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Reviews and Overviews   |    
Exploration of the Patient-Therapist Relationship in Psychotherapy
Per Høglend, M.D., Ph.D.
Am J Psychiatry 2014;171:1056-1066. doi:10.1176/appi.ajp.2014.14010121
View Author and Article Information

The author reports no financial relationships with commercial interests.

Supported by Diakonhjemmet Hospital, Vestre Viken Health Trust, and the University of Oslo.

From the Division of Mental Health and Addiction, University of Oslo.

Address correspondence to Dr. Høglend (p.a.hoglend@medisin.uio.no).

Copyright © 2014 by the American Psychiatric Association

Received January 31, 2014; Revised April 12, 2014; Accepted April 24, 2014.

Abstract

Research from several domains indicates that genetic factors, childhood environment, and later interpersonal experiences are important sources of how patients relate to their therapists (transference). Transference work, a core specific technique in psychodynamic psychotherapy, focuses on exploring the patient-therapist relationship, with the idea that this may lead to improvement of the patients’ relationships outside therapy. Many psychotherapy researchers hold the position that specific techniques do not contribute much to the outcome of psychotherapy. However, more than 30 studies have reported significant associations between transference work and outcome. These findings indicate that transference work interventions are indeed active ingredients (for better or worse). Naturalistic studies suggest that a high frequency of transference interventions may have negative effects. Randomized clinical trials indicate that transference-based treatments and alternative treatments work equally well with regard to symptom improvement. However, transference-based treatments appear to be much more effective with regard to interpersonal relations and other measures of personality functioning. The average between-groups effect size for the experimental studies listed in this article was large. Contrary to common clinical wisdom, transference interventions seem to be most important for (mainly female) patients with difficult interpersonal relationships and more severe personality pathology. Gain of insight may be a specific mechanism of change in dynamic psychotherapy, but only one treatment component study has linked transference work directly to gains in insight and subsequent improvement in interpersonal functioning. Research that examines how transference phenomena may be responded to in nondynamic therapies is scarce.

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TABLE 1.Naturalistic Studies of Transference Work
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a Effect size: r=0.10, small; r=0.25, moderate; r=0.50, large.

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b Unquantified positive correlation between number of transference interpretations and outcome.

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c Within subgroup with high quality of object relations.

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d Within subgroup with low quality of object relations.

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TABLE 2.Experimental Studies of Transference Work
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a Effect size (between-groups): d=0.20, small; d=0.50, moderate; d=0.80 large.

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b Adolescents.

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c Within subgroup with low quality of object relations.

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