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Objective: According to psychoanalytic theory, interpretation of transference leads to increased insight that again leads to improved interpersonal functioning over time. In this study, we performed a full mediational analysis to test whether insight gained during treatment mediates the long-term effects of transference interpretation in dynamic psychotherapy. Method: This study is a randomized clinical trial with a dismantling design. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment with the same therapists but without the use of transference interpretation. Interpersonal functioning and insight were measured pretreatment, posttreatment, and 1 year and 3 years after treatment termination. Results: Contrary to common expectation, patients with a life-long pattern of low quality of object relations and personality disorder pathology profited more from therapy with transference interpretation than from therapy with no transference interpretation. This long-term effect was mediated by an increase in the level of insight during treatment. Conclusions: Insight seems to be a key mechanism of change in dynamic psychotherapy. Our results bridge the gap between clinical theory and empirical research.

Objective: Transference interpretation has remained a core ingredient in the psychodynamic tradition, despite limited empirical evidence for its effectiveness. In this study, the authors examined long-term effects of transference interpretations. Method: This was a randomized controlled clinical trial, dismantling design, plus follow-up evaluations 1 year and 3 years after treatment termination. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were referred to the study therapists. Patients were randomly assigned to receive weekly sessions of dynamic psychotherapy for 1 year with or without transference interpretations. Five full sessions from each therapy were rated in order to document treatment fidelity. Outcome variables were the Psychodynamic Functioning Scales (clinician rated) and the Inventory of Interpersonal Problems (self-report). Rating on the Quality of Object Relations Scale (lifelong pattern) and presence of a personali...

The clinical proposition that an ideal focus for intensive brief dynamic psychotherapy is an intra-psychic conflict rooted in oedipal pathology with circumscribed effects on personality functioning has been widely accepted a priori, without empirical validation. In this study 4 clinical raters assessed the 'degree of circumscribed conflict' and 'hypothesized psychosexual development level' from a dynamic evaluation interview. The variables were only marginally associated with DSM-III diagnoses. Within a subsample of 22 patients treated with intensive psychoanalytic technique, patients with whom a highly circumscribed conflict could be identified had the most favourable dynamic change 4 years after therapy.

Dynamic change in psychotherapy, as measured by theory-related or mode-specific instruments, have been criticized for being too intercorrelated with symptomatic change measures. In this study, long-term changes after brief dynamic psychotherapy were studied in 45 moderately disturbed neurotic patients by a reliable outcome battery. The factor structure of all the change variables suggested that they tapped 2 distinct and stable sources of variance: dynamic and symptomatic change. The categories of overall dynamic change were different from categories of change on the Global Assessment Scale. A small systematic difference was found between the categories of overall dynamic change and the categories of target complaints change also, due to false solutions of dynamic conflicts.

Dear Sir We would like to congratulate Skjeie and coworkers on their well-accomplished study [1], but still, we would like to make some comments. The authors do not comment on the marked reduction in total crying time in both the acupuncture group and the control group already on the third of the three consecutive treatment days. The acupuncture group had a somewhat faster reduction, but the difference was not statistically significant. On the fourth day after baseline, the daily crying in the acupuncture group was reduced from 220 minutes to 120 minutes. We think that a 45% reduction in crying time would be most welcome to tired and worried parents. On the fourth day from the start of treatment, only nine out of 38 in the acupuncture group and 10 out of 41 in the control group still met Wessel's criteria for infantile colic. An explanation for this reduction could be that it represents the natural course of the ailment. This we do not know, as there was no completely untreated group in the study. The very steep curve displaying the reduction in crying time in immediate connection with the treatment does not resemble what would be expected from a natural fading out of the disease. Another hypothetical cause could be a placebo effect on the parents. A third possibility could be that both groups have had sensory stimulation on point ST 36. The acupuncture group was given a mark on ST 36 with a felt pen, an acupuncture needle, and a small adhesive bandage that was removed the next day to cover any possible needle mark. There was no manipulation of the needle, which was retained for only 30 seconds. There is no clear knowledge as to what is sufficient acupuncture stimulation in an infant. The needling procedure in the study would be considered as a minimal stimulus. The control group was given the same procedure, except for the needling. One of us, NL, participated in the study and observed that many of the children cried when the adhesive bandage was removed. The children's reaction to the bandage removal seemed stronger than their reaction to the needling, which might indicate that the removal of the adhesive bandage evoked at least a similar level of sensory stimulus as the needling itself. It might well be that the lack of significant difference between the two groups is due to the adhesive bandage procedure. This study might thus be a comparison between two groups that both received sensory stimulation. A possible suboptimal needling procedure might have added to the lack of significant difference between the two groups. It would be interesting if the authors would comment on the reduction in crying time discussed above and also reflect on the difference between their results and the results of the two Swedish RCT studies that found significant differences between the acupuncture group and control group on several parameters.

Psychoanalytic theory holds that dynamic insight is used for self-observation and self-analysis during and after explorative therapy. Such self-analysis is held to lead to stable dynamic change. Within a sample of 43 moderately disturbed out-patients, pre-treatment level of insight was associated with treatment length, with not being an early or late drop-out, and with receiving additional psychotherapy during a four-year follow-up period. Pre-treatment level of insight turned out to be not directly correlated with outcome two and four years after therapy. However, level of insight was significantly correlated with outcome in interaction with treatment length. Gain of insight measured at two-year follow-up was the strongest predictor of overall dynamic change four years after therapy, compared with all the other outcome assessments made at two-year follow-up.

Forfatteren har nettopp tiltradt stilling som ass. overlege ved Oslo Helserad avd. for psykiatri.Han har sin utdannelsestid i ferskt minne, og gav mai 1976 nedenstaende synspunkter pa de veiledetes situasion.