Rolf Holmqvist

Linköping University | LiU · Department of Behavioural Sciences and Learning (IBL)

Background In addition to theoretical education, clinical psychology programs should include practical skills training. This skill training may be tied to specific assessment and treatment methods; other skills, such as the ability to create a collaborative alliance with patients, are more generic. Previous research has shown that the ability to bu...

Background: Eating disorders are psychiatric conditions involving not just weight, body, and shape concerns but also self-esteem, emotional, interpersonal, and cognitive difficulties. Understanding the deeper meaning of living with an eating disorder is significant from a theoretical standpoint and crucial for identifying factors that maintain or i...

Therapists’ in-session feelings in psychotherapy can be seen as indications of the development of the therapeutic relationship and the therapeutic process. To manage them appropriately, it is important to know to what extent they may be influenced by patients’ pretreatment characteristics. This study aims to improve the understanding of therapists’...

Various models of specialized foster care have been developed, but research on them is limited. This longitudinal, exploratory study analysed data on adaptive functioning, emotional and social problems and self‐concept in a specialized foster care service in Sweden. The focus of the study was on the development of the children and young people in p...

Background: Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psy...

Background Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the s...

Objective: The objective of this study was to analyze the effect of adherence to both specific technique factors and facilitative condition variables (e.g., therapists’ involvement, understanding and support) in Cognitive Behavior Therapy (CBT) and Interpersonal Psychotherapy (IPT). In addition, we were interested in whether the effect of therapist...

Objective: Brief Relational Therapy (BRT) includes the idea that the therapists use their in-session feelings in meta-communications about the therapy relationship to facilitate resolution of alliance ruptures. The current study aimed to explore the effect of therapist feelings on patient depressive symptoms in BRT compared to Interpersonal Psychot...

Knowledge about the development of mental health in young people in foster care is limited. This naturalistic study examined the effects of a relational and mentalization-focused treatment in foster families in Sweden on the placed young people’s mental health. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure change...

Objective: To better understand the complexity of dyadic processes, such as the mechanisms of the working alliance, researchers recommend taking advantage of innovations in data analytic procedures when studying the interactions between therapists and patients that are associated with favorable therapeutic outcomes. Inspired by a recent line of all...

Objective: The main objective of this study was to explore the relationship between alliance and treatment outcome of substance use disorder (SUD) outpatients in routine care. Attachment, type of substance use, and treatment orientation were analyzed as potential moderators of this relationship. Method: Ninety-nine SUD outpatients rated their psych...

Background: Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease. Methods: Thirty-one patients with BN an...

Objective: This study analyzed the prevalence of psychoform and somatoform dissociation among individuals with the whole spectrum of eating disorder diagnoses and compared it with ratings from a non-clinical group. The relationship between dissociation and severity of eating disturbance was examined as well as differences between the eating disorde...

Understanding how different groups of patients change at different rates is important for treatment selection, planning and evaluation. This study aimed to assess whether an approach to classifying patients on the basis of initial symptom distress profiles (ISDPs) derived from a self-rated questionnaire measuring psychological distress may be usefu...

There is little research about the long-term effects on children that were separated from their parents and moved from Finland to Sweden during World War II. The aim of this study was to capture these now-lifelong reflections, and so questionnaires were sent to 14 potential participants. Ten persons aged 73 − 81 responded. The themes that emerged c...

Objective The aim of this study was to test a new observer‐rated instrument, the Alliance and Rupture Observation Scale (AROS). It was designed for repeated measurements of the alliance within sessions and to detect alliance ruptures. Method Videotaped therapy sessions with depressed adults were analyzed. Reliability was mainly assessed as inter‐r...

Objective: Evidence is inconclusive on whether variability in alliance ratings within or between therapists is a better predictor of treatment outcome. The objective of the present study was to explore between and within patient and therapist variability in alliance ratings, reciprocity among them, and their significance for treatment outcome. Me...

Objectives: To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment. Design and methods: In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical...

Objective. There is a need for better understanding the relation between parents’ mentalizing about their child and their actual behavior toward the child. Specifically, it is important to understand the significance of mentalization about discrete parental challenges in comparison with mentalization about the relationship in general in relation to...

