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Holmqvist, Rolf
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Publications (10 of 63) Show all publications
Holmqvist Larsson, M., Falkenström, F., Andersson, G. & Holmqvist, R. (2018). Alliance ruptures and repairs in psychotherapy in primary care. Psychotherapy Research, 28(1), 123-136
Open this publication in new window or tab >>Alliance ruptures and repairs in psychotherapy in primary care
2018 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 28, no 1, p. 123-136Article in journal (Refereed) Published
Abstract [en]

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 care, and if three alliance patterns (a Rupture pattern, a Repair pattern, and a No Rupture pattern) were differentially associated with treatment outcome.

METHOD: The psychotherapies (N = 605) included a wide range of different treatment orientations and patient diagnoses. Alliance patterns were studied at session-to-session level, using patient-rated alliance scores. Outcome data were analyzed using longitudinal multilevel modeling with a slopes-as-outcomes model.

RESULTS: The Repair pattern accounted for 14.7% (n = 89) of the treatments, 10.7% (n = 65) exhibited a Rupture pattern, and 74.5% (n = 451) contained no ruptures. The Rupture pattern was associated with inferior treatment outcomes. The Repair pattern was, in longer treatments, associated with better outcomes than the No Rupture pattern.

CONCLUSIONS: The results support theory about the importance of ruptures in the therapeutic alliance and suggest that identification of alliance ruptures is important in alliance-outcome research, for feedback purposes in clinical practice, and in training of therapists.

Place, publisher, year, edition, pages
Routledge, 2018
Keyword
alliance, alliance patterns, alliance ruptures, longitudinal multilevel modeling, naturalistic process and outcome research
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143855 (URN)10.1080/10503307.2016.1174345 (DOI)000418942800011 ()27139816 (PubMedID)2-s2.0-84965032354 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-12Bibliographically approved
Keselman, H., Osvaldsson Cromdal, K., Kullgard, N. & Holmqvist, R. (2018). Responding to mentalization invitations in psychotherapy sessions: A conversation analysis approach. Psychotherapy Research
Open this publication in new window or tab >>Responding to mentalization invitations in psychotherapy sessions: A conversation analysis approach
2018 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381Article in journal (Refereed) Published
Abstract [en]

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 therapy that aimed at increasing the patients mentalizing capacity were identified and studied using conversation analysis. 

Results: The analysis indicated that resistance to mentalizing may not only be due to lack of capacity but also may be seen as a linguistic resource in which this resistance demonstrates precisely the ability to mentalize. 

Conclusions: Consequences for psychotherapy practice and process research are discussed.

Place, publisher, year, edition, pages
Routledge, 2018
Keyword
qualitative research methods, process research, philosophical/theoretical issues in therapy research, psychoanalytic/psychodynamic therapy
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-141589 (URN)10.1080/10503307.2016.1219422 (DOI)000432559000013 ()27580952 (PubMedID)2-s2.0-84984677265 (Scopus ID)
Available from: 2017-10-02 Created: 2017-10-02 Last updated: 2018-06-04Bibliographically approved
Nissen-Lie, H. A., Goldberg, S. B., Hoyt, W. T., Falkenström, F., Holmqvist, R., Nielsen, S. L. & Wampold, B. E. (2016). Are Therapists Uniformly Effective Across Patient Outcome Domains? A Study on Therapist Effectiveness in Two Different Treatment Contexts. Journal of counseling psychology, 63(4), 367-378
Open this publication in new window or tab >>Are Therapists Uniformly Effective Across Patient Outcome Domains? A Study on Therapist Effectiveness in Two Different Treatment Contexts
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2016 (English)In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 63, no 4, p. 367-378Article in journal (Refereed) Published
Abstract [en]

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 examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patients change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct.

Place, publisher, year, edition, pages
AMER PSYCHOLOGICAL ASSOC, 2016
Keyword
therapist effects; therapist uniformity; multilevel factor analysis
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-130661 (URN)10.1037/cou0000151 (DOI)000380110100001 ()27124549 (PubMedID)
Available from: 2016-08-20 Created: 2016-08-19 Last updated: 2017-11-28
Holmqvist, R., Philips, B. & Mellor-Clark, J. (2016). Client and therapist agreement about the clients problemsAssociations with treatment alliance and outcome. Psychotherapy Research, 26(4), 399-409
Open this publication in new window or tab >>Client and therapist agreement about the clients problemsAssociations with treatment alliance and outcome
2016 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 26, no 4, p. 399-409Article in journal (Refereed) Published
Abstract [en]

