Erkki Heinonen | University of Oslo (original) (raw)
Papers by Erkki Heinonen
Frontiers in Psychiatry, 2022
BackgroundExternalising behaviours are becoming a remarkably prevalent problem during adolescence... more BackgroundExternalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old).MethodsA systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers fro...
Frontiers in Psychology, 2021
Introduction Anxiety and depressive disorders are a significant problem that starts in childhood ... more Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with d...
BMJ Open, 2021
IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than... more IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The ‘European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders’, funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents.MethodA systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer...
Journal of affective disorders, 2018
Childhood adversities are frequent among adults who seek treatment for depression or anxiety. The... more Childhood adversities are frequent among adults who seek treatment for depression or anxiety. These disorders are commonly treated by psychotherapy. Yet it is not known if specific types or durations of psychotherapy are particularly suited for patients who have suffered various early adversities. 221 depressed and anxious adult outpatients from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire. They were randomly assigned to short- (solution-focused or psychodynamic) or long-term (psychodynamic) psychotherapy. Outcome was assessed via patient questionnaires and clinician interviews of psychiatric symptoms and global functioning during a 5-year follow-up. Linear regression analyses were conducted. Less separations from caregivers expectedly predicted better outcomes in all therapies; unexpectedly, so did greater abuse. Family unhappiness and parental problems predicted faster or greater improvement when patients we...
Psychology and Psychotherapy: Theory, Research and Practice, 2016
Objectives. How level of personality organization (LPO) predicts psychiatric symptoms and work ab... more Objectives. How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short-versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. Design. A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). Methods. The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. Results. For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. Conclusions. In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. Practitioner points Level of personality organization is relevant for selection between short-and long-term psychotherapies.
Psychiatry Research, 2016
Information on how the patient's interpersonal problems predict alliance development during long-... more Information on how the patient's interpersonal problems predict alliance development during long-term therapy is lacking. The aim of this study was to explore how the patient's pre-treatment interpersonal problems predict the development of alliance in long-term psychotherapy. Altogether 128 adult outpatients experiencing mood or anxiety disorder were assigned to long-term psychodynamic psychotherapy in the Helsinki Psychotherapy Study. The Inventory of Interpersonal Problems (IIP) total score and the eight octant scores, assessed at baseline, were used as predictors. The trajectories of change in patient-and therapist-rated Working Alliance Inventory (WAI) were used as outcome measures at 7, 12, and 36 months of follow-up after baseline. Study of the changes by time showed that the patient-rated alliance was significantly improved by the 36-month follow-up, i.e. the most usual end-point of therapy, in persons with higher pre-treatment level of the IIP total score. Low total IIP score and low to moderate level of hostile type problems showed no slope of improvement of patient-rated alliance during followup. The therapist-rated alliance showed a similar course as the patient-rated alliance with the exception of a faster improvement for higher IIP scores. In conclusion, a higher level of patients' interpersonal problems predicted favorable alliance development.
Journal of affective disorders, 2015
Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in... more Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in personality functioning are available. In this study we compared the effects of two short-term therapies and long-term psychodynamic psychotherapy on patients' personality functioning during a 5-year follow-up. Altogether 326 patients of the Helsinki Psychotherapy Study, with anxiety or mood disorder, were randomly assigned to either short-term psychotherapy of about six months (solution-focused therapy (SFT, n=97) or short-term psychodynamic psychotherapy (SPP, n=101)), or to long-term psychodynamic psychotherapy (LPP, n=128), lasting on average three years. Outcomes in personality functioning (i.e., self-concept, defense style, interpersonal problems, and level of personality organization) were assessed five to seven times using, respectively, questionnaires (SASB, DSQ, IIP) and interview (LPO) during the 5-year follow-up from randomization. Personality functioning improved in all...