Objective: Patients with eating disorders (ED) often suffer from co-morbid depression, which may complicate the ED treatment. Previous studies have found that ED interventions seem to have limited capacity to reduce depressive symptoms. Several studies of interpersonal psychotherapy (IPT), have found that when patients have been treated for depress...

Objective: There is a need for rigorous methods to study the mechanisms that lead to individual-level change (i.e., process-outcome research). We argue that panel data (i.e., longitudinal study of a number of individuals) methods have 3 major advantages for psychotherapy researchers: (1) enabling microanalytic study of psychotherapeutic processes...

Background: Clinical experience points to the importance of significant experiences in the therapy relationship for patients who have been interpersonally traumatised but the empirical research is limited. Aim: The aim was to gain increased knowledge about how significant and potentially corrective experiences within the therapeutic relationship we...

Background: More knowledge is needed about outcome of treatments in routine care for patients with substance use disorders (SUDs). These patients often suffer from psychological distress in addition to SUDs. Objectives: To evaluate the effects of community-based psychological treatment on SUD patients’ psychosocial problems, as well as on their sub...

Objective: Increase in the capacity to mentalize has been proposed to be an important mechanism of change in psychotherapy. However, mentalization has primarily been studied as an individual skill that people either possess or lack, rather than as an interactional phenomenon. Method: In this study, excerpts from three different sessions in a the...

Objective: Developments in working alliance theory posit that the therapist's attention to fluctuations in the alliance throughout treatment is crucial. Accordingly, researchers have begun studying the alliance as a time-varying mechanism of change rather than as a static moderator. However, most studies to date suffer from bias owing to the nonin...

Objective: The association between alliance level and outcome in psychotherapy has been extensively studied. One way to expand this knowledge is to study alliance patterns. The main aims of this study were to examine how frequent alliance patterns with ruptures or rupture-repair episodes were in a naturalistic sample of psychotherapies in primary...

As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to e...

Background: Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patient...

Objective: As there are theoretical, clinical, and "common sense" reasons to expect a relationship between organizational factors and outcome in clinics providing psychotherapy and other mental health treatments, a review of empirical research in this area was undertaken with the aim of finding empirical evidence for organizational effects. Metho...

Psychoanalytic authors have traditionally been skeptical of nomothetic studies, in which group averages obscure the uniqueness of individual cases. Several relational psychoanalytic authors have expressed more pronounced skepticism, affirming, for example, that given the uniqueness of each therapist-patient dyad, systematic empirical research is pa...

Emotional reactions are a vital part of the therapeutic relationship. The Feeling Word Checklist-24 (FWC-24) is an instrument asking the clinician (or the patient) to report to what degree he or she has experienced various feelings during a therapeutic interaction. The aim of this study was to assess the factor structure of the clinician-rated FWC-...

The Dose-Effect model holds that longer therapy leads to better outcome, although increasing treatment length will yield diminishing returns, as additional sessions lead to progressively less change in a negatively accelerating fashion. In contrast, the Good-Enough-Level (GEL) model proposes that patients, therapists, or patients-with-therapists de...

Aims: Although considerable attention has been paid to the concept of mentalization in psychotherapy, there is little research on mentalization as predictor of psychotherapy process and outcome. Using data from a randomized controlled trial of cognitive-behavioral therapy and interpersonal psychotherapy for depression, we studied mentalization in...

Despite substantial effect sizes for psychological therapy among different diagnosis groups and in different treatment contexts, many studies show that a large proportion of patients do not attain reliable improvement and a substantial portion are worse off after treatment. Previous studies suggest that patients in psychiatry may have worse outcome...

Although self-disclosure, when handled with discretion, is often seen as an important intervention in many psychotherapy orientations, including psychodynamic as well as humanistic and cognitive-behavioral approaches, many psychotherapists seem reluctant to use it. The frequency and type of those interventions from psychotherapists of different ori...

Objective: A shared understanding of the patient's symptoms and problems is seen by most theories as a crucial aspect of the collaboration in therapy, presumably influencing alliance and outcome. The empirical ground for this argument is not solid, however. Several studies have found weak associations between a common view of the patient's problem...

The present article analyses staff members' discourses on the treatment method token economy, as it is implemented at a detention home for young men. The study draws on interviews with eight staff members and on participant observations at the detention home. Using discursive psychology, the analysis centers on the staff members' own constructions...

