


My main field of interest is psychotherapy research and psychoanalytic research. I am studying change processes in psychotherapy and outcomes of psychotherapeutic treatments for different patient groups and therapy types. I am interested in the patients' and the therapists' perspective on what is going on in psychotherapy. I am keen on conducting studies that are clinically relevant and I consider studies of cases with different outcomes as particularly instructive, for example not started treatments, treatments unilaterally discontinued by the patient or the therapist, most successful cases, cases with reliable deterioration or no reliable change at termination, dissatisfied patients, etc. Most of my research is based on naturalistic studies in routine clinical practice, applying both quantitative and qualitative methods.

In my ongoing research I am studying different needs of anaclitic and introjective patients (focus on relatedness vs focus on self-definition). I explore changes in personality configurations and mental representations of self and others during and after psychotherapeutic treatments. Furthermore, I am studying the impact of therapist factors on the therapeutic process and treatment outcome.

Ongoing research projects

  • Beginnings and Endings in Psychoanalysis and Psychoanalytic Psychotherapy: A multi-center case-control research project within the anaclitic-introjective personality spectrum (the BEP project – Milan – Stockholm)
  • The role of anaclitic and introjective personality configuration for psychotherapy process and outcome.
  • The patients’ and the therapists’ view of successful and unsuccessful psychoanalytic psychotherapies.
  • Young adults’ inner representations of their therapists – and the therapists’ self-representations: A comparative typology.

Selected completed research projects

  • Long-term outcomes of psychodynamic residential treatment for severely disturbed young adults: A naturalistic study at a Swedish therapeutic community (2000-2012)
  • Private theories of pathogenesis and cure: Patients in psychoanalysis and their analysts (PSA) (1997-2011)
  • Psychoanalysis in Public Service Setting (PPSS) (1998-2015)
  • Young Adult Psychotherapy Project (YAPP) (1998-2009)
  • Young Adult's Own Thinking, Understanding, and Managing of Everyday Life (YOUTH) (2000-2006)
  • Changes in representations of parents among young adults in psychoanalytic psychotherapy (2003-2011)
  • Changes in self- and object representations following psychotherapy measured by a theory-free, computational, semantic space method (2008-2011)
  • Depression among young men and women in psychotherapy: Patient perspective on own problems, medication and psychotherapy in relation to outcome (2005-2009)
  • Patients' view of helpful and hindering factors in psychotherapy in relation to longitudinal outcomes: Post-termination changes (2007-2010)
  • Therapists' view of helpful and hindering factors in psychotherapy with young adults (2007-2010)
  • Quality Assurance of Psychotherapy in Sweden (QAPS) (2007-2009)
  • Which psychotherapy suits whom? A naturalistic study of interaction effects in psychotherapy in public service settings (2010-2014)


A selection from Stockholm University publication database
  • 2018. Diane Bimont, Andrzej Werbart. Counselling Psychology Quarterly 31 (2), 243-268

    The aim of this study was to conduct an in-depth exploration of therapists' experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting "under their skin". In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists' reactions to having a patient "under their skin" varied from resistance to symbiotic relatedness. The therapists' ideas of their professional role influenced how the experience of carrying the patient's suffering was interpreted. The phenomenon of the patient's presence in the therapist's representational world might be interpreted as a distinct countertransference phenomenon when working in a more "thin boundary" manner with particular cases. The therapists' ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.

  • 2018. Björn Philips (et al.). Psychoanalytic psychology 35 (2), 205-216

    Negative therapeutic reaction was first described by Freud, and theories about this phenomenon have focused on various patient factors, for example, unconscious guilt, narcissistic pride, and overwhelming feelings of shame, as well as devaluation of the therapist as a defense against envy. Different strategies to counteract negative therapeutic reactions in patients with severe personality disorder have been proposed. Bateman and Fonagy suggested that some psychoanalytic techniques are iatrogenic for patients with borderline personality disorder and, thus, the therapeutic method must be modified. One manifestation of negative therapeutic reaction is that patients discontinue therapy prematurely. The aim of this study was to explore the differences in the early therapeutic process between therapy dropouts and therapy completers in mentalization-based treatment (MBT) for patients with concurrent borderline personality disorder (BPD) and substance use disorder (SUD). The first 2 videotaped therapy sessions from 6 MBT therapies were selected—3 therapies that were completed and 3 therapies that were prematurely discontinued by the patient. The therapy process was analyzed using the Psychotherapy Process Q set (PQS). Lists of the most frequent and least frequent PQS items among therapy completers versus dropouts are presented. In comparing the sessions from therapy completers and dropouts, significant differences in frequencies were detected for 13 PQS items. These items included therapist and patient activities, as well as features of the therapeutic interaction. Continuation in therapy seems to be related to therapists’ general skills and adherence to MBT, as well as patients bringing up significant material and not being distant.

