Jag har handlett forskarstuderande på deras avhandlingsarbeten samt studenter vid Psykologiska institutionen på deras uppsatser (psykologexamensabeten, psykoterapeutexamnsarbeten och examensarbeten på master- och C-nivån).

Mitt huvudsakliga intresseområde är psykoterapiforskning och psykoanalytisk forskning. Jag studerar förändringsprocesser i psykoterapi och utfall av psykoterapeutisk behandling för olika patientgrupper och terapityper. Jag är intresserad av patienternas och deras terapeuters perspektiv på det som händer i psykoterapi. Jag är mån om att bedriva studier som är kliniskt relevanta och jag anser att det är särskilt lärorik att studera fall med olika typer av utfall, t.ex. icke-påbörjade terapier, terapier som ensidigt avbryts av patienten eller terapeuten, mest framgångsrika fall, behandlingar som inte har lett till förbättring, missnöjda patienter, konsekvenserna av övergångar till psykoterapi på distans under och efter pandemin, osv. Största delen av min forskning bygger på naturalistiska studier i rutinmässig klinisk praktik, med tillämpning av både kvantitativa och kvalitativa metoder.

I min pågående forskning studerar jag olika behov hos patienter med olika personlighetskonfigurationer (t.ex. fokus på relaterande eller fokus på självständighet och prestationer) samt terapeutfaktorernas betydelse för den terapeutiska processen och för behandlingsutfallet. Mina aktuella forskningsprojekt handlar om processer i början och vid avslut av långtidsterapier samt om lärdomar från övergångar till psykoterapi på distans och tillbaka till terapeutens mottagning.

Aktuella forskningsprojekt

• Att påbörja och avsluta psykoanalytisk psykoterapi: En mulicenter fallkontrollstudie (BEP-SE)
• 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.
• Övergångar till psykoterapi på distans, personlighetsorientering och anknytningsstil: Lärdomar från covid-19 pandemin och dess effekter på genomförande av psykoterapi.

Några avslutade forskningsprojekt

• 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)
• Young adults’ inner representations of their therapists – and the therapists’ self-representations: A comparative typology (2014–2018)

I urval från Stockholms universitets publikationsdatabas

• When the screen deepens the sense of connectedness: What therapists have found effective in successful cases of teletherapy

  2024. Andrzej Werbart (et al.). Counselling and Psychotherapy Research

  Artikel

  Objectives: The objective of this study was to explore therapists' new-found experiences of what works in successful cases of teletherapy. Design: This was a qualitative study of therapists' experiences, making their implicit knowledge explicit and systematised. Methods: Twelve therapists were recruited via posts on social media and via the interviewers' professional networks. The therapists were interviewed at their office or via Zoom using a semi-structured interview guide. The interviews were analysed using inductive, reflexive thematic analysis. Results: The therapists described a number of interacting favourable factors, together contributing to successful remote treatments. Establishing a good therapeutic relationship and cooperation was a general success factor common to in-person and remote treatments. Specific factors included well-functioning communication technology, co-creating a sense of co-presence, safeguarding therapeutic boundaries adjusted to the remote setting, finding ways of compensating for the loss of several cues available in an in-person setting and the patient being motivated for a remote therapeutic endeavour. Conclusions: In the successful cases, therapists in this study seem to have developed specific skills to counteract the inherent challenges and to benefit from the advantages specific to the remote setting. In the post-pandemic era, when hybrid and remote therapeutic modalities become increasingly common, these specific skills and mechanisms have to be included in psychotherapy training programmes, supervision and continuing education.

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• The meaning and feeling of the time and space between psychotherapy sessions and everyday life: Client experiences of transitions

  2024. Andrzej Werbart (et al.). Psychotherapy Research 34 (7), 899-912

  Artikel

  Objective: To explore how clients in psychodynamic or psychoanalytic psychotherapy, conducted in the traditional in-person setting, experience the transitions in time and space between psychotherapy sessions and everyday life.

  Method: Twelve semi-structured interviews were analyzed with inductive experiential thematic analysis, focusing on how the participants experience and make sense of the phenomenon in focus.