Journal of Affective Disorders, 2014
Background: Quality of object relations and self-concept reflect clinically relevant aspects of p... more Background: Quality of object relations and self-concept reflect clinically relevant aspects of personality functioning, but their prediction as suitability factors for psychotherapies of different lengths has not been compared. This study compared their prediction on psychiatric symptoms and work ability in shortand long-term psychotherapy. Methods: Altogether 326 patients, 20-46 years of age, with mood and/or anxiety disorder, were randomized to short-term (solution-focused or short-term psychodynamic) psychotherapy and longterm psychodynamic psychotherapy. The Quality of Object Relations Scale (QORS) and the Structural Analysis of Social Behavior (SASB) self-concept questionnaire were measured at baseline, and their prediction on outcome during the 3-year follow-up was assessed by the Symptom Check List Global Severity Index and the Anxiety Scale, the Beck Depression Inventory and by the Work Ability Index, Social Adjustment Scale work subscale and the Perceived Psychological Functioning scale. Results: Negative self-concept strongly and self-controlling characteristics modestly predicted better 3year outcomes in long-term therapy, after faster early gains in short-term therapy. Patients with a more positive or self-emancipating self-concept, or more mature object relations, experienced more extensive benefits after long-term psychotherapy. Limitations: The importance of length vs. long-term therapy technique on the differences found is not known. Conclusions: Patients with mild to moderate personality pathology, indicated by poor self-concept, seem to benefit more from long-term than short-term psychotherapy, in reducing risk of depression. Longterm therapy may also be indicated for patients with relatively good psychological functioning. More research is needed on the relative importance of these characteristics in comparison with other patientrelated factors.
Journal of Clinical Psychology, 2019
Objective: The personal self of psychotherapists, i.e., experiences of self in close personal rel... more Objective: The personal self of psychotherapists, i.e., experiences of self in close personal relationships and its association with therapists' individual and professional attributes is explored. The study aimed to: (a) describe therapists' self-ratings on specific self-attributes; (b) determine their dimensionality; (c) explore demographic, psychological, and professional correlates; and (d) assess the convergence with professional self. Method: Data from the Development of Psychotherapists Common Core Questionnaire were available for >10,000 psychotherapists of various professions, theoretical orientations, career levels, and nations. Results: Most psychotherapists described themselves in close relationships in affirming terms (e.g., warm/friendly), although a substantial minority also described themselves in negative terms. Factor analyses yielded four dimensions: Genial/Caring, Forceful/Exacting, Reclusive/Remote, and Ardent/Expressive. Being Genial/Caring was associated with life satisfaction. Among professional attributes, personal self-experiences and parallel dimensions of relationship with clients correlated strongly. Conclusions: Analyses of >10,000 psychotherapists revealed meaningful variations in personal self relevant to personal and professional life.
Journal of Clinical Psychology, 2021
Objectives: We investigated how patients' psychological capacities to engage in psychotherapy pre... more Objectives: We investigated how patients' psychological capacities to engage in psychotherapy predict changes in work ability in short-and long-term psychotherapy. Methods: A cohort study of 326 patients, aged 20-46 years and suffering from mood and anxiety disorders, treated by short-term solution-focused, short-term psychodynamic, or long-term psychodynamic psychotherapy, followed-up for 5 years. The Suitability for Psychotherapy Scale, assessed at baseline, was the predictor. Outcomes were assessed at baseline and at six follow-up occasions using the Work Ability Index as the primary indicator. Results: Patients with good pretreatment psychological suitability for psychotherapy, good reflective ability in particular, improved more than patients with poor suitability in short-term psychodynamic psychotherapy. Comparisons between therapy groups showed poorer suitability to predict more improvement in solutionfocused and in long-term psychodynamic psychotherapy than in short-term psychodynamic psychotherapy. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Patient Education and Counseling
Psychiatry Research, 2015
Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term ther... more Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.
OBJECTIVES. Dispositional optimism predicts various beneficial outcomes in somatic health and tre... more OBJECTIVES. Dispositional optimism predicts various beneficial outcomes in somatic health and treatment, but has been little studied in psychotherapy. This study investigated whether an optimistic disposition differentially predicts patients’ ability to benefit from short-term versus long-term psychotherapy.
DESIGN. A total of 326 adult outpatients with mood and/or anxiety disorder were randomized into short-term (solution-focused or short-term psychodynamic) or long-term psychodynamic therapy and followed up for 3 years.
METHODS. Dispositional optimism was assessed by patients at baseline with the self-rated Life Orientation Test (LOT) questionnaire. Outcome was assessed at baseline and seven times during the follow-up, in terms of depressive (BDI, HDRS), anxiety (SCL-90-ANX, HARS), and general psychiatric symptoms (SCL-90-GSI), all seven follow-up points including patients’ self-reports and three including interview-based measures.