  • 2018. Andrzej Werbart, Mikael Hägertz, Nadja Borg Ölander. Journal of Contemporary Psychotherapy 48 (4), 241-251

    Decades of psychotherapy research suggest that patient–therapist match accounts for outcome beyond single patient or therapist variables. This study examines the associations between different patterns of patient–therapist matching (in terms of orientation on relatedness or self-definition) and outcomes at termination of psychoanalytic psychotherapy with young adults. Thirty-three patients and their therapists were classified as predominately anaclitic or introjective at baseline. Patients in the convergent patient–therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Moreover, convergent patient–therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or self-definition to their patients’ predominant personality configuration in order to enhance treatment outcomes.

  • 2018. Andrzej Werbart (et al.). Psychotherapy Research

    Objective: To explore therapists’ experiences of therapeutic process in psychoanalytic psychotherapy with nonimproved young adults. Method: Eight nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of therapist interviews (8 at baseline and 8 at termination) were analyzed applying grounded-theory methodology. Results: A tentative conceptual process model was constructed around the core category Having Half of the Patient in Therapy. Initially, the therapists experienced collaboration as stimulating, at the same time as the therapeutic relationship was marked by distance. At termination negative processes predominated: the patient reacted with aversion to closeness and the therapist experienced struggle and loss of control in therapy. The therapists described therapy outcome as favorable in form of increased insight and mitigated problems, while core problems remained. Conclusions: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist one-sidedly allied herself with the patient’s capable and seemingly well-functioning parts. The therapists’ experiences could be compared to the nonimproved patients’ “spinning one’s wheels” in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients’ core problems, despite attempts to meta-communicate.

  • 2017. Andrzej Werbart, Siri Aldén, Anders Diedrichs. Research in Psychotherapy: Psychopathology, Process and Outcome 20 (1), 30-42

    Treatment goals in psychoanalytic psychotherapy often include changes in underlying psychological structures, rather than only symptom reduction. This study examines changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults in relation to outcomes. Thirty-three patients were interviewed pretreatment and at termination using the Object Relations Inventory (ORI). Prototype Matching of Anaclitic-Introjective Personality Configuration (PMAI) was applied to the ORI material by two independent judges (intraclass correlation coefficient=0.73). The patients were classified pretreatment as predominately anaclitic (n=13) or introjective (n=20). Outcome measures included the Symptom Checklist-90-R (SCL-90) and Differentiation-Relatedness scale (D-R) pretreatment, at termination, at the 1.5-year and three-year follow-up. Both groups improved post-treatment in terms of symptoms and developmental levels of representations of self, mother, and father. No significant differences between the anaclitic and the introjective group were found in this respect, and could not be expected due to the low power (0.27). The anaclitic group showed better balance between relatedness and self-definition post-treatment, while this improvement was not significant in the introjective group. Further and larger studies are needed to draw more farreaching conclusions about the relations between changes in personality configurations over the course of treatment and the treatment efficacy. The clinical implications of this approach to underlying dynamic psychological structures are discussed.

  • 2016. Andrzej Werbart (et al.). Journal of the American Psychoanalytic Association 64 (5), 917-958

    Changes in dynamic psychological structures are often a treatment goal in psychotherapy. The present study aimed at creating a typology of self-representations among young women and men in psychoanalytic psychotherapy, to study longitudinal changes in self-representations, and to compare self-representations in the clinical sample with those of a nonclinical group. Twenty-five women and sixteen men were interviewed according to Blatt’s Object Relations Inventory pretreatment, at termination, and at a 1.5-year follow-up. In the comparison group, eleven women and nine men were interviewed at baseline, 1.5 years, and three years later. Typologies of the 123 self-descriptions in the clinical group and 60 in the nonclinical group were constructed by means of ideal-type analysis for men and women separately. Clusters of self-representations could be depicted on a two-dimensional matrix with the axes Relatedness-Self-definition and Integration-Nonintegration. In most cases, the self-descriptions changed over time in terms of belonging to different ideal-type clusters. In the clinical group, there was a movement toward increased integration in self-representations, but above all toward a better balance between relatedness and self-definition. The changes continued after termination, paralleled by reduced symptoms, improved functioning, and higher developmental levels of representations. No corresponding tendency could be observed in the nonclinical group.

