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Latest Paper:
Am J Psychiatry. 2008 Apr 15; : 18413707 (P,S,E,B,D) Transference Interpretations in Dynamic Psychotherapy: Do They Really Yield Sustained Effects?
 
[My paper] Per Høglend, Kjell-Petter Bøgwald, Svein Amlo, Alice Marble, Randi Ulberg, Mary Cosgrove Sjaastad, Oystein Sørbye, Oscar Heyerdahl, Paul Johansson 
Objective 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. Method This was a randomized controlled clinical trial, dismantling design, plus follow-up evaluations 1 year and 3 years after treatment termination. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were referred to the study therapists. Patients were randomly assigned to receive weekly sessions of dynamic psychotherapy for 1 year with or without transference interpretations. Five full sessions from each therapy were rated in order to document treatment fidelity. Outcome variables were the Psychodynamic Functioning Scales (clinician rated) and the Inventory of Interpersonal Problems (self-report). Rating on the Quality of Object Relations Scale (lifelong pattern) and presence of a personality disorder were postulated moderators of treatment effects. Change over time was assessed using linear mixed models. Results Despite an absence of differential treatment efficacy, both treatments demonstrated significant improvement during treatment and also after treatment termination. However, patients with a lifelong pattern of poor object relations profited more from 1 year of therapy with transference interpretations than from therapy without transference interpretations. This effect was sustained throughout the 4-year study period. Conclusions The goal of transference interpretation is sustained improvement of the patient's relationships outside of therapy. Transference interpretation seems to be especially important for patients with long-standing, more severe interpersonal problems. Am J Psychiatry. 2006 Oct ;163 (10):1739-46 17012684 (P,S,E,B,D) Analysis of the patient-therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations.
 
[My paper] Per Høglend, Svein Amlo, Alice Marble, Kjell-Petter Bøgwald, Oystein Sørbye, Mary Cosgrove Sjaastad, Oscar Heyerdahl 
OBJECTIVE: 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. METHOD: One hundred patients were randomly assigned to two groups. One group received dynamic psychotherapy over 1 year, with a moderate level of transference interpretations, while the other group received dynamic psychotherapy with no transference interpretations. The most common axis I disorders were depression and anxiety disorders. Forty-six patients fulfilled the general criteria for personality disorder. Seven experienced psychotherapists treated patients in both groups. Five full sessions from each treatment were rated by two evaluators with process measures in order to document treatment integrity. Outcome variables were the Psychodynamic Functioning Scales, Inventory of Interpersonal Problems Scale-Circumplex version, Global Assessment of Functioning Scale, and Symptom Checklist-90-R. Quality of Object Relations Scale (lifelong pattern) and personality disorders were preselected as possible moderators of treatment effects. Change was assessed using linear-mixed models. Clinically significant change was also calculated. RESULTS: The authors could not demonstrate differential treatment effects between the groups. However, the moderator analyses showed that transference interpretations were more helpful for patients with a lifelong history of less mature object relations. Small negative effects were observed for patients with mature object relations. CONCLUSIONS: The authors could not show differences in average effectiveness between treatments. However, the moderator analyses indicated that treatment worked through different active ingredients for different patients. Contrary to common expectation, patients with poor object relations profited more from therapy with transference interpretations than from therapy with no transference interpretations. 
Mesh-terms: Adult; Comparative Study; Female; Humans; Interpersonal Relations; Male; Object Attachment; Personality Inventory; Physician-Patient Relations; Psychiatric Status Rating Scales :: statistics & numerical data; Psychoanalytic Therapy; Psychotherapeutic Processes; Psychotherapy :: methods; Psychotherapy, Brief; Research Support, Non-U.S. Gov't; Severity of Illness Index; Transference (Psychology); Treatment Outcome; J Clin Psychol. 2005 Dec ;61:1541-53 16193478 (P,S,E,B) Predictors of change after long-term analytic group psychotherapy.
 
[My paper] Steinar Lorentzen, Per Høglend 
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, and Chief Complaints), assessed after termination of therapy. In this study, we wanted to test whether the same variables also predicted patients' status at follow-up, 1 year after termination. Bivariate correlations and multiple regression analyses were used. Initial status and treatment duration up to 2.5 years turned out to be strong positive predictors of status at both time points. Contrary to findings from many short-term studies, presence of personality disorder, high initial severity, chronicity, and less optimistic expectations had no predictive power at either time. Higher age predicted a less favourable status at follow-up in secondary exploratory analyses. The findings suggest that different patients may benefit from long-term versus short-term group psychotherapy. More studies should examine patient aptitude and the significance of the time factor (Aptitude-Treatment Interaction [ATI-effects]). Am J Psychother. 2004 ;58 (3):349-61 15675257 (P,S,E,B) Is there an optimal adjustment of interpretation to the patients' level of defensive functioning?
 
