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Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders

Published online by Cambridge University Press:  16 April 2020

P. Høglend ,
H.-S. Dahl ,
A.G. Hersoug ,
S. Lorentzen  and
J.C. Perry
P. Høglend*
Affiliation:
Department of psychiatry, University of Oslo, PO Box 85, Vinderen, 0319 Oslo, Norway
H.-S. Dahl
Affiliation:
Department of psychiatry, University of Oslo, PO Box 85, Vinderen, 0319 Oslo, Norway
A.G. Hersoug
Affiliation:
Department of psychiatry, University of Oslo, PO Box 85, Vinderen, 0319 Oslo, Norway
S. Lorentzen
Affiliation:
Department of psychiatry, University of Oslo, Aker University Hospital, Sognsvannsveien 21, 0372 Oslo, Norway
J.C. Perry
Affiliation:
Psychotherapy research Institute of Community and Family Psychiatry, McGill University, Montreal, Quebec H3T 1E4, Canada
*
⁎Corresponding author. Tel.: +4722029960; fax: +4722495861. E-mail address: p.a.hoglend@medisin.uio.no
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Abstract

Background

Only a few treatment studies of personality disorders (PD) patients are on longer-term psychotherapy, general outcome measures are used, and follow-up periods are usually short. More studies of long-term therapies, using outcome measures of core psychopathology, are needed.

Method

This study is a dismantling randomized controlled clinical trial, specifically designed to study long-term effects of transference interpretation. Forty-six patients with mainly cluster C personality disorders were randomly assigned to 1 year of dynamic psychotherapy with or without transference interpretations. The outcome measures were remission from PD, improvement in interpersonal functioning, and use of mental health resources in the 3-year period after treatment termination.

Results

After therapy with transference interpretation PD-patients improved significantly more in core psychopathology and interpersonal functioning, the drop-out rate was reduced to zero, and use of health services was reduced to 50%, compared to therapy without this ingredient. Three years after treatment termination, 73% no longer met diagnostic criteria for any PD in the transference group, compared to 44% in the comparison group.

Conclusions

PD-patients with co-morbid disorders improved in both treatment arms in this study. However, transference interpretation improved outcome substantially more. Long-term psychotherapy that includes transference interpretation is an effective treatment for cluster C personality disorders and milder cluster B personality disorders.

Keywords

Personality disordersPsychotherapyLong-term outcome
Type
Original article
Information
European Psychiatry , Volume 26 , Issue 7 , October 2011 , pp. 419 - 424
Copyright
Copyright © European Psychiatric Association 2010