  • 2016. Andrzej Werbart. Subjektivität und Verstehen: Psychoanalyse und Sozialwissenschaften im Dialog, 133-144
  • 2016. Andrzej Werbart, Sonja Levander. Psychoanalytic psychology 33 (2), 217-242

    Treatment goals in psychoanalysis often include changes in underlying psychological structures. Different patterns of change have been demonstrated in anaclitic and introjective patients. In a series of 14 cases, we took a further step and examined changes in the anaclitic - introjective personality configurations following psychoanalysis, as well as patients' experiences of these changes. Clinical case formulations were based on repeated interviews and the application of prototype-matching methodology. Patients' experiences were explored by applying inductive thematic analysis. We found a development toward more mature levels of differentiation and individuation in the anaclitic group, whereas relatedness and intimacy remained problematic in some introjective cases. Patients described their experienced changes in terms of complementary personality configuration, but the introjective group described more benefits from psychoanalysis. Several patients expressed their ambivalence toward these changes and a feeling of loss of their former selves. Patients' view of their analysts and the analytic method were congruent with patients' primary personality configuration. To reactivate developmental processes, the psychoanalytic technique has to be adjusted to the anaclitic and introjective patients' different needs and defenses.

  • 2015. Andrzej Werbart. An open door review of outcome and process studies in psychoanalysis, 246-247

    Treatment goals in psychoanalysis often include changes in underlying dynamic mental structures, such as self- and object representations, or personality configurations. The aim of this ongoing research program is to study changes in self- and object representations, and in the anaclitic- introjective personality configuration following psychoanalysis and long-term psychoanalytic psychotherapy. Furthermore, we investigate personality related responses to the psychoanalytic process, as well as patients’ experiences of changes in dynamic mental structure. This research program combines quantitative and qualitative methods, and integrates theory-neutral and empirically- driven, inductive approach with a theory-driven, deductive approach.

  • 2015. Andrzej Werbart. An open door review of outcome and process studies in psychoanalysis, 244-245

    This research program aims to explore patient and therapist views of helpful and hindering factors in psychoanalysis and psychoanalytic psychotherapy, applying rigorous qualitative methods. A series of studies was based on periodical interviews with seven analysands and their analysts (Werbart & Levander, 2006, 2011). Double sets of private theories of cure were found among analysands and their analysts. Ideas of utopian cure involved a profound transformation of the personality by way of deep regression. Ideas of an attainable and more limited cure included new ways of managing old problems and new ways of thinking and reflecting. The ongoing treatment was then seen as the ‘next-best solution’. Both parties’ mourning of the preferred but abandoned utopian theories of cure seems to be an important ingredient in the psychoanalytic process. Furthermore, the utopian fantasy of creating ‘the new person’ by means of ‘proper’ psychoanalysis or analytic training has far-reaching consequences for psychoanalytic education and supervision.

  • 2015. Peter Lilliengren (et al.). Journal of counseling psychology 62 (1), 1-13

    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.

  • 2015. Annelie Werbart Törnblom, Andrzej Werbart, Per-Anders Rydelius. Qualitative Health Research 25 (8), 1099-1116

    Risk factors, suicidal behavior, and help-seeking patterns differ between young women and men. We constructed a generic conceptual model of the processes underlying youth suicide, grounded in 78 interviews with parents in 52 consecutive cases of suicide (19 women, 33 men) identified at forensic medical autopsy and compared by sex. We found different forms of shame hidden behind gender-specific masks, as well as gender differences in their paths to suicide. Several interacting factors formed negative feedback loops. Finding no way out, the young persons looked for an emergency exit. Signs and preparations could be observed at different times but recognized only in retrospect. Typically, the young persons and their parents asked for professional help but did not receive the help they needed. We discuss parents' experiences from the theoretical perspective on gender identity and developmental breakdown. Giving voice to the parents' tacit knowledge can contribute to better prevention and treatment.

