Per Høglend

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• Professor dr. med.
• Professor emeritus dr. med. at University of Oslo

According to attachment theory, the quality of the early child-parent bond determines the child’s interpersonal relationships later in life. Utilising data from The First Experimental Study of Transference Work-In Teenagers (FEST-IT), the current paper investigated the connection between the self-reported quality of bonding with mother and father a...

Health and social care workers are exposed to varying degrees of stress in their work, which may be reflected in their trajectories of psychological distress during the education program and the first years in the job. The aim of this study was to add to the knowledge concerned with the long-term development of psychological distress in five groups...

Background Little is known about the influence on outcome of exploration of the patient-therapist relationship (that is, transference work) in psychoanalytic psychotherapy. We hypothesized that depressed adolescents would have better long-term effects from psychoanalytic psychotherapy with than without transference work. Methods Depressed adolesce...

There is limited evidence that patients with a personality disorder (PD) have poorer psychotherapyoutcomes compared to those without, but the majority of these studies are from short-term andsymptom-focused interventions. In contrast, the present study provided open-ended psychotherapy to asample of patients (N�370), half of which had a PD a pretre...

Findings from previous psychotherapy research suggest that the majority of improvement takes place in the initial phase of treatment with the relative effectiveness dropping at a negatively accelerating rate. However, the evidence for this pattern of change comes from investigations of short-term treatments and it is unclear whether this also holds...

Findings from previous psychotherapy research suggest that the majority of improvement takes place in the initial phase of treatment with the relative effectiveness dropping at a negatively accelerating rate. However, the evidence for this pattern of change comes from investigations of short-term treatments and it is unclear whether this also holds...

Psychotherapy tends to produce meaningful and sustained positive changes for individuals suffering from a mental illness. A salient distinction can be made between patients with a Personality Disorder (PD) and those without. There is some evidence that patients with PD have poorer treatment outcomes, but the majority of these studies are from time-...

The authors wish to make the following correction to their paper [...]

There is uncertainty concerning what the active ingredients in psychotherapy are. The First Experimental Study of Transference interpretations (FEST) was a randomized controlled trial of the effects of transference work (TW) in psychodynamic psychotherapy. Women with low quality of object relations (QOR) showed a large positive effect of transferen...

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 t...

Background: Creating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient's interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns. The CCRT method is based on the assumption...

Background: Creating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient’s interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns. The CCRT method is based on the assumption t...

Background: Creating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient’s interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns. The CCRT method is based on the assumption t...

Background To bridge the gap between symptoms and treatment, constructing case formulations is essential for clinicians. Limited scientific value has been attributed to case formulations because of problems with quality, reliability, and validity. For understanding, communication, and treatment planning beyond each specific clinician-patient dyad,...

Objective: Insight and affect awareness are correlated with outcome in a number of studies across different treatment orientations. In this study, we perform a full mediational analysis to examine whether improvement of both cognitive insight and affect awareness are mediators of the specific effects of transference work in dynamic psychotherapy. M...

No abstract available.

Background Diagnostic interviews and questionnaires are commonly used in the assessment of adolescents referred to child and adolescent mental health services. Many of these rating scales are constructed for adults and focus on symptoms related to diagnosis. Psychodynamic Functioning Scales (PFS) focus on relational aspects and how the patients han...

The First Experimental Study of Transference Interpretation (FEST), conducted in Norway, is a dismantling, randomized clinical trial of the long-term effects of transference interpretation (TI). This article examines two case studies of women with poor quality of object relations (QOR), one who was rated as recovered after psychotherapy and one who...

According to psychoanalytic and psychodynamic theory, insight is an important mechanism that may lead to better interpersonal functioning. In this article, we have summarized empirical studies attempting to shed some light on insight as a putative mediator of treatment effects. Two case examples illustrate how improved insight might lead to clinica...

Psychological distress have been found to be high and influence negatively nurses' and teachers' work. In this nine-year project, we present the first longitudinal study comparing psychological distress from 1467 students and young professionals in nursing and teaching. Psychological distress was measured with GHQ 12 at the start and the end of the...