Recently, researchers have started to measure the working alliance repeatedly across sessions of psychotherapy, relating the working alliance to symptom change session by session. Responding to questionnaires after each session can become tedious, leading to careless responses and/or increasing levels of missing data. Therefore, assessment with the...

The working alliance concerns the quality of collaboration between patient and therapist in psychotherapy. One of the most widely used scales for measuring the working alliance is the Working Alliance Inventory (WAI). For the patient-rated version, the short form developed by Hatcher and Gillaspy (WAI-SR) has shown the best psychometric properties....

Background: Somatoform dissociation is supposed to be a vital aspect of the general concept of dissociation. The Somatoform Dissociation Questionnaire-20 (SDQ-20) and the brief version SDQ-5 are self-report instruments constructed to identify somatic dissociation. Aim: In the present study, the psychometric qualities of the Swedish version of th...

The aim of this study was to illuminate experiences of the process of recovering from pathological dissociation. The study used data from interviews with six female participants diagnosed with pathological dissociative disturbances. All the women had a history of having been sexually abused. Data were analyzed using Interpretative Phenomenological...

Caregiving practices in Tanzania are potentially affected by socio-demographic change such as urbanization and globalization. The aim of this study is to explore adult caregivers' discourses regarding the responsibility of caregiving, related to guidance and control of children in Tanzania. Data was collected in focus group discussions with parents...

Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed that purportedly measure these concepts, but little is known about their interrelationships. We discuss conceptual overlaps and distinctions between these thre...

In order to prevent relapse into criminality, it is important to understand what precedes criminal behavior. Two earlier studies found deficits in mentalizing ability to be related to violent and criminal actions. Mentalizing refers to the ability to make human behavior predictable and meaningful by inferring mental states (thoughts, feelings, etc....

Although many studies have found associations between trauma and eating disorders, it is important to study associations between the whole spectrum of potentially traumatic experiences and eating disorders. This study examined to what extent noninterpersonal traumas, interpersonal traumas, and adverse childhood circumstances were reported in a samp...

Abstract Attempts to regulate service delivery in line with results from randomized trials have been vigorously debated. In this paper, results from practice-based studies using the CORE System illustrate the potential to enrich knowledge about the actual outcome of psychological therapy in routine care. These studies also provide data for importan...

This study explores how siblings in Tanzania actively engage in their own socialization through the negotiation and local design of caregiving practices and control between younger siblings (age 1-3), older siblings (age 3-13) and adults. Analyses of moment-to-moment embodied, multimodal sequences of interaction illustrate how caregiving responsibi...

Objective: Although the working alliance as been found to be a robust predictor of psychotherapy outcome, critics have questioned the causal status of this effect. Specifically, the effect of the alliance may be confounded with the effect of prior symptom improvement. The objective of the present study was to test this possibility. Method: A lar...

Abstract The aim of this study was to assess whether a modified version of the Emotional Availability Scales (EAS), created to assess interaction quality between parents and children, could be applied to psychotherapy sessions and whether emotional availability (EA), as assessed by the modified EAS-T, was associated with client- and therapist-rated...

Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outc...

Accession Number: 2013-24148-005. First Author & Affiliation: Kullgard, Niclas; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Release Date: 20130729. Publication Type: Journal, (0100); Peer Reviewed Journal, (0110); . Media Covered: Electronic. Document Type: Journal Article. Language: English. Major Descr...

The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic improve- ments. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analy...

Objective: Clinical trials sometimes have the same therapists deliver more than 1 psychotherapy, ostensibly to control for therapist effects. This "crossed therapist" design makes controlling for therapist allegiance imperative, as therapists may prefer one treatment they deliver to the other(s). Research has established a strong relationship betw...

The aim of the study was to analyse differences in observer rated affect consciousness (AC) between subgroups of patients diagnosed with eating disorders (N = 44; 30 with anorexia nervosa and 14 with bulimia nervosa), and a non-clinical group (N = 40). Another aim was to study the short-term stability of AC over 10-11 weeks of treatment and its rel...

The aim of this exploratory study was to bring understanding to the experiences of witnesses who have given testimony in the post-genocide Rwandan gacaca courts. Qualitative interviews were conducted with 8 women. The Interpretative Phenomenological Analysis method was used, and resulted in 3 main findings: (a) Witnessing can have a negative impact...