  • 2015. Andrzej Werbart (et al.). Psychotherapy Research 25 (5), 546-564

    Objective: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. Method: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. Results: Spinning One's Wheels emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. Conclusions: When the therapist does not contribute to the achievement of the patient's treatment goals-even when the patient gains some benefit-the patient does not fully profit from the therapy.

  • Chapter Ytterligheter
    2015. Andrzej Werbart. Relationer från A till Ö, 214-215

    Varför väljer en livlig och utåtriktad människa ofta en tyst, asocial eller tillbakadragen partner – och tvärtom? Är det något slags jämvikt som naturen eftersträvar? Svar: Det är en spännande fråga du ställer. Som vanligt finns det flera svar. Sedan antiken har västerländsk kultur präglats av två oförenliga föreställningar om partnerval: ”lika dras till lika” – vi har en naturlig tendens att inleda relationer med människor vars värderingar och strävan liknar våra – och ”motsatser dras till varandra” – vi söker partner som har egenskaper som vi själva saknar.

    Flera biologiska och sociologiska argument har använts för båda dessa föreställningar. Psykoanalytiker har tidigt intresserat sig för frågan. Enligt Freud har vår förmåga att bli förälskade sin källa i barnets självkärlek. Narcissistiskt val innebär att man letar efter en kärlekspartner med sig själv som förebild. Anaklitiskt eller stödberoende val utgår från identifikation med den person som vi varit beroende av under vår tidiga barndom. Flera moderna psykologiska teorier beskriver, i olika termer, våra två grundläggande strävanden och två sammanvävda utvecklingslinjer: egen lycka och gemenskap, egoism och altruism, att värna om självbilden och att hysa medkänsla, att sträva efter oberoende och att värna om att bli omtyckt. Dessa två huvudspår, självavgränsning och relaterande, finns hos oss alla. Kanske söker vi i kärleken det vi själva saknar för att bättre älska oss själva och för att uppnå bättre balans. Men när obalansen blir för stor påverkas vår förmåga att älska både oss själva och en annan person, och vi kan få psykiska problem.

  • 2014. Mo Wang, Andrzej Werbart. Counselling Psychology Quarterly 27 (1), 75-95

    The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.

  • 2014. Andrzej Werbart, Håkan Andersson, Rolf Sandell. Psychotherapy Research 24 (6), 724-737

    Objective: To explore the association between the stability or instability of services' organizational structure and patient- and therapist-initiated discontinuation of therapy in routine mental health. Method: Three groups, comprising altogether 750 cases in routine mental health care in eight different clinics, were included: cases with patient-initiated discontinuation, therapist-initiated discontinuation, and patients remaining in treatment. Multilevel multinomial regression was used to estimate three models: An initial, unconditional intercept-only model, another one including patient variables, and a final model with significant patient and therapist variables including the organizational stability of the therapists' clinic. Results: High between-therapist variability was noted. Odds ratios and significance tests indicated a strong association of organizational instability with patient-initiated premature termination in particular. Conclusions: The question of how organizational factors influence the treatment results needs further research. Future studies have to be designed in ways that permit clinically meaningful subdivision of the patients' and the therapists' decisions for premature termination.

  • 2014. Andrzej Werbart, David Forsström. Psychoanalytic Psychotherapy 28 (4), 397-410

    This study investigates changes in latent mental structures along the anaclitic and introjective dimensions in relation to outcomes in 14 cases of publicly financed psychoanalysis. The method of prototype matching was adapted for personality assessment, and multiple outcome measures were applied. For the anaclitic cases, symptom reduction was accompanied by more mature integration of anaclitic and introjective personality dimensions, while the introjective cases showed symptom reduction without such improvement. This could indicate that sustainable change in latent mental structures is more difficult to achieve in introjective than in anaclitic patients. Further research is needed to validate these preliminary results.

  • 2014. Andrzej Werbart. Art and freedom, 102-111
  • 2013. Annelie Werbart Törnblom, Andrzej Werbart, Per-Anders Rydelius. Archives of Suicide Research 17 (3), 242-261

    Suicides are more frequent among boys than girls. A tentative, conceptual model of processes behind suicide among boys and young men (aged 12-25), grounded in their parents' views, is presented. Extensive interviews with parents in 33 cases of suicide were analyzed using grounded-theory methodology. Family alliances, coalitions, and secrets interacted with the boy concealing problems and hiding behind a mask, while the professionals did not understand the emergency. Four interwoven paths to suicide were found: the boy was hunted and haunted, addicted, depressed, or psychotic. Different forms of shame were hidden behind the masks of the clown, the warrior, and the prince. Future preventive programs need to address barriers to communication among all parties involved.