No prior randomized trials have investigated how personality disorders (PDs) impact the long-term outcomes of group psychotherapy treatment of different durations. The present study compared the effects of short-term and long-term group analytic therapy among patients with and without PD, with regards to symptoms and interpersonal problems during a...

Background In psychodynamic psychotherapy, one of the therapists’ techniques is to intervene on and encourage exploration of the patients’ relationships with other people. The impact of these interventions and the response from the patient are probably dependent on certain characteristics of the context in which the interventions are given and the...

Received: November 19, 2015 Accepted: February 09, 2016 Published online: August 12, 2016 Issue release date: August 2016

The 2 treatments, in this case comparison study, are strategically chosen to illustrate one of many or a result from a randomized controlled study on the long-term effect of transference work (Høglend et al., 2006). Namely, the interaction between transference work, therapists’ self-reported parental countertransference, and patients’ personality p...

Key practitioner message: Therapists' emotional reactions to their patients (countertransference) seem to have a significant impact on both the treatment process and outcome of psychotherapy. Therapists' heightened level of disengaged feelings over a treatment period shows an adverse impact on the effect of transference work for all patients, and...

Objective: In this study, we compared the patterns of change in interpersonal problems between short-term and long-term psychodynamic group therapy. Method: A total of 167 outpatients with mixed diagnoses were randomized to 20 or 80 weekly sessions of group therapy. Interpersonal problems were assessed with the Inventory of Interpersonal Problem...

Objective: There are reasons to suggest that the therapist effect lies at the intersection between psychotherapists' professional and personal functioning. The current study investigated if and how the interplay between therapists' (n = 70) professional self-reports (e.g., of their difficulties in practice in the form of 'professional self-doubt'...

The present paper is a manual for the Transference Work Scale (TWS). The inter-rater agreement on the 26 TWS items was good to excellent and previously published. TWS is a therapy process rating scale focusing on Transference Work (TW) (i.e. analysis of the patient-therapist relationship). TW is considered a core active ingredient in dynamic psycho...

Objectives In a randomized clinical trial, short- and long-term psychodynamic group psychotherapy (STG and LTG, respectively) schedules were equally effective for the typical' patient during a 3-year study period. Although several studies have reported good effects for patients with personality disorders (PD) in diverse forms of psychotherapy, the...

Research from several domains indicates that genetic factors, childhood environment, and later interpersonal experiences are important sources of how patients relate to their therapists (transference). Transference work, a core specific technique in psychodynamic psychotherapy, focuses on exploring the patient-therapist relationship, with the idea...

The primary aim of this article was to explore the effects of the therapist's disengaged feelings (i.e., bored, tired of, sleepy, indifferent, aloof) in psychodynamic therapy. The Transference Work Scale was used in combination with the Defense Mechanism Rating Scales and Structural Analyses of Social Behavior to explore the in-session process in 2...

This article presents the main results of the First Experimental Study of Transference (FEST). The background of the study, as well as the aims, main hypotheses, and methods are described. The participants were 100 patients who were randomized to psychodynamic psychotherapy of one year's duration, with transference work or without transference work...

Objective: Analysis of the patient-therapist relationship (relationship work) is considered a core active ingredient in dynamic psychotherapy. However, there are contradictory findings as for whom and under what circumstances these interventions are beneficial. This study investigates long-term effects of relationship work in the context of patien...

Interpreting the transference has been considered a core ingredient in psychodynamic psychotherapy. The effects of analyzing the transference are probably dependent on certain characteristics of the interventions themselves and the context in which transference interventions are given. The present study describes the development and use of a therap...

Unlabelled: Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore...

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or...

There are no randomised clinical trials comparing the outcomes of short- with long-term psychodynamic group psychotherapy. To compare differences in outcome during and after short- and long-term group psychotherapy. In total, 167 out-patients with mood, anxiety and personality disorders were randomised to short- or long-term group therapy (20 or 80...

Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists’ personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists’ qual...

Background: Depression in adolescents seems to be a growing problem that causes mental suffering and prevents young people from joining the workforce. There is also a high risk of relapse during adult life. There is emerging evidence for the effect of psychodynamic psychotherapy in adolescents. In-session relational intervention (that is, transfer...