  Results: The participants described therapy as a sheltered space where they could be open, vulnerable, receptive, and present. Approaching and leaving psychotherapy sessions, the participants established different behavioral patterns and routines dealing with their anxieties and resistances. In this in-between area, the participants could handle interconnections and differences between therapy and everyday life. Participants stressed the clinical impact of transitions: transitions affect both therapy and everyday life; disturbed transitions have an adverse impact; transitions are insufficiently addressed in therapy.

  Conclusion: Transitions between therapy and life appear to be an essential but seldom recognized part of the therapy process beyond the borders of therapy sessions. Implications of these findings for psychotherapy training and practice are discussed, and a tentative transtheoretical framework for further research is proposed.

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• New skills for distance regulation: Therapists’ experiences of remote psychotherapy following the COVID-19 pandemic

  2024. Andrzej Werbart (et al.). Journal of psychotherapy integration 34 (1), 27-44

  Artikel

  Social distancing during the COVID-19 pandemic forced many therapists to shift from in-person sessions to the use of communication technology. This shift actualizes the issue of for whom and when remote therapy is suitable and how the therapeutic technique should be adjusted. Our study explored therapists’ long-term experiences of remote psychotherapy after this transition. Data were collected about 2 years after World Health Organization’s (WHO’s) declaration of the COVID-19 pandemic. Semistructured interviews with 10 therapists with different treatment orientations were analyzed, applying the qualitative method of inductive experiential thematic analysis. The therapists said that the use of communication technology implied a new and different in-session interaction, inclusive of changed relational dynamics and the need to adjust their way of working. All therapists experienced possibilities and advantages as well as difficulties and challenges with remote psychotherapy. As time went on, they gained both positive and negative new experiences of the distinctive features of remote therapy and became more comfortable with remote communication. Above all, they acquired new technical and relational skills. Taken together, the therapists’ experiences illustrate the need to develop new skills for negotiating setting alternations and distance regulation and to adapt therapeutic interventions when shifting between in-person settings and remote sessions.

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• Understanding psychoanalytic work online and back to the couch in the wake of the COVID-19 pandemic: an investigation among Italian psychoanalysts

  2023. Licia Lea Reatto (et al.). Frontiers in Psychology 14

  Artikel

  Background: Worldwide, psychotherapists’ clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts’ experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients’ attachment styles and personality configurations.

  Method: Seventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered.

  Results: All of the analysts chose to continue the treatment using audio-visual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting.

  Conclusion: Online psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient’s personality configuration did not influence their adaptation to the setting alternation. The supportive and interpretive styles did not undergo significant changes in the transition from in-person setting to remote setting and vice versa, thus suggesting a continuity in the analysts’ “internal setting.”

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• It turned into something else: patients’ long-term experiences of transitions to or from telepsychotherapy during the COVID-19 pandemic

  2023. Camilla von Below (et al.). Frontiers in Psychology 14

  Artikel

  Introduction: The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients’ long-term experiences of transitions to telepsychotherapy and back to the office.

  Methods: Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis.

  Results: (1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives.

  Discussion: The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.

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• Deadlock in psychotherapy: A phenomenological study of eight psychodynamic therapists’ experiences

  2022. Andrzej Werbart, Emma Gråke, Fanny Klingborg. Counselling Psychology Quarterly 35 (4), 744-762

  Artikel

  Problematic interactional patterns between client and therapist involve several phenomena, such as different forms of ruptures, enactments, impasses, and stalemates. This study explores psychodynamic therapists’ experiences and understanding of deadlock in the psychotherapy process. Interviews with eight experienced therapists were analyzed applying the Interpretative Phenomenological Analysis (IPA). Generally, the therapists described the deadlock as a negative process, blocking the progress of therapy. The deadlock confronted them with unfulfilled expectations of closeness and connection, as well as unwelcome feelings and wishes, and evoked self-doubt and questioning of their own professional role. The therapists experienced a loss of agency and reflective capacity in the encounter with the client. We found an elusive quality of something absent and incomprehensible in the therapists’ experiences. Resolution of deadlock interacted with therapists finding a constructive role in the therapeutic relationship and being able to give meaning to their experiences. We conclude that the therapists need to be observant of their experiences of deadlock and talk to others about them. The knowledge of deadlocks as natural phenomena in the therapy process that can be recognized, addressed, and worked with must be more widely diffused and should be an integral part of psychotherapy education and training.