  • 2013. Vendela Palmstierna, Andrzej Werbart. Psychoanalytic Psychotherapy 27 (1), 21-40

    In order to understand mechanisms of change, patients' experiences are an invaluable source of information. Psychotherapy with young adults confronts therapists with specific challenges. This qualitative study explores experiences of therapeutic process and outcome in 11 cases of psychoanalytic psychotherapy that fulfilled the rigorous quantitative criteria for long-term therapeutic success. Interviews at termination and at a 1.5-year follow-up were analysed applying basic grounded theory methodology and the software ATLAS.ti. At the core of the tentative conceptual model is the experience of a growth-promoting and secure therapeutic relationship. Within the therapeutic frames, the patients and the therapists could overcome obstacles to their collaboration. The patients obtained support in close relationships and continued to apply therapeutic experiences after termination. The therapists experienced the therapeutic work in a strikingly similar way, worked actively towards joint goals, explored what was painful and actively promoted the use of new skills after termination. Positive factors in therapy and in life reinforced each other in a positive feedback loop. The patients' and their therapists' view of successful change processes confirms the centrality of the therapeutic relationship as a secure base for exploration and change.

  • 2013. Andrzej Werbart (et al.). Psychotherapy 50 (1), 119-130

    This naturalistic study presents outcomes for three therapy types practiced in psychiatric public health care in Sweden. Data were collected over a 3-year period at 13 outpatient psychiatric care services participating in the online Quality Assurance of Psychotherapy in Sweden (OAPS) system. Of the 1,498 registered patients, 14% never started psychotherapy, 17% dropped out from treatment, and 36% dropped out from data collection. Outcome measures included symptom severity, quality of life, and self-rated health. Outcomes were studied for 180 patients who received cognitive behavioral, psychodynamic, or integrative/eclectic therapy after control for dropout representativity. Among treatment completers, patients with different pretreatment characteristics seem to have received different treatments. Patients showed significant improvements, and all therapy types had generally good outcomes in terms of symptom reduction and clinical recovery. Overall, the psychotherapy delivered by the Swedish public health services included in this study is beneficial for the majority of patients who complete treatment. Multilevel regression modeling revealed no significant effect for therapy type for three different outcome measures. Neither did treatment duration have any significant effect. The analysis did not demonstrate any significant therapist effects on the three outcome measures. The results must be interpreted with caution, as there was large attrition and incomplete data, nonrandom assignment to treatment, no treatment integrity control, and lack of long-term follow-up.

  • 2013. Johanna Roos, Andrzej Werbart. Psychotherapy Research 23 (4), 394-418

    Among potential predictors of dropout, client variables are most thoroughly examined. This qualitative literature review examines the current state of knowledge about therapist, relationship and process factors influencing dropout. Databases searches identified 44 relevant studies published January 2000-June 2011. Dropout rates varied widely with a weighted rate of 35%. Fewer than half of the studies directly addressed questions of dropout rates in relation to therapist, relationship or process factors. Therapists' experience, training and skills, together with providing concrete support and being emotionally supportive, had an impact on dropout rates. Furthermore, the quality of therapeutic alliance, client dissatisfaction and pre-therapy preparation influenced dropout. To reduce dropout rates, therapists need enhanced skills in building and repairing the therapeutic relationship.

  • 2012. Camilla von Below, Andrzej Werbart. Psychoanalytic Psychotherapy 26 (3), 211-229

    Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.

