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Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of Depression
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: Despite considerable clinical attention to the concept of mentalization in psychotherapy, research on mentalization and the psychotherapy process is virtually absent. Using data from two ongoing randomized controlled trials of psychotherapy for depression, we studied mentalization in 45 patients diagnosed with DSM-IV Major Depressive Disorder. The initial psychotherapy process was hypothesized to be experienced as more difficult with patients showing lower capacity for mentalization because of their difficulty understanding behavior in terms of mental states.

Methods: Mentalization was measured as Reflective Functioning (RF) on the Adult Attachment Interview, conducted before therapy start. Additionally, a measure of Depression-Specific Reflective Functioning (DSRF) measuring mentalization about depressive symptoms was tested. Psychotherapy process was measured by the Working Alliance Inventory – Short form (WAI-S) and the Feeling Checklist (FC), which were completed after each session by both therapist and patient.

Results: Pre-treatment RF on the AAI was on average low (M = 3.1), but variation in RF did not predict any aspect of the initial (first four sessions) psychotherapy process. Higher DSRF predicted better working alliance and more positive feelings as rated by the patient. RF on the AAI did not predict any process measure significantly.

Discussion: The low RF in depression replicates two previous studies, and may help explaining why maternal depression is a risk factor for infant developmental problems. If the results for DSRF are replicated, this measure might be used for identifying patients who are not easy candidates for psychotherapy.

Keyword [en]
Psychotherapy process, mentalization, reflective functioning, alliance, depression
National Category
URN: urn:nbn:se:liu:diva-82031OAI: diva2:557551
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2012-09-28Bibliographically approved
In thesis
1. The Capacity for Self-Observation in Psychotherapy
Open this publication in new window or tab >>The Capacity for Self-Observation in Psychotherapy
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Förmågan till Självobservation i Psykoterapi
Abstract [en]

The phenomena of self-awareness and self-observation are thought by many to be uniquely human qualities, and questions about how they develop have engaged philosophers and spiritual thinkers throughout history. More recently these issues have come to interest psychologists, psychotherapists, and researchers of diverse clinical psychology orientations as well. This dissertation explored conceptual issues and empirical measurement methods related to self-awareness and self-observation capacities. The four studies approached this from different angles: Study I used mainly qualitative methods to study post-treatment processes related to continuing clinical improvement after termination of long-term psychotherapeutic treatments. The main finding was that self-analysis seemed to be related to continued improvement after ending of therapy, but contrary to our hypothesis there was no difference between psychotherapy and the more intensive psychoanalysis in this regard. Study II tested the measurement of mindfulness by self report in a sample of experienced Buddhist meditators. The findings confirmed relationships between mindfulness and psychological well-being, but raised doubt about the instruments’ sensitivity to change. Study III compared different methods for measuring theoretically related concepts of self-observation: mindfulness, mentalization, and affect consciousness. This study showed surprisingly little common variance between affect consciousness and mentalization/mindfulness. Finally, the results of Study IV showed that in patients diagnosed with clinical depression, mentalization about depressive symptoms predicted aspects of the initial psychotherapy process better than mentalization about attachment. Taken together, these studies show the complexity of the phenomenon of self-observation and the corresponding complexity of research on it. The relationships between variables related to self-observation, their measurements, and their relationships to the psychotherapy process seem more complex than would be expected from current theories. A model for types of self-observation in the process of change in psychotherapy is tentatively proposed.

Abstract [sv]

Förmågan till självmedvetande och självobservation brukar sägas vara unik för människan, och frågor om hur den uppstår och utvecklas har engagerat filosofer och andliga tänkare genom historien. Under de senaste årtiondena har detta även kommit att intressera psykologer, psykoterapeuter och forskare inom olika kliniska psykologiinriktningar. I denna avhandling utforskades konceptuella frågor och empiriska mätmetoder relaterade till självobservationsförmåga. De fyra studierna tog sig an detta från olika utgångspunkter: I Studie I användes främst kvalitativ metod för att undersöka processer relaterade till fortsatt klinisk förbättring efter avslutning av längre psykoterapeutisk behandling. Beskrivningar av självanalys var relaterade till fortsatt förbättring efter avslutad terapi, men i kontrast till vår hypotes syntes ingen skillnad mellan psykoterapi och den mer intensiva psykoanalysen ur denna aspekt. I Studie II prövades mätning av medveten närvaro (mindfulness) genom självrapport på ett urval erfarna Buddhistiska meditatörer. Resultaten bekräftade samband mellan medveten närvaro och psykologiskt välmående, men visade på osäkerhet kring instrumentens känslighet för förändring. I Studie III jämfördes olika metoder för mätning av teoretiskt relaterade självobservationsbegrepp: medveten närvaro, mentalisering och affektmedvetenhet. Resultaten visade på förvånansvärt liten gemensam varians mellan affektmedvetenhet och mentalisering/medveten närvaro. Slutligen visade resultaten i Studie IV att hos patienter diagnostiserade med klinisk depression predicerade mentalisering om depressiva symptom aspekter av den initiala psykoterapiprocessen bättre än det vanliga måttet på mentalisering utifrån anknytningsintervju. Sammantaget visar dessa studier på komplexiteten i fenomenet självobservationsförmåga och dess utforskande. Relationerna mellan variabler relaterade till självobservation, mätning av dem och samband med psykoterapiprocessen tycks mer komplexa än förväntat utifrån nuvarande teorier. En tentativ modell för samband mellan typer av självobservation i den psykoterapeutiska förändringsprocessen presenteras.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 56 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 560Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 168
Self-Observation, Mentalization, Mindfulness, Affect Consciousness, Psychotherapy, Självobservationsförmåga, Mentalisering, Medveten närvaro, Affektmedvetenhet, Psykoterapi
National Category
urn:nbn:se:liu:diva-82033 (URN)978-91-7519-797-5 (ISBN)
Public defence
2012-11-09, I:101, Hus I, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2012-10-04Bibliographically approved

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Falkenström, FredrikEkeblad, AnnikaSandell, RolfHolmqvist, Rolf
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