Little research has been done on therapeutic alliance in group psychotherapy, especially the impact of treatment duration and therapist professional characteristics. Therapeutic alliance was rated by patients on the Working Alliance Inventory—Short Form at three time points (sessions 3, 10 and 17) in a randomized controlled trial of short-term and...

Abstract Mentalization is the capacity to understand behavior as expressions of various mental states. It is assumed to be important for understanding the underlying psychopathology, the therapeutic process, and the outcome of therapy associated with patients with personality disorders (PDs). However, to date, empirical findings are scarce and inco...

The present study focuses on whether there is a sustained difference in treatment response to transference interventions between women and men. Data from the First Experimental Study of Transference Interpretations were used. One hundred patients were randomized to receive dynamic psychotherapy in 1 year with either a moderate level of transference...

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 leve...

Although countertransference phenomena have been given much attention within psychotherapy theory, single-case studies and clinical anecdotes, empirical research is still conspicuous by its absence. To assess the therapists' emotional reactions, which are understood to be part of the countertransference (CT), we used the Feeling Word Checklist 58 (...

Compulsory commitment in mental health care represents a dramatic infringement on an individual's life. In Norway, this deprivation of liberty is based on a professional medical assessment that does not require a court verdict. This article presents possible changes that may increase legal protection for the mentally ill. The concept of legal prote...

Only a few treatment studies of personality disorders (PD) patients are on longer-term psychotherapy, general outcome measures are used, and follow-up periods are usually short. More studies of long-term therapies, using outcome measures of core psychopathology, are needed. This study is a dismantling randomized controlled clinical trial, specifica...

OBJECTIVES. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome. DESIGN. In this dismantling, randomized clinical study, 100 out-patients wh...

Objective: Transference interpretation is considered as a core active ingredient in dynamic psychotherapy. In common clinical theory, it is maintained that more mature relationships, as well as a strong therapeutic alliance, may be prerequisites for successful transference work. In this study, the interaction between quality of object relations, tr...

Evidence-based psychotherapy is typically based on treatment outcome for the "average" patient in aggregate designs; reports on individual non-responders are rarely published. In this observational study, we explored factors that might have contributed to non-response in long-term dynamic group psychotherapy. Eight patients (14%) who did not change...

The Norwegian Mental Health Care Act allows use of coercion under certain conditions. Even though the current practice has been criticized, little empirical data exist about the attitudes towards compulsory mental health care. This study used Q-methodology to identify prototypical attitudes and to test possible differences of attitudes between grou...

This study examined whether 49 patients from a randomized controlled trial developed insight during therapy and whether insight predicted long-term outcome in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for Cluster C personality disorders. Videotaped sessions early and late in treatment were analyzed using the Achievement of...

According to psychoanalytic theory, interpretation of transference leads to increased insight that again leads to improved interpersonal functioning over time. In this study, we performed a full mediational analysis to test whether insight gained during treatment mediates the long-term effects of transference interpretation in dynamic psychotherapy...

The goal was to investigate patients' rating of working alliance in longer-term individual psychotherapy (N=201), in order to determine different patterns of development and predictors of positive versus negative development. The study explored patient factors that might be associated with positive versus negative development of the alliance, from...

Scientific methods for rating psychological defence mechanisms have over time had problems with unstable reliability and undetermined validity. This article outlines conceptual and historical aspects of these problems and then reviews some of the recent methods for assessing defensive functioning: 1) The Defence Mechanism Test (Kragh); 2) Vaillant'...

Because of problems with reliability and undetermined validity, psychodynamic case formulations have for a long time had limited scientific value. This article reviews some of the recent methods for making psychodynamic case formulations: 1) Malan's Method for Overall Psychodynamic Formulations; 2) The Plan Formulation Method (Mr. Zion); 3) The Cor...

The associations between use of specific techniques and treatment outcome were very similar in two independent studies of brief dynamic psychotherapy in Edmonton. Canada, and Oslo. However, the associations between treatment length and outcome were the opposite in the two studies. The Edmonton study used a fixed time limit, while the Oslo study use...

