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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, transference interpretation, and alliance is estimated. Method: One hundred outpatients seeking psychotherapy for depression, anxiety, and personality disorders were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment, but without the use of transference interpretation. Quality of Object Relations (QOR)--lifelong pattern was evaluated before treatment (P. Hoglend, 1994). The Working Alliance Inventory (A. O. Horvath & L. S. Greenberg, 1989; T. J. Tracey & A. M. Kokotovic, 1989) was rated in Session 7. The primary outcome variable was the Psychodynamic Functioning Scales (P. Hoglend et al., 2000), measured at pretreatment, posttreatment, and 1 year after treatment termination. Results: A significant Treatment Group x Quality of Object Relations x Alliance interaction was present, indicating that alliance had a significantly different impact on effects of transference interpretation, depending on the level of QOR. The impact of transference interpretation on psychodynamic functioning was more positive within the context of a weak therapeutic alliance for patients with low quality of object relations. For patients with more mature object relations and high alliance, the authors observed a negative effect of transference work. Conclusion: The specific effects of transference work was influenced by the interaction of object relations and alliance, but in the direct opposite direction of what is generally maintained in mainstream clinical theory. (Contains 1 table and 2 figures.)

Objective: 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. Method: This study is a randomized clinical trial with a dismantling design. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment with the same therapists but without the use of transference interpretation. Interpersonal functioning and insight were measured pretreatment, posttreatment, and 1 year and 3 years after treatment termination. Results: Contrary to common expectation, patients with a life-long pattern of low quality of object relations and personality disorder pathology profited more from therapy with transference interpretation than from therapy with no transference interpretation. This long-term effect was mediated by an increase in the level of insight during treatment. Conclusions: Insight seems to be a key mechanism of change in dynamic psychotherapy. Our results bridge the gap between clinical theory and empirical research. (Contains 3 tables and 4 figures.)

Objective: 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. Method: This study is a randomized clinical trial with a dismantling design. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment with the same therapists but without the use of transference interpretation. Interpersonal functioning and insight were measured pretreatment, posttreatment, and 1 year and 3 years after treatment termination. Results: Contrary to common expectation, patients with a life-long pattern of low quality of object relations and personality disorder pathology profited more from therapy with transference interpretation than from therapy with no transference interpretation. This long-term effect was mediated by an increase in the level of insight during treatment. Conclusions: Insight seems to be a key mechanism of change in dynamic psychotherapy. Our results bridge the gap between clinical theory and empirical research. Keywords: dynamic psychotherapy, transference interpretation, insight, long-term outcome DOI: 10.1037/a0019245

Exploration of the patient-therapist relationship (transference 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 transference work in the context of patients' quality of object relations (QOR) and therapists' self-reported disengaged feelings. Therapists' disengaged feelings may negatively influence the therapeutic process, especially while working explicitly with the transference since discussing feelings that are present in the session is an essential aspect of transference work. One hundred outpatients seeking psychotherapy for depression, anxiety and personality disorders were randomly assigned to one year of dynamic psychotherapy with transference work or to the same type and duration of treatment, but without transference work. Patients' QOR-lifelong pattern was evaluated before treatment and therapists' feelings were assessed using the Feeling Word Checklist-58 after each session. Outcome was measured with self-reports and interviews at pre-treatment, mid-treatment, post-treatment, one year and three years after treatment termination. A significant interaction of treatment group (transference work versus no transference work) by QOR by disengaged therapist feelings was present, indicating that disengaged feelings, even small amounts, were associated with negative long-term effects of transference work, depending on QOR Scale scores. The strengths of the negative association increased significantly with lower levels of QOR. The negative association between even a small increase in disengaged therapist feelings and long-term effects of transference interpretation was substantial for patients with poor QOR, but small among patients with good QOR. Copyright © 2016 John Wiley & Sons, Ltd. 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 especially so for patients with a history of poor, non-mutual and complicated relationships., For patients with a history of reciprocal, sound relationships the negative influence of therapists' disengaged countertransference is minimal., Higher therapist disengagement is strongly related to inferior therapists' skill for patients with a history of poor relationships and/or more personality disorder pathology., Training and supervision should provide direct feedback and focus on therapists' internal thought processes and emotional reactions., Therapists need to recognize and understand their feelings and attitudes in order to use the countertransference as a tool to understand the interpersonal process in therapy. [ABSTRACT FROM AUTHOR]

Background: 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 psychotherapy. Adequate process scales are needed to identify and analyze in-session effects of therapist techniques in psychodynamic psychotherapy and empirically establish their links to outcome. TWS was constructed to identify and categorize relational (transference) interventions, and explore the in-session impact of analysis of the patient-therapist relationship (transference work). TWS has sub scales that rate timing, content, and valence of the transference interventions, as well as response from the patient. Methods: Descriptions and elaborations of the items in TWS are provided. Clinical examples of transference work from the First Experimental Study of Transference Interpretations (FEST) are included and followed by examples of how to rate transcripts from therapy sessions with TWS. Results: The present manual describes in detail the rating procedure when using Transference Work Scale. Ratings are illustrated with clinical examples from FEST. Conclusion: TWS might be a potentially useful tool to explore the interaction of timing, category, and valence of transference work in predicting in-session patient response as well as treatment outcome. TWS might prove especially suitable for intensive case studies combining quantitative and narrative data. Trial registry name: First Experimental Study of Transference-interpretations (FEST307/95). Registration number: ClinicalTrials.gov Identifier: NCT00423462. URL: http://clinicaltrials.gov/ct2/show/NCT00423462?term=FEST&rank=2. [ABSTRACT FROM AUTHOR]