The aim of this study was to analyze whether self-reported attachment style (measuring avoidance and anxiety) among adolescents was associated with dissociative symptoms, in addition to self-reported potentially traumatic experiences. A group consisting of 462 adolescents completed three self-assessment questionnaires: Linkoping Youth Life Experien...

This study presents findings from analyses of naturally occurring literacy events, where children jointly focus on reading and writing letters of the alphabet, illustrating social constructions of learning created through language and embodied action. Video recorded data from two different families living in an urban low-income area in Tanzania is...

This study investigates conceptions of early childhood discipline strategies discussed in focus groups with parents and grandparents in a poor urban area in Tanzania. A grounded theory analysis suggested a model that included four discipline strategies related to corporal punishment: to beat with care, to treat like an egg, as if beating a snake an...

This study describes interactional structures and practices in client-identified important events in psychotherapy sessions. Twelve of 16 events from seven client-therapist dyads were found to contain disagreement. A turn-by-turn investigation using conversation analysis displayed three different ways that therapists used to handle disagreement. Th...

This study presents a modified version of the affect consciousness interview (Monsen, Eilertsen, Melgård & Odegård, 1996), intended to capture the individual's affective consciousness. The aim of the modified version - The Affect Consciousness Interview - Revised (ACI-R) - is to measure consciousness about own and others' affects. Three groups of p...

A key characteristic of psychopathy is the individual's problematic relation to certain affects, particularly shame. Previous research has studied relations between expressed shame and psychopathy. In this study, the author analyzes potential associations between psychopathy and consciousness of feelings (i.e., participants' ability to recognize an...

Self-harming behaviour among adolescents, and particularly adolescent girls, has evoked much public attention. This article presents a Swedish study about what information assessment and treatment agencies have about self-harming behaviour in the form of cutting and burning in adolescent girls. The study was made on assignment by the Swedish Nation...

This article reports a study where aggression replacement training (ART), combined with token economy, was compared with relationally oriented treatment at four residential treatment units in a nonrandomized design. In all, 57 adolescents in the ages between 16 and 19 participated. Outcome was measured as weighted indices of sentences and police su...

Research on relationship aspects in residential treatment of criminal young persons has largely been neglected despite the general finding in treatment research that such aspects have a large bearing on outcome. In this article, two studies of associations between relationship aspects and outcome in this treatment context are presented. In one of t...

This study had two purposes. The first was to assess to what extent psychiatric staff members' feelings towards patients in small psychiatric units could be attributed to (a) the individual staff member's habitual feeling style, (b) stable and consistent feelings towards individual patients (the patient's evocative style) and (c) the interaction be...

The concept of burnout describes a number of destructive aspects in work relationships. In this study, the relations between psychiatric staff members' feelings towards their patients and burnout were analyzed. Staff feelings were measured with a feeling checklist, and burnout with BM (Burnout Measure) and MBI (Maslach's Burnout Inventory). The sta...

Interpersonal theory, as well as relational models of psychoanalytic and cognitive therapy, posits the importance for positive treatment outcome of the therapist's becoming emotionally involved in the patient's interpersonal patterns. Using the same data as in this study, we have previously found associations between psychiatric patients' self-imag...

Psychiatric patients' influence on therapists' feelings has received much clinical attention but scant interest among empirical researchers. In this study, the staff at 25 small psychiatric treatment units for mainly psychotic patients reported their feelings towards the patients twice a year over 5 years. At intake, the patients completed the self...

The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff me...

The idea that psychotherapists' feelings may reflect some aspect of the content in the patients' material has long been clinically accepted but on the whole poorly systematically studied. The aim of this study was to analyse associations between relationship episodes told by patients at evaluation interviews, and therapists' subsequent feelings tow...

Milieu therapists' feelings toward their patients in three treatment homes for psychotic patients were measured with a feeling word checklist. The answers were examined with regard to two feeling dimensions: helpfulness and closeness. By using a two-way ANOVA, contributions to the therapist's countertransference feelings could be separated into thr...

The concept of affect consciousness refers to the ability to perceive, reflect upon, express and respond to one's own or other individuals' affective experiences. The aim of this study was to investigate how affect consciousness and adult attachment are related. Three clinical groups (eating disorders, relational prob-lems, and stress-related probl...