  • 2012. Andrzej Werbart, David Forsstrom, Madeleine Jeanneau. Nordic Journal of Psychiatry 66 (6), 367-375

    Aims: This study examined the long-term effectiveness of a treatment model at a Swedish therapeutic community for young adults with severe personality disorders, combining milieu therapy and inpatient long-term psychodynamic psychotherapy. Methods: Data were collected for the 56 residents between 1994 and 2008 at intake, termination and 2-year follow-up. Patient residency ranged from 2 to 60 months, with average psychotherapy duration of 30 months. Self-rated outcome was measured using the Symptom Checklist-90-R. Expert-rated outcomes comprised the Global Assessment of Functioning, the Strauss-Carpenter Outcome Scale and the Integration/Sealing-over Scale. A series of mixed-model analyses of variance with one fixed factor (time) was performed to examine the outcomes for the total sample of completers. Effect sizes for within-group change and percentages of improved, unchanged and deteriorated patients were calculated for patients participating in the data collection on all three time points. Results: All outcome measures showed significant improvement on a group level from intake to discharge. Most patients had maintained the therapeutic gains at the 2-year follow-up. The effect sizes were high and the Reliable Change Index provided evidence of good outcome for 92% of the patients at follow-up. The expert ratings gave somewhat larger effect sizes than the patients' self-ratings. Conclusions: The effect sizes and success rates are at a comparable level with corresponding studies of long-term treatments of personality disorders. Most patients had a substantial individual improvement from intake to termination and follow-up. This indicates the effectiveness of this highly specialized and intensive treatment approach for severely disturbed young adult patients.

  • 2012. Andrzej Werbart, Mo Wang. Nordic Psychology 64 (2), 128-146

    This naturalistic study examines potential predictors of treatment attendance and discontinuation among patients in the three most common psychotherapy types in Swedish public health service settings. Patients who did not start psychotherapy after pretherapy assessment are compared with patients who started psychotherapy. Patients who discontinued psychotherapy are compared with those remaining in treatment. Data were collected over a 3-year period at 13 outpatient psychiatric clinics, using online patient and therapist questionnaires. Of the 1498 registered patients, 14% never started psychotherapy, 17% dropped out from treatment, 33% continued in treatment, while 36% dropped out from data collection. Being dangerous to others, having Axis I diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), lower level of therapeutic alliance, organizational factors, having younger therapists, psychotic features, and being older were predictive of not starting treatment, while organizational factors, more acting out and criminality, less mental ill-health, and being younger predicted dropout from treatment. Significantly more nonstarters and dropouts were found at clinics with lower levels of organizational structure and stability. Organizational factors predicted both starting and continuing in treatment.

  • 2011. David Arvidsson, Sverker Sikström, Andrzej Werbart. Psychotherapy Research 21 (4), 430-446

    We propose a theory-neutral, computational and data-driven method for assessing changes in semantic content of object representations following long-term psychodynamic psychotherapy. Young adults in psychotherapy are 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.

  • 2011. Andrzej Werbart (et al.). Psychoanalytic psychology 28 (1), 95-116

    The present study explores the changes in young adult patients’ representations of their parents from prior to psychotherapy through long-term follow-up. Twenty-five women and 16 men from the Young Adult Psychotherapy Project (YAPP) were interviewed according to Sidney Blatt’s unstructured Object Relations Inventory prior to psychoanalytic psychotherapy, at termination and at the 1.5-year follow-up, comprising 123 interviews in all. Typologies of the 246 parental descriptions were constructed by means of ideal-type analysis for male and female patients separately, and for representations of mother and father separately. The analysis resulted in 5 to 7 ideal types of mother and father representations. Prior to psychotherapy, women’s representations of their fathers and men’s representations of their mothers seemed most problematic. As to the content, the most common descriptions of the parent were the emotionally or physically absent parent, and the parent with his or her own problems. In most cases, the descriptions of the parent changed over time in terms of belonging to different ideal-type clusters. There were important improvements in the quality of the descriptions, and the changes continued after termination of psychotherapy. However, most of the parental representations were negative in all three interviews. The possible explanations of these findings are discussed.

  • 2011. Andrzej Werbart, Sonja Levander. International Journal of Psychoanalysis 92 (6), 1455-1481

    This longitudinal prospective study focuses on analysands’ and analysts’ implicit ideas of how psychoanalysis might help analysands’ psychological problems. Seven analysands and their analysts were periodically interviewed. Single ideas of cure from 75 interviews were inductively categorized. Nine distinct types of cures emerged, representing the wished-for goals of psychoanalysis, as well as the actions to achieve the wished-for changes. Each category might comprise more or less utopian ideas of wished-for cure as well as ideas of an attainable, more limited cure, or combinations of these. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process for more than half the analysands and analysts. The abandonment of these ideas was related to the experienced outcome of psychoanalysis. The relation between the theories of one analysand and her analyst is explored in depth in a case study with special emphasis on the analytic process. The study suggests that the psychoanalytic process might profit from the analyst’s observance of such incongruities and an openness to work through them.