Objetivo: El propósito de este estudio era medir el efecto de la interpretación de la transferencia (supuesto ingrediente activo esencial) en la psicoterapia dinámica, utilizando un diseño experimental. Método Se asignaron al azar 100 pacientesa dos grupos Un grupo recibió psicoterapia dinámica durante 1 año, con un nivel moderado de interpretatión de la transferencia, mientras que el otro grupo recibió psicoterapia dinámica sin interpretación de la transferencia. Los trastornos del Eje I más frecuentes fueron la depresón y los trastornos de ansiedad. Cuarenta y seis pacientes cumplían los criterios generales para un trastorno de la personalidad. Siete psicoterapeutas con experiencia llevaron a cabo el tratamiento delos pacientes de ambos grupos, Dos evaluadores puntuaron cinco sesiones completas de cada uno de los tratamientos con medidas de proceso para oomprobar la integridad del tratamiento. Los criterios de valoración fueron las Psychodynamic Functioning Scales, el Inventory of Interpersonal Problems Scale-Circumplex version, la Escala de Evaluación Global de la Actividad y el Listado de Síntomas-90-R Se preseleccionaron la Quality of Object Relations Scale (patrón durante toda la vida) y los trastornos de la personalidad como posibles moderadores de los efectos de tratamiento. El cambio se evaluó utilizando modelos lineales mixtos Tambien se calculo el cambio clínicamente significativo. Resultados: Los autores no pudieron demostrar efectos de tratamiento diferentes entre los grupos. Sin embargo, el análisis de los moderadores mostró que la interpretación de la transferencia fue de mayor utilidad en pacientes con antecedentes de relaciones objetales menos maduras durante toda la vida. Se observaron efectos negativos de poca importancia en pacientes con relaciones objetales maduras. Conclusiones: Los autores no pudieron demostrar diferencias en la eficacia real media entre tratamientos. Sin embargo, los análisis de los moderadores indicaban que el tratamiento actuó sobre diferentes componentes activos en los diferentes pacientes, En contra de lo que cabía esperar, los pacientes con retaciones objetales deficientes se beneficiaron más de la terapia con interpretación de la transferencia que de la terapia sin ella. [ABSTRACT FROM AUTHOR]

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 I 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. [ABSTRACT FROM AUTHOR]

Objetivo: La interpretación de la transferencia continúa siendo un componente fundamental en la tradición psicodinámica, a pesar de la reducida demostración empírica de su efectividad. En este estudio, los autores analizaron los efectos a largo plazo de las interpretaciones de la transferencia. Método: Se trata de un ensayo comparativo y aleatorizado, de diseño desmantelado, más evaluaciones de seguimiento al cabo de 1 y 3 años de finalizar el tratamiento. Cien pacientes en régimen ambulatorio que solicitaron psicoterapia por depresión, ansiedad, trastornos de la personalidad y problemas interpersonales fueron derivados a los terapeutas del estudio. Los pacientes fueron asignados aleatoriamente a recibir sesiones con frecuencia semanal de psicoterapia dinámica durante 1 año con interpretaciones de la transferencia y sin ellas. Se evaluaron cinco sesiones completas de cada terapia para corroborar la fidelidad al tratamiento. Los criterios de valoración fueron las Escalas de Funcionamiento Psicodinámico (Psychodynamic Functioning Scales) (puntuadas por el médico) y el Cuestionario de Problemas Interpersonales (Inventory of Interpersonal Problems) (autoevaluación). Se presupuso que las puntuaciones en la Escala de Calidad de las Relaciones Objetales (Quality of Object Relations Scale) (patrón a lo largo de la vida) y la presencia de algún trastorno de la personalidad eran variables moderadoras de los efectos del tratamiento. El cambio a lo largo del tiempo se evaluó utilizando modelos lineales mixtos. Resultados: A pesar de no haber diferencias en la eficacia de los tratamientos, ambos tratamientos demostraron una mejoría significativa durante su aplicación y también después de finalizarlos. Sin embargo, los pacientes con un patrón de peores relaciones objetales a lo largo de la vida se beneficiaron más del año de terapia con interpretaciones de la transferencia que de la terapia sin interpretaciones de la transferencia. Este efecto se mantuvo a lo largo del período de estudio de 4 años. Conclusiones: El objetivo de la interpretación de la transferencia es mantener la mejoría de las relaciones del paciente fuera de la terapia. La interpretación de la transferencia parece especialmente importante en los pacientes que presentan problemas interpersonales de larga duración y más graves. [ABSTRACT FROM AUTHOR]