[My paper] Anne Grete Hersoug, Per Høglend, Kjell-Petter Bøgwald 
Department of Psychiatry, University of Oslo, Norway. a.g.hersoug@psykiatri.uio.no
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 was assumed to be an optimal Adjustment Ratio in relation to patients' defensive functioning, was associated with lower quality of working alliance, whereas what was assumed to be a poor Adjustment Ratio was associated with a more favorable alliance. The general finding was that when relatively more supportive interventions were given to patients with higher ODF, the working alliance was improved. Implications of the findings are discussed. 
Mesh-terms: Adult; Analysis of Variance; Defense Mechanisms; Female; Humans; Male; Mental Disorders :: diagnosis; Mental Disorders :: psychology; Mental Disorders :: therapy; Middle Aged; Norway; Observer Variation; Predictive Value of Tests; Professional-Patient Relations; Psychiatric Status Rating Scales; Psychotherapy, Brief :: methods; Research Support, Non-U.S. Gov't; Self Assessment (Psychology); Severity of Illness Index; Transference (Psychology); Treatment Outcome; J Psychosom Res. 2004 Jul ;57 (1):103-11 15256302 (P,S,E,B) A 7-year prospective quasi-experimental study of the effects of removing dental amalgam in 76 self-referred patients compared with 146 controls.
 
[My paper] Per Nerdrum, Ulrik Fredrik Malt, Per Høglend, Bjørn Oppedal, Roger Gundersen, Martin Holte, Jostein Löne 
Oslo University College, Pilestredet 56, 0167 Oslo, Norway. per.nerdrum@oks.hio.no
BACKGROUND: 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. PURPOSE: To investigate the long-term effects of removal of dental amalgam on physical and mental symptoms in self-referred patients who complained of multiple somatic and mental symptoms attributed to dental amalgam fillings. METHODS: In a quasi experimental study, changes in the mental and physical symptoms in 76 patients who had their dental amalgam removed 7 years ago were compared with changes in symptoms among patients with known chronic medical disorders seen in alternative (n=51) and ordinary (n=51) medical family practices and noncomplaining patients with similar amounts of dental amalgam fillings (n=44) seen in an ordinary dental practice. The assessments included written self-reports, a 131-item somatic symptom checklist, Eysenck Personality Questionnaire (EPQ), the General Health Questionnaire (GHQ) and Toronto Alexithymia Scale (TAS). RESULTS: Subjects who removed their dental amalgam reported reduced physical and mental symptom load compared to status prior to removal, but only to a level comparable with that reported by the other groups with chronic medical disorders. The dental control group consistently reported lower symptom load during the whole period. In a hierarchical three-step regression model, pretreatment physical symptom load (P<.01), age (P<.10) and removal of dental amalgam (ns) predicted 26% of the variance in posttreatment physical symptom load. CONCLUSION: In a self-referred group of subjects with health complaints attributed to dental amalgam who remove their dental amalgam, the symptom load at follow-up corresponds to the level seen in chronic medical disorders despite the strong implicit placebo effect of the present quasi-experimental design. The finding does not support the hypothesis that removal of dental amalgam will reduce health complaints to normal levels and seriously questions the hypothesis that dental amalgam is an important cause of distress and health complaints. 
Mesh-terms: Adolescent; Adult; Affective Symptoms :: diagnosis; Affective Symptoms :: epidemiology; Aged; Attitude to Health; Dental Amalgam :: adverse effects; Dental Restoration, Permanent :: psychology; Fatigue :: diagnosis; Fatigue :: etiology; Female; Health Status; Humans; Male; Middle Aged; Mood Disorders :: diagnosis; Mood Disorders :: epidemiology; Personality Inventory; Prospective Studies; Psychometrics :: methods; Research Support, Non-U.S. Gov't; Sick Role; Somatoform Disorders :: diagnosis; Somatoform Disorders :: epidemiology; Nord J Psychiatry. 2004 ;58 (1):33-40 14985152 (P,S,E,B) Therapeutic alliance, cohesion and outcome in a long-term analytic group. A preliminary study.
 