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• Accessibility at What Price? Therapists’ Experiences of Remote Psychotherapy with Children and Adolescents During the COVID-19 Pandemic

  2022. Anette Erlandsson (et al.). Journal of Infant, Child, and Adolescent Psychotherapy 21 (4), 293-308

  Artikel

  Psychotherapy has traditionally been delivered in person, but recent technological advances have made it possible to conduct remote treatments. There is currently strong evidence for the efficacy of guided self-help with online support from a therapist, but less is known about video-mediated psychotherapy. The COVID-19 pandemic has however forced many therapists to provide remote treatments. This transition might be especially trying for therapists of children and adolescents, but their experiences are underexplored. This study aimed to investigate their perceptions of video-mediated psychotherapy. Semi-structured interviews were conducted with 16 therapists and analyzed using thematic analysis. The therapists described how they struggled with technical and ethical issues and tried to overcome the loss of their usual therapeutic tools. They were concerned that the online format led to less effective treatments or could have negative effects, even if it might increase care availability. Generally, they felt frustrated, inadequate, and stressed, and experienced less job satisfaction. The therapists concluded that video-mediated sessions might be a good alternative for children and adolescents – provided the therapists themselves could determine for whom and when to offer video sessions. Implications of their experiences are discussed, including how psychotherapy training might have to incorporate issues related to remote psychotherapy.

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• How much time does psychoanalysis take? The duration of psychoanalytic treatments from Freud’s cases to the Swedish clinical practice of today

  2022. Andrzej Werbart, Sven Lagerlöf. International Journal of Psychoanalysis 103 (5), 786-805

  Artikel

  The starting point for this paper is Freud's thinking about the length of psychoanalysis and the conditions for ending it. His psychoanalytic treatments were intense, but varied greatly in length. Freud's assertion that deep psychological changes take time is still topical; however, the length of time has gradually increased. Available documentation from psychoanalytic training institutes, and findings from empirical studies, indicate that the mean length of psychoanalysis ranges from between three to seven years, and varies between different countries and periods. A recent survey among Swedish psychoanalysts found a mean length of 5.7 years and a wide variation in length from 1.5 to 12 years. Discussions in a seminar group on endings and the qualitative follow-up survey showed that a unique combination of factors determined the duration of psychoanalysis in each individual case. We briefly review the potential determinants of the treatment length and the different meanings of time in open-ended psychoanalytic treatments. To conclude, we stress the need for systematic clinical and empirical studies of determinants and the underlying processes behind the different lengths of psychoanalyses.

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• Therapeutic encounters at the onset of the COVID-19 pandemic: psychodynamic therapists' experiences of transition to remote psychotherapy

  2022. Katrin Ahlström (et al.). Psychoanalytic Psychotherapy

  Artikel

  The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.

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• Loss of Rituals, Boundaries, and Relationship