  • 2010. Camilla von Below, Andrzej Werbart, Susanna Rehnberg. European Journal of Psychotherapy 12 (2), 129-147

    The study aims to explore the process of overcoming depression as experienced by young adult psychotherapy patients. Seventeen patients in individual or group psychotherapy with diagnoses within the depression spectrum were interviewed at termination of psychotherapy and at 1.5 years' follow-up. Grounded theory analysis of transcripts 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. These findings are related to age-specific challenges on the threshold of adulthood.

  • 2010. Peter Lilliengren, Andrzej Werbart. Psychotherapy 47 (4), 570-585

    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.

  • 2012. Sonja Levander, Andrzej Werbart. Psychoanalytic psychology 29 (1), 1-16

    Seven analysands and their analysts were repeatedly interviewed at the beginning, during, and after the analysis about the analysands' problems and helpful and hindering factors in the analytic process. Using the analysands' initial descriptions of their problems, the authors categorized them as anaclitic or introjective according to Blatt's personality model. The hypothesis was that they would differ as to experiences of the analytic work. The introjective group expected improved emotional control and ability to regulate interpersonal distance in addition to better understanding the roots of their problems. The anaclitic group believed that the analyst's strength and empathy would help them handle their need for support and love. The introjective group saw their own problems as the main hindrance in analysis but also directed critique to the analyst as a person. Their analysts experienced that the analysands wanted to do the work by themselves and were difficult to engage in the analytic process. The analysands in the anaclitic group were more occupied by hindrances in the psychoanalytic frame and attitude. Their analysts, on the other hand, sometimes found the work difficult and frustrating. The authors underline the importance of being aware of personality differences in analysands' response to specific dimensions of the analytic process.

  • Conference Everyday evidence
    2011. Andrzej Werbart. Book of Abstracts, 177-177

    Aim: Defining empirically supported treatments exclusively in terms of randomized controlled trials has numerous limitations. This naturalistic study presents patients’ pre-treatment characteristics and compares outcomes for three psychotherapy types as practiced in psychiatric routine care. Method: Data were collected during a 3-year period at 13 out-patient psychiatric care services participating in the on-line system for Quality Assurance of Psychotherapy in Sweden (QAPS). Of the 1,498 registered patients 14% never started psychotherapy, 17% dropped out from treatment and 36% are dropouts from data collection. Outcomes were studied for 180 patients who received CBT, PDT or integrative/eclectic psychotherapy. Results: Some minor differences were found between patients who remained in therapy, dropouts from treatment and from data collection. There were no significant differences in psychological distress pre-treatment between the three psychotherapy types, and patients showed significant improvements post-treatment. There were no statistically significant differences in effectiveness between psychotherapy types. Discussion: 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. Variations in the size and type of improvement were noted depending on outcome measure, indicating that a majority of patients may experience reduced symptoms through brief psychotherapy, but not necessarily an increased life satisfaction to the same extent. The results must be interpreted with caution since there were no treatment integrity or adherence controls, non-random assignment to treatments, large attrition, and incomplete data.

  • 2009. Lena Johansson, Andrzej Werbart. Group Analysis 42 (2), 120-142

    Patients’ views of curative and hindering factors in psychoanalytic group psychotherapy are explored, starting with semi-structured interviews with 28 young adult patients at therapy termination. Using grounded theory methodology, a theoretical model of therapeutic action is constructed, elucidating the interactions between positive and negative experiences in the group. The focal point appears to be the patient’s experience of their own activity within the context of the group as whole, leading to increased self-knowledge and improved handling of emotions. The positively experienced change is also affected by people outside of therapy and real life events. The patients ascribed most frequent hindering factors to the absence of their own action to other group members and to the therapeutic frames. In contrast to therapist-based theoretical models, positive experience in the group leads patients to minimize the therapist’s role, while negative experiences lead patients to want a more active therapist.

  • 2005. Peter Lilliengren, Andzej Werbart. Psychotherapy 42 (3), 324-339

    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.

Show all publications by Andrzej Werbart at Stockholm University

Last updated: December 13, 2018

Bookmark and share Tell a friend