[My paper] Steinar Lorentzen, Harold C Sexton, Per Høglend 
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 a steady increase in the alliance ratings by patients and therapist during the first 2 years of therapy. This differs from findings in short-term therapies, where the alliance quickly reaches a high level and then remains stable throughout therapy. Therapist ratings of early alliance correlated significantly with positive symptomatic outcome, but did not predict interpersonal change. Patients' alliance ratings did not predict change. Early cohesion ratings did not predict change. The concordance between the patients' and the therapist's alliance ratings was highest between 16 and 30 sessions, and was essentially maintained throughout therapy. An early concordance of patient and therapist alliance ratings predicted a better symptomatic outcome. The measures of therapeutic alliance and cohesion used in this study seem to address different elements in the group process. 
Mesh-terms: Adult; Cooperative Behavior; Depression :: diagnosis; Depression :: therapy; Female; Follow-Up Studies; Human; Interpersonal Relations; Male; Middle Aged; Outcome Assessment (Health Care); Patient Care Team; Physician-Patient Relations; Psychoanalytic Therapy; Questionnaires; Support, Non-U.S. Gov't; Tidsskr Nor Laegeforen. 2004 Jan 22;124 (2):223; author reply 223 14743248 (P,S,E,B) [Sexual child abuse]
 
[My paper] Einar Kringlen, Per Høglend 
Mesh-terms: Adaptation, Psychological; Child; Child Abuse, Sexual :: psychology; Humans; Personality Development; Research Design; Psychother Psychosom. ;73 (1):25-35 14665793 (P,S,E,B) Predictors of Change during Long-Term Analytic Group Psychotherapy.
 
[My paper] Steinar Lorentzen, Per Høglend 
Psychiatric Institute, University of Oslo, Oslo, Norway.
BACKGROUND: 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). METHODS: Based on results from research on short-term groups, we selected 6 predictor variables representing central domains (demographics, diagnosis, initial severity of disturbance, chronicity, expectancy, and treatment duration) and explored their relationship with 5 outcome variables (Global Assessment of Functioning, Global Severity Index, Inventory of Interpersonal Problems-Circumplex, global improvement, and chief complaints) by multiple regression analyses. RESULTS: Treatment duration up to 2.5 years was a strong positive predictor. Contrary to findings from many short-term studies, the presence of personality disorder, chronicity, and high initial severity of symptoms were not associated with less favourable outcome. Furthermore, marital status was not a positive predictor, and expectancy of a better outcome was only positively related to 1 of the outcome variables. Highly tentative results from exploratory stepwise regression analyses indicated that interpersonal problems on the subscale of 'coldness' might also be a negative predictor in long-term therapy. CONCLUSIONS: The study indicates that predictors of outcome in long-term group therapy may be different from those found in short-term therapy. 
Mesh-terms: Adult; Demography; Female; Human; Male; Mental Disorders :: therapy; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Psychiatric Status Rating Scales; Psychotherapy, Group; Severity of Illness Index; Support, Non-U.S. Gov't; Treatment Outcome; Tidsskr Nor Laegeforen. 2003 Oct 23;123 (20):2918; author reply 2918 14600728 (P,S,E,B) [Sexual abuse of children]
 
[My paper] Einar Kringlen, Per Høglend 
Mesh-terms: Adaptation, Psychological; Child; Child Abuse, Sexual :: psychology; Humans; Meta-Analysis; Personality Development; Research Design; Am J Psychother. 2002 ;56 (4):539-54 12520889 (P,S,E,B) Contribution of defensive functioning to the quality of working alliance and psychotherapy outcome.
 
[My paper] Anne Grete Hersoug, Harold C Sexton, Per Høglend 
Department of Psychiatry, University of Oslo, P.O. Box 85, Vinderen, N-0319 Oslo, Norway. a.g.hersoug@psykiatri.uio.no
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 defensive functioning (ODF) as rated by DMRS changed significantly. We found that the initial ODF's neither predicted the quality of working alliance nor influenced the outcome. Symptoms improved most rapidly early in therapy, while defenses changed during the last half of therapy, consistent with the phase model of change. 
Mesh-terms: Adaptation, Psychological; Adult; Anxiety Disorders :: psychology; Anxiety Disorders :: therapy; Defense Mechanisms; Female; Human; Male; Personality Disorders :: psychology; Personality Disorders :: therapy; Professional-Patient Relations; Psychotherapy :: methods; Psychotherapy :: standards; Questionnaires; Support, Non-U.S. Gov't; © BioInfoBank Institute     
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