  2022. Andrzej Werbart (et al.). Frontiers in Psychology 13

  Artikel

  Telepsychotherapy is an increasingly common way of conducting psychotherapy. Previous research has shown that patients usually have positive experiences of online therapy, however, with large individual differences. The aim of this study was to explore patients’ experiences of transition from in-person psychotherapy sessions to telepsychotherapy during the COVID-19 pandemic, as well as variation in the experiences with regard to the patients’ personality orientation. Seven psychotherapy patients in Sweden were interviewed and the transcripts were analyzed using thematic analysis. Additionally, the participants were asked to rate their dissatisfaction/satisfaction with the transition, how hindering/helpful the transition was, and how unsafe/safe they felt after the transition in comparison to before. Personality orientation on relatedness or self-definition was assessed applying a self-assessment instrument (Prototype Matching of Anaclitic-Introjective Personality Configuration; PMAI). The participants experienced telepsychotherapy as qualitatively different from in-person psychotherapy. They reported several essential losses: the rituals surrounding therapy sessions were lost, including the transitional time and space between their every-day life and the therapy sessions, less therapeutic work was done, the therapists could lose their therapeutic stance, the sense of rapport was impaired, and the patients felt less open and emotionally available. On the other hand, some patients could feel freer online. As six of the participants had an anaclitic personality orientation, the present study could especially contribute to the understanding of how patients with strong affiliative needs and fear of abandonment experience the transition to meeting their therapists via communication technology. The participants’ self-ratings showed that they were only marginally dissatisfied with the transition and experienced the transition as slightly hindering, whereas they felt rather safe after the transition, indicating low concordance between qualitative and quantitative evaluations. New studies are needed to explore the introjective patients’ experiences of the transition. An essential topic is also to collect evidence and to test how the impaired sense of rapport when using communication technology can be remedied by adequate, patient-tailored interventions, a topic that has to be included in psychotherapy education and training.

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• Unsuccessful Psychotherapies

  2021. .

  Bok (red)

  Taken together, the 11 articles included in this book demonstrate that we, as researchers and clinicians, can learn a lot from further studies of unsuccessful treatments. To do so, we need to look not only for the patient factors, but also the therapist contributions, as well as the therapeutic relationship. As proposed by the third APA task force, we have to “identify effective elements of the therapy relationship and to determine effective methods of adapting or tailoring therapy to the individual patient on the basis of transdiagnostic characteristics” (Norcross and Wampold, 2019, p. 3). The therapist’s ability to recognize and manage the ruptures is decisive in the repair process and in the prevention of the treatment failure (Eubanks-Carter et al., 2011). The focus on the therapists’ emotional reactions, presumably determined by their specific personality traits, for example narcissistic (Oasi et al., 2019), is of fundamental importance. A further crucial issue is patient-therapist match in terms of personality orientation: the therapists’ early adjusting their orientation on relatedness or self-definition to their patients’ predominant personality configuration might enhance treatment outcomes (Werbart et al., 2018). Even the well-known construct of therapeutic alliance can receive (and give) further strength if it is placed in a relational context. Taking up the groundbreaking statement by Horwitz et al. (1996), we run less risks if we are able to tailor our way of working to the patient.

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• When 'good outcome' does not correspond to 'good therapy'

  2021. Melissa M. De Smet (et al.). European Journal of Psychotherapy 23 (2), 156-176

  Artikel

  In the present paper we examine four cases in which the assumption that good outcome necessarily means good therapy did not hold. Cases were selected that reported good pre-post outcome (i.e., clinically reliable decrease in symptom severity) but a negative (disappointing) therapy experience, drawn from a randomized controlled trial (the Ghent Psychotherapy Study) and a naturalistic outcome study (the Stockholm Young Adults Psychotherapy Project). Analysis of these seemingly contrasting findings made it possible to identify three distinct patterns of client experience of outcome. Implications for research and practice are discussed.

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• Am I Really Bipolar? Personal Accounts of the Experience of Being Diagnosed With Bipolar II Disorder

  2020. Cecilia Johansson, Andrzej Werbart. Frontiers in Psychology 11

  Artikel

  Bipolar disorder (BD) is a complex and chronic mental illness with highs and lows beyond the ordinary, which induces a significant risk of suicide. The aim of this study was to explore the experience of being diagnosed with BD and the impact that receiving a correct diagnosis had had on life situations and relationships with others. Semi-structured qualitative interviews were conducted with seven people diagnosed with BD. The results showed that the primary treatment all participants had received or were currently receiving was pharmacotherapy, typically without any psychological component. A major concern that arose was delayed diagnosis, leading to inadequate treatment, and lack of knowledge among professionals about non-typical forms of BD. Moreover, the experiences of others’ reactions were multifold, though generally surprisingly positive. Generally, the participants had learned to recognize, understand and tackle early symptoms of both hypomanic and depressive episodes to avoid developing a full-blown acute episode. This study highlights the crucial importance of a collaborative relationship between the clinician and the patient.

