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The Capacity for Self-Observation in Psychotherapy
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Förmågan till Självobservation i Psykoterapi (Swedish)
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
Keyword [en]
Self-Observation, Mentalization, Mindfulness, Affect Consciousness, Psychotherapy
Keyword [sv]
Självobservationsförmåga, Mentalisering, Medveten närvaro, Affektmedvetenhet, Psykoterapi
National Category
URN: urn:nbn:se:liu:diva-82033ISBN: 978-91-7519-797-5OAI: diva2:557559
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
List of papers
1. Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy
Open this publication in new window or tab >>Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy
2007 (English)In: Journal of the American Psychoanalytic Association, ISSN 0003-0651, Vol. 55, no 2, 629-674 p.Article in journal (Refereed) Published
Abstract [en]

Long-term follow-up studies of long-term psychoanalytically oriented psychotherapy or psychoanalysis are extremely rare, and few have focused on the post-treatment process itself. In the Stockholm Outcome of Psychoanalysis and Psychotherapy project, one of the results was that patients in psychoanalysis continued to improve after termination to a higher degree than patients in long-term psychotherapy. In this study 20 patients selected from the project were interviewed on two occas ions, one and two years after termination, in order to explore how they described their post-treatment processes. The interviews were studied qualitatively using a multiple case study design, and categories of different types of post-treatment development were created from these case studies. Results indicate that the variation within treatment groups is large, and that development may continue in several ways after termination. The most striking difference between psychoanalysis and psychotherapy was not, as hypothesized, in the self-analytic function, but in various self-supporting strategies described by former analysands but not by former psychotherapy patients. However, only self-analysis was significantly correlated with post-termination improvement across both treatments. Three patients improving after termination and three deteriorating are described in detail as illustrations. Some methodological constraints of the design limit the generalizeability of results.

National Category
Social Sciences
urn:nbn:se:liu:diva-48012 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-09-28
2. Studying mindfulness in experienced meditators: A quasi-experimental approach
Open this publication in new window or tab >>Studying mindfulness in experienced meditators: A quasi-experimental approach
2010 (English)In: PERSONALITY AND INDIVIDUAL DIFFERENCES, ISSN 0191-8869, Vol. 48, no 3, 305-310 p.Article in journal (Refereed) Published
Abstract [en]

Self-report measures were used to study mindfulness and well-being in experienced meditators in a quasi-experimental intervention study. Seventy-six experienced meditators were studied, 48 who were participating in an intensive meditation retreat in the Vipassana (insight meditation) tradition and 28 who did not. Retreat participants had scheduled meditation practice from early morning to late at night, and were encouraged to practice mindfulness throughout the whole day. The Kentucky Inventory of Mindfulness Skills (KIMS) and the Five Facet Mindfulness Questionnaire (FFMQ) were used to measure mindfulness, and the General Population version of the Clinical Outcomes in Routine Evaluation (GP-CORE) was used to measure well-being. Correlation analyses in the pre-intervention data showed that self-reported mindfulness was strongly related to well-being, with the exception for the observe subscale of FFMQ, Only the acceptance subscales were associated with meditation experience. Mindfulness increased after the retreat, but the increase was not significantly larger for retreat participants than for the control group. However. well-being increased more in the retreat group than the control group, and increase in mindfulness was associated with increase in well-being across both groups. Results are discussed in relation to previous research and methodological aspects.

Mindfulness, Meditation, Measurement, Vipassana
National Category
Engineering and Technology
urn:nbn:se:liu:diva-54252 (URN)10.1016/j.paid.2009.10.022 (DOI)000274678000009 ()
Available from: 2010-03-05 Created: 2010-03-05 Last updated: 2012-09-28
3. Reflective Functioning, Affect Consciousness, and Mindfulness: Are These Different Functions?
Open this publication in new window or tab >>Reflective Functioning, Affect Consciousness, and Mindfulness: Are These Different Functions?
Show others...
2014 (English)In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 31, no 1, 26-40 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed that purportedly measure these concepts, but little is known about their interrelationships. We discuss conceptual overlaps and distinctions between these three concepts, and present results from a preliminary empirical study comparing their measures.

Methods: To study the relationships between these concepts, data from a group of psychotherapy students (N = 46) was used. Mentalization operationalized as Reflective Functioning (RF) was rated on transcripts of a brief version of the Adult Attachment Interview, the Five Facet Mindfulness Questionnaire (FFMQ) was used to measure mindfulness, and the Affect Consciousness Interview-Self/Other version (ACI-S/O) to measure affect consciousness.

Results: There was a small but statistically significant relationship between RF and FFMQ, but surprisingly no relationship between AC-S/O and RF or FFMQ. A post-hoc analysis showed a relationship between consciousness of others’ affects and a reduced version of the RF scale.

Discussion: Results confirm that mentalization and mindfulness share some  common variance, but contrary to expectations affect consciousness seems to be more different from RF and mindfulness than expected. A possible explanation for the counterintuitive finding of no relationship between RF and affect consciousness is that affect consciousness measures a mature capacity for mentalized affectivity, while RF (especially at the high end) is largely a buffer against trauma and adversity. Low or absent findings for the FFMQ are explained more in terms of different methods variance.

Place, publisher, year, edition, pages
American Psychological Association, 2014
National Category
urn:nbn:se:liu:diva-82029 (URN)10.1037/a0034049 (DOI)000331876500003 ()
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2014-03-28Bibliographically approved
4. Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of Depression
Open this publication in new window or tab >>Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of Depression
(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.

Psychotherapy process, mentalization, reflective functioning, alliance, depression
National Category
urn:nbn:se:liu:diva-82031 (URN)
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2012-09-28Bibliographically approved

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