Psychotherapy research continues to turn out findings at an increasing speed. Despite the methodological complexity of the field, progress has been made. Training and clinical practice is being significantly influenced by empirical research, not only in behavioural and - cognitive psychotherapy but also in psychodynamic and client-centred psychothe...

Gender as a moderator of long-term treatment effects has to a very little extent been explored in individual psychotherapy. We have previously reported a short-term difference in treatment-response to transference interpretations between women with poor relational functioning (low Quality of Object Relations Scale; low QOR) and men with good relati...

In the First Experimental Study of Transference Interpretations (FEST), showing the best treatment effects from dynamic psychotherapy with transference interpretations, one subgroup was female patients who had difficult relationships with others (low quality of object relations). The aim of the present study was to explore further a highly successf...

This study explored pretreatment patient characteristics associated with the level and growth of working alliance in therapies lasting up to 120 therapy sessions. The quality of working alliance was rated by both patients (N=201) and therapists (N=61) at Sessions 3, 12, and 20 and then at every 20th successive session. Patients reported that experi...

This study explored therapist characteristics associated with the development of working alliance in long-term therapies, up to 120 sessions. The quality of working alliance was rated by both patients (n = 201) and therapists (n = 61) at sessions 3, 12, 20 and every 20th successive session. Therapists' self-reported scores on the 'cold/detached' di...

To examine whether men and women respond differentially to brief dynamic psychotherapy, with or without transference interpretations. Data from the First Experimental Study of Transference Interpretation were used. Patients (n = 100) were randomized to receive 2 different dynamic psychotherapies during 1 year, with either a moderate level of transf...

Precision and generalizability for relative and absolute change scores were estimated by means of error/tolerance ratios and generalizability coefficients for 51 patients receiving 1 year of psychodynamic psychotherapy. These estimations involved 6 scale indicators and 3 raters. Practical suggestions are offered for the number of raters needed to o...

Transference interpretation has remained a core ingredient in the psychodynamic tradition, despite limited empirical evidence for its effectiveness. In this study, the authors examined long-term effects of transference interpretations. This was a randomized controlled clinical trial, dismantling design, plus follow-up evaluations 1 year and 3 years...

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The primary aim of this study is to measure effects of transference interpretations in brief dynamic psychotherapy using an experimental design. One hundred patients were randomized to dynamic psychotherapy over 1 year either with a moderate level of transference interpretations or without transference interpretations. The outcome measures were the...

We know that psychotherapy works, but the processes and mechanisms underlying therapeutic change are still largely unknown. The study of mediators and moderators of change in psychotherapy is one way to improve our understanding of mechanisms operating in psychotherapy. Consensus is slowly building on how to define both mediators and moderators of...

The purpose of this study was to measure the effects of transference interpretations (the assumed core active ingredient) in dynamic psychotherapy, using an experimental design. One hundred patients were randomly assigned to two groups. One group received dynamic psychotherapy over 1 year, with a moderate level of transference interpretations, whil...

In a study of long-term (mean=32.5 months) analytic group psychotherapy we explored the relationships among six predictors shown to influence outcome in short-term group studies and five outcome variables (Global Assessment of Functioning [GAF], Global Symptom Index [GSI], Inventory of Interpersonal Problems-Circumplex [IIP-C], Global Improvement,...

In this process–outcome study, we explored the changes of patients' defensive functioning (rated with the Defence Mechanism Rating Scales) over the course of brief dynamic psychotherapy (N = 39, maximum 40 sessions). We investigated whether therapists' use of interpretation (rated with the Psychodynamic Intervention Rating Scale) would influence th...

Dental amalgam has been suggested to cause long-term physical and mental problems. Claims that removal of the amalgam may lead to dramatic improvements in health have not been tested empirically in controlled studies with a long follow-up period. To investigate the long-term effects of removal of dental amalgam on physical and mental symptoms in se...

We studied the ongoing relationship of patients and their therapist in a long-term, analytic group. The therapeutic alliance was rated weekly and group cohesion was rated every month, by patients and therapist. The patients' symptoms (SCL-90-R) and interpersonal problems (IIP-C) were rated every third month during therapy (self-reports). There was...