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• Editorial: Unsuccessful Psychotherapies

  2020. Osmano Oasi, Andrzej Werbart. Frontiers in Psychology 11

  Artikel

  As humans, but also as researchers and clinicians, we can learn a lot from our failures. The issue of failures in psychotherapeutic treatments is extremely important, as from them we can infer the signs that precede them, and the strategies to deal with them. In psychotherapy we are also aware of the important fact that the amount of unwanted effects is very similar to fields such as pharmacotherapy, and the number of patients reporting unwanted effects of psychotherapy is between 3 and 15% of cases (Berk and Parker, 2009). In 2012, a meta-analytic study by Swift and Greenberg (2012)suggested that approximately one in every five clients still chooses to end treatment prior to its completion. Similarly, Lambert (2013) has demonstrated that 5 to 10% of patients deteriorate in therapy, and 35 to 40% of participants in clinical trials do not improve. This Research Topic asks how we can address this situation.

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• Love, Work, and Striving for the Self in Balance

  2020. Andrzej Werbart, Annelie Bergstedt, Sonja Levander. Frontiers in Psychology 11

  Artikel

  One of the most famous quotations credited to Freud is that, when asked what he thought a psychologically healthy person should be able to do, he said: “to love and to work.” A central goal in psychoanalytic treatment is to bring about changes in basic, mostly unconscious, mental structures. The aim of this study was to investigate, applying an inductive thematic analysis, the experiences anaclitic and introjective patients have had of change after psychoanalysis with regard to the domains Love and Relationships and Work and Achievements. Analyzing patient interviews, we identified a third domain of experienced changes, The Self, which refers to increased self-understanding, self-acceptance, and self-care rather than an improved dynamic balance between love and work. All patients experienced several positive changes in their lives during and after psychoanalysis. We also found distinctive patterns that appear to be closely linked to the patients’ initial personality orientation with regard to relationships and achievements. Generally, the patients described symmetrical, but opposite, change processes within the two specific domains of Love and Work. For the anaclitic patients, this indicated a movement inward in the domain of Love (from an excessive preoccupation with issues of their relationship with others toward more distinct self-boundaries and increased agency) and outward in the domain of Work (from unenterprising toward becoming more outgoing and daring). For the introjective patients, this pointed to a reverse movement outward in the domain of Love (from an excessive preoccupation with issues of autonomy toward increased responsiveness to others and desire to be establish close, mutual relationships) and inward in the domain of Work (from an excessive orientation on achievements toward increased becoming more grounded in their own feelings, needs, and desires). In conclusion, patients in both groups have experienced a reduced preoccupation with issues related to their initially predominant personality dimension (relatedness or self-definition) and increased receptivity to needs typical for the complementary dimension. These changes seem to be mediated by changes in the domain of The Self. Our study suggests the clinical relevance of focusing the therapeutic work on fostering a better and more dynamic balance between love and work, relatedness, or self-definition.

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• Successful and Less Successful Psychotherapies Compared