Objective: A shared understanding of the patients 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 patients problems and outcome. The purpose of the present study was to analyze whether agreement in the understanding of the patients depression and anxiety problems was important for alliance and outcome. Method: The study used data from a practice-based study using the CORE system with 846 patients who received psychological treatment in primary care. Results: The analyses indicated that although patients who were assessed by their therapists as having depression and anxiety problems scored higher on these subscales than other patients, about half of the patients reported such problems when the therapists did not, and vice versa. Agreement was not associated with better alliance or outcome. Conclusions: Productive collaboration in psychotherapy may be based on other factors than agreement about symptoms.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2016
Keyword
outcome research; alliance; agreement about problems; therapeutic collaboration
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-130673 (URN)10.1080/10503307.2015.1013160 (DOI)000380056300003 ()25751451 (PubMedID)
Available from: 2016-08-20 Created: 2016-08-19 Last updated: 2017-11-28
Mechler, J. & Holmqvist, R. (2016). Deteriorated and unchanged patients in psychological treatment in Swedish primary care and psychiatry. Nordic Journal of Psychiatry, 70(1), 16-23
Open this publication in new window or tab >>Deteriorated and unchanged patients in psychological treatment in Swedish primary care and psychiatry
2016 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 1, p. 16-23Article in journal (Refereed) Published
Abstract [en]

Background: 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 than patients in primary care. Aims: In this practice-based study of psychological treatment in Swedish primary care and adult psychiatry, the proportions of patients who did not improve and who deteriorated were assessed. Methods: Proportions of reliably improved, unchanged, and reliably deteriorated patients among 840 patients in primary care and 317 patients in specialist psychiatry were assessed by self-ratings using the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM). Results: More than half of the patients did not change reliably. About 2% of the patients in primary care and 7% in psychiatry deteriorated. Multilevel analyses of the data from primary care indicated that there were no therapist effects. Conclusions: The results emphasize the importance of monitoring treatment continuously in order to increase results for patients who do not improve.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keyword
Adult specialist psychiatry; Deteriorated; Primary care; Treatment outcome; Unchanged
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-124092 (URN)10.3109/08039488.2015.1028438 (DOI)000365719100003 ()25994483 (PubMedID)
Available from: 2016-01-25 Created: 2016-01-19 Last updated: 2018-01-10
Falkenström, F., Josefsson, A., Berggren, T. & Holmqvist, R. (2016). How Much Therapy Is Enough? Comparing Dose-Effect and Good-Enough Models in Two Different Settings. Psychotherapy, 53(1), 130-139
Open this publication in new window or tab >>How Much Therapy Is Enough? Comparing Dose-Effect and Good-Enough Models in Two Different Settings
2016 (English)In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 53, no 1, p. 130-139Article in journal (Refereed) Published
Abstract [en]

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 decide on ending treatment when treatment outcome is satisfactory, meaning that patients who change faster will have shorter treatments. If true, this means that aggregating among patients with different treatment lengths would yield biased results. Most previous research has shown that symptom change rate depends on treatment length, but all of these studies used data from University counseling centers in the United States. There is a need to test if previous results hold in different settings. Two datasets from Swedish community-based primary care (n = 640) and psychiatric care (n = 284) were used. Patients made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel models indicated better fit for a model in which treatment length moderated symptom change rate. In the primary care sample, patients in longer treatments achieved more symptom change from pre- to posttreatment, despite having slower rate of improvement. The most important aspect of the GEL model was supported, and no evidence was found for a negatively accelerating Dose-Effect curve. Results cannot be generalized beyond about 12 sessions, due to scarcity of data for longer treatments.

Place, publisher, year, edition, pages
AMER PSYCHOLOGICAL ASSOC, DIV PSYCHOTHERAPY, 2016
Keyword
psychotherapy; naturalistic research; outcome research; GEL model; Dose-Effect
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-126834 (URN)10.1037/pst0000039 (DOI)000371345200013 ()26928273 (PubMedID)
Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2018-01-10
Ekeblad, A., Falkenström, F. & Holmqvist, R. (2016). Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression. Journal of Consulting and Clinical Psychology, 84(1), 67-78
Open this publication in new window or tab >>Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression
2016 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 84, no 1, p. 67-78Article in journal (Refereed) Published
Abstract [en]

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 85 outpatients with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders. It was hypothesized that patients showing lower capacity for mentalization would experience poorer quality of alliance and worse outcome. Method: Depressive symptoms were measured each session using the Beck Depression Inventory-II. Mentalization was measured as reflective functioning (RF) on a slightly shortened version of the Adult Attachment Interview. A measure of depression-specific reflective functioning (DSRF), measuring mentalization about depressive symptoms, was also used. The Working Alliance Inventory-Short Form Revised was completed after each session by both therapist and patient. Longitudinal multilevel modeling was used to analyze data. Results: The patients had on average very low RF (M = 2.62, SD = 1.22). Lower pretreatment RF/DSRF predicted significantly lower therapist-rated working alliance during treatment. RF did not affect patient-rated alliance, but lower DSRF predicted lower patient-rated alliance across treatment. Patients with higher RF/DSRF had better outcomes on self-rated depression. Conclusions: The findings showed lower than normal capacity for mentalization in patients with MDD. Lower RF/DSRF predicted worse treatment outcome. More research is needed to understand how RF affects psychotherapy response and how RF is affected after recovery from depression.