In this process-outcome study, we explored whether the therapists' Adjustment Ratio of interpretation would be predictive of the development of working alliance in brief dynamic psychotherapy (N = 39, max 40 sessions). Therapist interventions were rated in an early session (7th) and in the mid-phase of therapy (16th session). We found that, what wa...

All studies on patient variables as predictors of outcome are on short-term groups. Therefore, we wanted to study predictors of outcome in an observational study of 69 out-patients treated in long-term, analytic group therapy (mean = 32.5 months). Based on results from research on short-term groups, we selected 6 predictor variables representing ce...

To investigate the impact of trainee personality on both short-term and long-term effects of a training program in empathic communication, we implemented a quasi-experimental study with two groups of students of social work. Level of empathic communication was measured from analogue data in both groups before training (T1), after the training perio...

The author addresses the use of transference interpretations in brief dynamic psychotherapy, length of treatment needed for limited characterological changes, and selection criteria for this treatment modality. Prior research has suggested that (a) frequent use of transference interpretations should be avoided in brief dynamic psychotherapy, (b) pa...

Patient and therapist characteristics were explored as predictors of the use of defence interpretation in non-manualized brief dynamic therapy (N = 38, max 40 sessions). Therapist interventions were rated with the Psychodynamic Intervention Rating Scale in an early session (7th) and in the mid-phase of therapy (16th session). Low quality of patient...

Given the complexity of analytic therapies and individual change, it seems desirable to introduce more objective and quantitative measures into the clinical situation in assessment of change. A traditional case study describes one patient's change pattern in symptomatic distress, interpersonal relations and self-esteem during 44 months of group ana...

There are very few empirical studies of long-term, analytic group psychotherapy. Sixty-nine patients in long-term analytic group psychotherapy were evaluated from pretherapy to posttherapy, and one year after termination. The primary outcome measures were the Symptom Checklist-90 (Revised) and the Inventory of Interpersonal Problems. In addition, t...

We analyzed whether defense mechanisms changed and/or predicted outcome during brief dynamic psychotherapy (N = 43, max 40 sessions, Norwegian Multisite Study on Process and Outcome of Psychotherapy). Defenses were rated with the Defense Mechanism Rating Scales (DMRS, clinician-rated) and Defense Style Questionnaire (DSQ self-rated). Overall defens...

The aim of the study was the prediction of the quality of early working alliance, using possible predictors among patient pretreatment variables: diagnoses, current and past relationships and intrapsychic ones. Data are from the ongoing, naturalistic Norwegian Multisite Project on Process and Outcome of Psychotherapy (NMSPOP). The sample, n = 270,...

Therapist characteristics were explored as possible predictors of working alliance, rated early and later in therapy both by therapists (n=59) and patients (n=270) in an ongoing multisite project on process and outcome of psychotherapy. Patients and therapists had divergent perspectives on the working alliance. Therapists' experience, training, ski...

Five scales have been developed to assess changes that are consistent with the therapeutic rationales and procedures of dynamic psychotherapy. Seven raters evaluated 50 patients before and 36 patients again after brief dynamic psychotherapy. A factor analysis indicated that the scales represent a dimension that is discriminable from general symptom...

The last decade has seen progress in psychotherapy research, despite the methodological complexity in this field. However, empirical research has influenced training and clinical practice to only a limited extent. This article is a brief evaluation of trends and some findings in modern psychotherapy research that may influence professional psychoth...

The authors present a cost-efficient process rating scale for detailed measurement of how much transference interpretations and related therapist interventions are used in brief dynamic psychotherapy. Theoretical and methodological considerations on how to operationalize and quantify such therapeutic interventions are discussed. The scale had highl...

We examined the validity of the construct of overall defensive functioning and its discrimination from standard diagnostic assessments. Within a multisite field trial, patients received intake diagnostic interviews by clinicians who made standard axis I through V diagnoses, then rated defense mechanisms using the Defense Mechanism Rating Scales (DM...

We investigated the predictive effect of psychological defenses on the course of major depression in a subsample of psychiatric patients from a larger study. We tested the hypothesis that a group of eight defenses, associated with depression in previous research, would predict, outcome of major depression. After an intake interview, 37 patients wer...