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References

Alden, L.Short-term structured treatment for avoidant personality disorder. J Consult Clin Psychol 1989; 56: 756–764CrossRefGoogle Scholar
Alnaes, R.Torgersen, S.The relationship between DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population. Acta Psychiatr Scand 1988; 78: 485–492CrossRefGoogle Scholar
Arnevik, E.Wilberg, T.Urnes, Ø.Johansen, M.Monsen, J.T.Karterud, S.Psychotherapy for personality disorders: short-term day hospital psychotherapy versus outpatient individual therapy – a randomized controlled study. Eur Psychiatry 2009; 24(2):71–78CrossRefGoogle ScholarPubMed
Bender, D.S.Dolan, R.T.Skodol, A.E.Sanislow, C.A.Dyck, I.R.McGlashan, T.H.et al.Treatment utilization by patients with personality disorders. Am J Psychiatry 2001; 158: 295–302CrossRefGoogle ScholarPubMed
Bøgwald, K.P.Høglend, P.Sørbye, Ø.Measurement of transference interpretations. J Psychother Pract Res 1999; 8: 264–273Google ScholarPubMed
Clarkin, J.F.Levy, K.N.Lenzenweger, M.F.Kernberg, O.Evaluating three treatments for borderline personality disorders: a multiwave study. Am J Psychiatry 2007; 164: 922–928CrossRefGoogle ScholarPubMed
Emmelkamp, P.M.Benner, A.Kuipers, A.Feiertag, G.A.Koster, H.C.van Apeldoorn, F.J.Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. Br J Psychiatry 2006; 189: 60–64CrossRefGoogle ScholarPubMed
Gabbard, G.O.Westen, D.Rethinking therapeutic action. Int J Psychoanal 2003; 84: 823–841CrossRefGoogle ScholarPubMed
Giesen-Bloo, J.van Dyck, R.Spinhoven, P.van Tilburg, W.Dirksen, C.van Asselt, T.et al.Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused therapy. Arch Gen Psychiatry 2006; 63: 649–658CrossRefGoogle Scholar
Glass, R.M.Psychodynamic psychotherapy and research evidence: Bambi survives Godzilla? JAMA 2008; 300: 1587–1589CrossRefGoogle ScholarPubMed
Grant, B.F.Hasin, D.S.Stinson, F.S.Dawson, D.A.Chou, S.P.Ruan, W.J.et al.Prevalence correlates and disability of personality disorders in the United States: results from the international epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2004; 65: 948–958CrossRefGoogle Scholar
Hardy, G.E.Barkham, M.Shapiro, D.A.Stiles, W.B.Rees, A.Reynolds, SImpact of cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression. J Consult Clin Psychol 1995; 63: 997–1004CrossRefGoogle ScholarPubMed
Havik, OEMonsen, JTHøglend, Pvon der, Lippe ALyngstad, GStiles, T et al. Norwegian Multi-Site Study of Process and outcome in psychotherapy (NSPOP): research protocol. Bergen, Norway: University of Bergen, Department of clinical psychology; 1995.Google Scholar
Høglend, P.Dynamisk korttidsterapi (brief dynamic psychotherapy).Alnes, R.Ekern, P.Jarval, P.Poliklinikken Psykiatrisk Klinikk 25 år. Oslo Norway:University of Oslo; 1990 27–38Google Scholar
Høglend, P.Personality disorders and long term outcome after brief dynamic psychotherapy. J Pers Dis 1993; 7: 168–181CrossRefGoogle Scholar
Høglend, P.Analysis of transference in psychodynamic psychotherapy: a review of empirical research. Can J Psychoanal 2004; 12: 279–300Google Scholar
Høglend, P.Amlo, S.Marble, A.Bøgwald, K.P.Sørbye, Ø.Sjaastad, M.C.et al.Analysis of the patient-therapist relationship in dynamic psychotherapy: An experimental study of transference interpretations. Am J Psychiatry 2006; 163: 1739–1746CrossRefGoogle ScholarPubMed
Høglend, P.Bøgwald, K.P.Amlo, S.Heyerdahl, O.Sørbye, O.Marble, A.et al.Assessment of change in dynamic psychotherapy. J Psychother Pract Res 2000; 9: 190–199Google ScholarPubMed
Høglend, P.Bøgwald, K.P.Amlo, S.Marble, A.Ulberg, R.Sjaastad, M.C.et al.Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? Am J Psychiatry 2008; 165: 763–771CrossRefGoogle ScholarPubMed
Jacobson, N.S.Truax, P.Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 12–19CrossRefGoogle ScholarPubMed
Knekt, P.Lindfors, O.Renlund, C.Kaipainen, M.Mäkelä, P.Järvikoski, A.et al.A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders. Design, methods, and results on the effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy during a one-year follow-up. Studies in social security and health 77 Social Insurance Institution:Helsinki, Finland; 2004 55–56Available from URL:http://www.ktl.fi/tto/hps/effectiveness.htmlGoogle Scholar
Leichsenring, F.Leibing, E.The effectiveness of psychodynamic therapy and cognitive behavioural therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003; 160: 1223–1232CrossRefGoogle ScholarPubMed