Place, publisher, year, edition, pages
AMER PSYCHOLOGICAL ASSOC, 2016
Keyword
psychotherapy process; mentalization; reflective functioning; working alliance; major depression
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-124490 (URN)10.1037/ccp0000055 (DOI)000367426900006 ()26594944 (PubMedID)
Note

Funding Agencies|Rehsam Fund [2010/013]; Swedish Research Council for Health, Working Life and Welfare [2013-0203]; L. J. Boethius Research Fund; Emil Andersson Research Fund

Available from: 2016-02-02 Created: 2016-02-01 Last updated: 2018-01-10
Lingiardi, V., Holmqvist, R. & Safran, J. D. (2016). RELATIONAL TURN AND PSYCHOTHERAPY RESEARCH. Contemporary psychoanalysis, 52(2), 275-312
Open this publication in new window or tab >>RELATIONAL TURN AND PSYCHOTHERAPY RESEARCH
2016 (English)In: Contemporary psychoanalysis, ISSN 0010-7530, E-ISSN 2330-9091, Vol. 52, no 2, p. 275-312Article in journal (Refereed) Published
Abstract [en]

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 particularly problematic. In this article we highlight the potential synergy between relational thinking and todays psychotherapy research, by exploring some of the ways in which the work of relational authors has influenced relational psychotherapy research, shifting the focus of study from validation of the models of treatment to the study of the clinical variables such as: countertransference, therapist empathy, self-disclosure, rupture and resolution in therapeutic alliance, intersubjective negotiation, and the patient-therapist attachment relationship. In conclusion, the aim of this article is to facilitate the dialogue between relational psychoanalysis and the field of psychotherapy research, by exploring ways in which these two different worlds can reciprocally stimulate and enrich one another.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2016
Keyword
psychoanalysis; psychotherapy research; relational turn; attachment; therapeutic alliance; intersubjective negotiation
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-130312 (URN)10.1080/00107530.2015.1137177 (DOI)000378719300005 ()
Available from: 2016-07-31 Created: 2016-07-28 Last updated: 2017-11-28
Falkenström, F., Hatcher, R. L. & Holmqvist, R. (2015). Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory-Short Form Revised. Assessment (Odessa, Fla.), 22(5), 581-593
Open this publication in new window or tab >>Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory-Short Form Revised
2015 (English)In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 22, no 5, p. 581-593Article in journal (Refereed) Published
Abstract [en]

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. In two confirmatory factor analyses of the WAI-SR, approximate fit indices were within commonly accepted norms, but the likelihood ratio chi-square test showed significant ill-fit. The present study used Bayesian structural equations modeling with zero mean and small variance priors to test the factor structure of the WAI-SR in three different samples (one American and two Swedish; N = 235, 634, and 234). Results indicated that maximum likelihood confirmatory factor analysis showed poor model fit because of the assumption of exactly zero residual correlations. When residual correlations were estimated using small variance priors, model fit was excellent. A two-factor model had the best psychometric properties. Strong measurement invariance was shown between the two Swedish samples and weak factorial invariance between the Swedish and American samples. The most important limitation concerns the limited knowledge on when the assumption of residual correlations being small enough to be considered trivial is violated.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2015
Keyword
Working Alliance Inventory; confirmatory factor analysis; Bayesian structural equations modeling; measurement invariance
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-121733 (URN)10.1177/1073191114552472 (DOI)000360791000004 ()25271007 (PubMedID)
Note

Funding Agencies|Swedish Research Council for Health, Working Life and Wellfare [2013-0203]

Available from: 2015-10-06 Created: 2015-10-05 Last updated: 2018-01-11
Holmqvist, R., Philips, B. & Barkham, M. (2015). Developing practice-based evidence: Benefits, challenges, and tensions. Psychotherapy Research, 25(1), 20-31
Open this publication in new window or tab >>Developing practice-based evidence: Benefits, challenges, and tensions
2015 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 25, no 1, p. 20-31Article in journal (Refereed) Published
Abstract [en]

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 important questions in psychotherapy research, like orientation differences, the importance of the therapist factor, number of sessions needed for clinical effect, and the alliance-outcome question. Obstacles and challenges in making such studies are illustrated. In conclusion, arguments are put forward for introducing a common measurement system that strikes a balance between clinicians' questions and the need for comparable data, and that encompasses the complexities of patients' reasons for seeking psychological help.

Place, publisher, year, edition, pages
Routledge, 2015
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104747 (URN)10.1080/10503307.2013.861093 (DOI)000345502700003 ()24283264 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2018-03-09Bibliographically approved
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