Psychotherapy patients with a lifelong pattern of poor object relations
profited more from one year of therapy with transference interpretations than
from therapy without such interpretations.
That was the finding from a unique, randomized, controlled clinical trial
of psychotherapy for depression, anxiety, personality disorders, and
interpersonal problems.
"Our study identifies a core active treatment component, transference
interpretation, with positive long-term impact on patient functioning, and
thus represents an extension of previous research," lead author Per
Høglend, M.D., Ph.D., of the Department of Psychiatry at the University
of Oslo, Norway, told Psychiatric News. "If our findings are
replicated, they may have far-reaching implications for the education of
psychotherapists and treatment of depression, anxiety, personality disorders,
and chronic, more severe interpersonal problems."
In the study 100 outpatients seeking psychotherapy for depression, anxiety,
personality disorders, or interpersonal problems were randomly assigned to
receive weekly sessions of dynamic psychotherapy for one year with or without
transference interpretations.
For the transference group, therapists used the following techniques:
In the comparison group, therapists explicitly avoided using these
techniques.
Outcome was measured by scores on the clinician-rated Psychodynamic
Functioning Scales and the self-reported Inventory of Interpersonal Problems.
Measurements were taken at baseline, mid-treatment, end of treatment, one-year
follow-up, and three-year follow-up.
The researchers hypothesized at the outset that a lifetime pattern of
object relations—as determined by the presence of a personality disorder
and scores on the Quality of Object Relations Scale (QOR)—would moderate
the effects of treatment with patients having poorer object relations
benefiting more.
What they found was that both forms of psychotherapy—with and without
transference interpretations—resulted in significant improvement during
treatment and after termination. But in keeping with their hypothesis, the
long-term effect of transference interpretations increased with lower scores
on the QOR.
This effect was sustained throughout the four-year study.
Høglend told Psychiatric News that life events and
additional treatment during the follow-up period were carefully recorded and
probably do not account for the differences between the two treatment
groups.
"On the contrary, the comparison group had more additional treatment
than the transference group," he said. He added that the study is the
first randomized, controlled trial designed to study long-term effects of
transference interpretations.
"The literature on transference is enormous—more than 8,000
articles and book chapters since Freud introduced the term in 1895," he
said. "But the empirical research on transference interpretation is
sparse. None of the studies so far used an experimental design in which only
one treatment component is experimentally manipulated. The associations
reported in passive observational studies, nonexperimental studies, are open
to several causal interpretations, rendering the research base
inconclusive."
He added that future research will try to identify the mechanism that links
transference interpretations to long-term improvement of interpersonal
functioning.
"Transference Interpretations in Dynamic Psychotherapy: Do
They Really Yield Sustained Effects?" will be posted on AJP Advance
on April 15 at<http://ajp.psychiatryonline.org/pap.dtl>
and will be in the June print edition of AJP. ▪