Leichsenring, F.Rabung, S.Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008; 300: 1551–1565CrossRefGoogle ScholarPubMed
Liberman, R.P.Ekman, T.Behavior therapy versus insight-oriented therapy for repeated suicide attempters. Arch Gen Psychiatry 1981; 38: 1126–1130CrossRefGoogle Scholar
Linehan, M.M.Comtois, K.A.Murray, A.M.Brown, M.Z.Gallop, R.J.Heard, H.L.et al.Two-year randomized controlled trial and follow-up of dialectical behaviour therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006; 63: 757–766CrossRefGoogle ScholarPubMed
McMain, S.F.Links, P.S.Gnam, W.H.Guimond, T.Cardish, R.J.Korman, L.et al.A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry 2009; 166: 1365–1374CrossRefGoogle ScholarPubMed
Monroe-Blum, H.Marziali, E.A controlled trial of short-term group treatment for borderline personality disorder. J Pers Dis 1995; 9: 190–198CrossRefGoogle Scholar
Oldham, J.M.Psychodynamic psychotherapy for personality disorders. Am J Psychiatry 2007; 164: 1465–1467CrossRefGoogle ScholarPubMed
Perry, J.C.Problems and considerations in the valid assessment of personality disorders. Am J Psychiatry 1992; 149: 1645–1653Google ScholarPubMed
Perry, J.C.Longitudinal studies of personality disorders. J Pers Dis 1993; 7: 63–85Google Scholar
Perry, J.C.Banon, E.Ianni, F.Effectiveness of psychotherapy for personality disorders. Am J Psychiatry 1999; 156: 1312–1321Google ScholarPubMed
Perry, J.C.Sanlian, N.Outcome measurement in personality disorders.IsHak, W.W.Burt, T.Sederer, L.Outcome Measurement in psychiatry, a critical review Washington DC, USA:American Psychiatric Press; 2002 235–257Google Scholar
Pilkonis, P.A.Neighbors, B.D.Corbitt, E.M.Personality disorders: treatments and costs.Miller, N.E.Magruder, K.M.Cost effectiveness of psychotherapy: a guide for practitioners, researchers and policy makers London, UK:Oxford Universities Press; 1999 279–290Google Scholar
Samuels, J.Eaton, W.W.Bienvenu, O.J.3rd Brown, C.H.Costa, P.T. Jr.et al.Prevalence and correlates of personality disorders in a community sample. Br J Psychiatry 2002; 180: 536–54210.1192/bjp.180.6.536CrossRefGoogle Scholar
Shea, M.T.Pilkonis, P.Beckhqam, E.Collins, J.F.Elkin, I.Sotsky, S.M.et al.Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry 1990; 147: 711–718Google ScholarPubMed
Soeteman, D.I.Hakkart van Reuen, L.Verheul, R.Bussch, J.J.The economic burden of personality disorders in mental health care. J Clin Psychiatry 2008; 69: 259–265CrossRefGoogle ScholarPubMed
Soetemman, D.I.Verheul, R.Busschbach, J.J.The burden of disease in personality disorders: diagnosis-specific quality of life. J Pers Dis 2008; 22: 259–268CrossRefGoogle Scholar
Spitzer, R.L.Psychiatric diagnosis: are clinicians still necessary? Compr Psychiatry 1983; 24: 399–411CrossRefGoogle ScholarPubMed
Spitzer, R.L.Williams, J.B.Gibbon, M.First, M.B.Structured clinical interview for DSM-III-R personality disorders (SCID-II). Washington DC, USA: American Psychiatric Press: 1990Google Scholar
Stiles, W.B.Shapiro, D.A.Disabuse of the drug metaphor: psychotherapy outcome correlations. J Consult Clin Psychol 1994; 62: 942–948CrossRefGoogle ScholarPubMed
Svartberg, M.Stiles, T.Seltzer, M.H.Randomised controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Am J Psychiatry 2004; 161: 810–817CrossRefGoogle ScholarPubMed
Torgersen, S.Kringlen, E.Cramer, V.The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 2001; 58: 590–596CrossRefGoogle Scholar
Vinnars, B.Barber, J.P.Noren, K.Gallop, R.Weinryb, R.M.Manualized supportive-expressive psychotherapy versus nonmanualized community-delivered psychodynamic therapy for patients with personality disorders: bridging efficacy and effectiveness. Am J Psychiatry 2005; 162: 1933–1940CrossRefGoogle ScholarPubMed
Winston, A.Laikin, M.Pollack, J.Samstag, L.W.McCullough, L.Muran, J.C.Short-term psychotherapy of personality disorders. Am J Psychiatry 1994; 151: 190–194Google ScholarPubMed
Woody, G.E.McLellan, T.Luborsky, L.L.O’Brien, C.P.Sociopathy and psychotherapy outcome. Arch Gen Psychiatry 1985; 42: 1081–1086CrossRefGoogle ScholarPubMed
Zanni, G.R.The graying of personality disorders: persistent but different. Consult Pharm 2007; 22: 995–1003CrossRefGoogle Scholar
Zimmermann, M.Rothschild, L.Chelminski, I.The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry 162102005 1911–1918CrossRefGoogle Scholar
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