  2019. Andrzej Werbart, Amanda Annevall, Johan Hillblom. Frontiers in Psychology 10

  Artikel

  Despite the general effectiveness of bona fide psychotherapies, the number of patients who deteriorate or fail to improve is still problematic. Furthermore, there is an increased awareness in the field that the therapists’ individual skills make a significant contribution to the variance in outcome. While some therapists are generally more successful than others, most therapists have experienced both therapeutic success and failure in different cases. The aim of this case-series study was to deepen our understanding of what matters for the therapists’ success in some cases, whereas other patients do not improve. How do the patients and their therapists make sense of and reflect on their therapy experiences in most successful and unsuccessful cases? Are there any distinctive features experienced by the participants at the outset of treatment? To explore these issues, we applied a mixed-method design. Trying to keep the therapist factor constant, we selected contrasting cases from the caseloads of three therapists, following the criterion of reliable and clinically significant symptom reduction or non-improvement at termination. Transcripts of 12 patient interviews and 12 therapist interviews (at baseline and at termination) were analyzed, applying inductive thematic analysis and the multiple-case comparison method. The comparisons within the three therapists’ caseloads revealed that in the successful cases the patient and the therapist shared a common understanding of the presenting problems and the goals of therapy and experienced the therapeutic relationship as both supportive and challenging. Furthermore, the therapists adjusted their way of working to their patients’ needs. In non-improved cases, the participants presented diverging views of the therapeutic process and outcome. The therapists described difficulties in the therapeutic collaboration but not how they dealt with obstacles. They tended to disregard their own role in the interactions and to explain difficulties as being caused by the nature of their patients’ problems. This could indicate that the therapists had difficulty in reflecting on their own contributions, accepting feedback from their patients, and adjusting their work accordingly. These within-therapist differences indicate that taking a “third position” is most needed and seems to be most difficult, when early signs of a lack of therapeutic progress appear.

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• “It was hard work every session”

  2019. Andrzej Werbart (et al.). Psychotherapy Research 29 (3), 354-371

  Artikel

  Objective: To explore therapists’ experiences of the therapeutic process in successful cases of psychoanalytic psychotherapy.

  Method: A two-stage, mixed-method design was used. Sixteen successful cases were drawn from a sample of 92 young adults in psychoanalytic psychotherapy according to Jacobson’s criteria for reliable and clinically significant improvement. Therapist interviews at baseline and termination were analyzed applying Inductive Thematic Analysis.

  Results: Three core themes emerged: Being Particularly Motivated to be This Patient’s Therapist, Maintaining a Safe and Attentive Therapeutic Position, and Assiduous Work Every Session. The therapists experienced positive feelings towards the patient from the outset of treatment and described active, relational work that included paying attention to incongruities in the patient’s self-presentation and being mindful of patient’s avoidant behavior. The therapist’s motivation and attentive position made it possible to balance support and challenge in the therapeutic relationship.

  Conclusions: Successful therapeutic work presupposes positive expectations, an active therapeutic stance and assiduous work session-by-session. Therapist expertise may involve the ability to mobilize and work effectively with patient-specific resources and obstacles from the beginning of treatment. In addition to identifying the characteristics and actions of effective therapists, research should also focus on processes emerging within effective therapeutic dyads.

  Clinical or methodological significance of this article: Our study indicates several factors that seem to characterize therapist expertise and can inform psychotherapy training. Successful therapeutic work presupposes positive expectations, an active therapeutic stance, courage to challenge the patient, and assiduous work session-by-session. Therapist expertise may involve the ability to mobilize and work effectively with patient-specific resources and obstacles from the beginning of treatment. In addition to identifying the characteristics and actions of effective therapists, research should also focus on processes emerging within effective therapeutic dyads.

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• “The Skin is the Cradle of the Soul”

  2019. Andrzej Werbart. Journal of the American Psychoanalytic Association 67 (1), 37-58

  Artikel

  Didier Anzieu’s notion of the skin-ego builds on a long psychoanalytic tradition that began with Freud’s idea that the ego is first and foremost a body ego, a projection in the psyche of the surface of the body, or, in other words, the idea that psychic phenomena are always embodied. An interface, a container for the ego, but also its origin: thus did Anzieu conceptualize the skin’s psychic function. The baby’s fantasy of having a common skin with the mother is the concrete starting point for a development that, through the prohibition on touching, leads to the experience of being a separate and individual person. Psychoanalytic work with severe mental disorders makes it necessary to investigate deficiencies in the skin-ego’s containing function before the patient’s psychic contents can be explored. In the psychoanalytic situation, the analyst’s words replace tactile contact and thereby contribute to healing injuries to the skin-ego. The clinical implications of Anzieu’s theoretical model are illustrated by examples from psychoanalyses of children and adults. The close connection between touch, psychic envelopes, and thinking opens a wider perspective on the necessity of setting limits to violence, against both nature and human beings.

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