Transference Interpretation Is Active Treatment Component

Psychotherapy patients with a lifelong pattern of poor object relations profited more from one year of therapy with transference interpretations than from therapy without such interpretations.

That was the finding from a unique, randomized, controlled clinical trial of psychotherapy for depression, anxiety, personality disorders, and interpersonal problems.

“Our study identifies a core active treatment component, transference interpretation, with positive long-term impact on patient functioning, and thus represents an extension of previous research,” lead author Per Høglend, M.D., Ph.D., of the Department of Psychiatry at the University of Oslo, Norway, told Psychiatric News. “If our findings are replicated, they may have far-reaching implications for the education of psychotherapists and treatment of depression, anxiety, personality disorders, and chronic, more severe interpersonal problems.”

In the study 100 outpatients seeking psychotherapy for depression, anxiety, personality disorders, or interpersonal problems were randomly assigned to receive weekly sessions of dynamic psychotherapy for one year with or without transference interpretations.

For the transference group, therapists used the following techniques:

In the comparison group, therapists explicitly avoided using these techniques.

Outcome was measured by scores on the clinician-rated Psychodynamic Functioning Scales and the self-reported Inventory of Interpersonal Problems. Measurements were taken at baseline, mid-treatment, end of treatment, one-year follow-up, and three-year follow-up.

The researchers hypothesized at the outset that a lifetime pattern of object relations—as determined by the presence of a personality disorder and scores on the Quality of Object Relations Scale (QOR)—would moderate the effects of treatment with patients having poorer object relations benefiting more.

What they found was that both forms of psychotherapy—with and without transference interpretations—resulted in significant improvement during treatment and after termination. But in keeping with their hypothesis, the long-term effect of transference interpretations increased with lower scores on the QOR.

This effect was sustained throughout the four-year study.

Høglend told Psychiatric News that life events and additional treatment during the follow-up period were carefully recorded and probably do not account for the differences between the two treatment groups.

“On the contrary, the comparison group had more additional treatment than the transference group,” he said. He added that the study is the first randomized, controlled trial designed to study long-term effects of transference interpretations.

“The literature on transference is enormous—more than 8,000 articles and book chapters since Freud introduced the term in 1895,” he said. “But the empirical research on transference interpretation is sparse. None of the studies so far used an experimental design in which only one treatment component is experimentally manipulated. The associations reported in passive observational studies, nonexperimental studies, are open to several causal interpretations, rendering the research base inconclusive.”

He added that future research will try to identify the mechanism that links transference interpretations to long-term improvement of interpersonal functioning.

“Transference Interpretations in Dynamic Psychotherapy: Do They Really Yield Sustained Effects?” will be posted on AJP Advance on April 15 at<http://ajp.psychiatryonline.org/pap.dtl> and will be in the June print edition of AJP. ▪