RESULTS. Lower dispositional optimism predicted faster symptom reduction in short-term than in long-term psychotherapy. Higher optimism predicted equally rapid and eventually greater benefits in long-term, as compared to short-term, psychotherapy.
CONCLUSIONS. Weaker optimism appeared to predict sustenance of problems early in long-term therapy. Stronger optimism seems to best facilitate engaging in and benefiting from a long-term therapy process. Closer research might clarify the psychological processes responsible for these effects and help fine-tune both briefer and longer interventions to optimize treatment effectiveness for particular patients and their psychological qualities.
PRACTITIONER POINTS.
Weaker dispositional optimism does not appear to inhibit brief therapy from effecting symptomatic recovery. Patients with weaker optimism do not seem to gain added benefits from long-term therapy, but instead may be susceptible to prolonged psychiatric symptoms in the early stages of long-term therapy.
Journal of The Society for Information Display, 2008
The benefits of stereoscopic viewing were explored in searching in words superimposed over a back... more The benefits of stereoscopic viewing were explored in searching in words superimposed over a background. In the first experiment, eight participants searched for text in a normal 2-D display, a 3-D display using a parallax barrier, and a darkened 2-D display of equivalent brightness to the 3-D display. Word-search performance was significantly faster for the bright 2-D display vs. the 3-D display, but when brightness was controlled, performance on the 3-D display was better relative to the 2-D (dim) display. In a second experiment, the effect of floating text vs. sinking background disparity was assessed across four background conditions. Twenty participants saw only the floating-text (FT) condition and 20 participants saw only the sinking-background (SB) condition. Performance of the SB group was significantly better than that of FT group, and the advantage of SB disparity was greater with the more-complex backgrounds. Thus, when a parallax-barrier 3-D display is used to view text or other figural information overlaid on a background, it is proposed that the layer of primary interest (foreground) should be displayed with zero disparity (on the physical display surface) with the secondary layer (background) appearing to be sunk beneath that surface.
International Encyclopedia of the Social & Behavioral Sciences, 2015
ABSTRACT Psychotherapy process research examines the interactions and experiences of patients and... more ABSTRACT Psychotherapy process research examines the interactions and experiences of patients and therapists in psychosocial mental health treatments. Early psychotherapy researchers differentiated between ‘outcome’ studies that focus on the impact of treatment on patients, and ‘process’ studies that examine the events of therapy. Process studies typically focus on verbal and nonverbal communications between patients and therapists in sessions, treatment methods, qualities of the patient–therapist relationship, and experiences of patients and therapists during and between therapy sessions. This article discusses basic concepts and methods of process research, the main findings linking process to outcome, and new areas of research.
Journal of affective disorders, 2015
Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in... more Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in personality functioning are available. In this study we compared the effects of two short-term therapies and long-term psychodynamic psychotherapy on patients' personality functioning during a 5-year follow-up. Altogether 326 patients of the Helsinki Psychotherapy Study, with anxiety or mood disorder, were randomly assigned to either short-term psychotherapy of about six months (solution-focused therapy (SFT, n=97) or short-term psychodynamic psychotherapy (SPP, n=101)), or to long-term psychodynamic psychotherapy (LPP, n=128), lasting on average three years. Outcomes in personality functioning (i.e., self-concept, defense style, interpersonal problems, and level of personality organization) were assessed five to seven times using, respectively, questionnaires (SASB, DSQ, IIP) and interview (LPO) during the 5-year follow-up from randomization. Personality functioning improved in all...
Psychodynamic Psychotherapy Research, 2011
Psychotherapy Research, 2013
Research shows psychotherapists espousing different theoretical approaches differ in mentality (e... more Research shows psychotherapists espousing different theoretical approaches differ in mentality (e.g., cognitive styles, beliefs and epistemologies) and personality (e.g., neuroticism). However, studies have not investigated the association between professional relational style prescribed by therapists' theoretical orientations and therapists' manner of relating in personal life. Analyses of over 4000 therapists of varied nationalities, professions and career levels having different theoretical preferences indicate: (i) therapists' self-experience in close personal relationships was significantly associated with the manner their theoretical orientations prescribed for relating with clients; (ii) therapists were less accepting, less tolerant and more demanding in their personal relationships than with clients; and (iii) therapists adjusted their professional relational manner in practice to meet the specific expectations of their preferred orientations.
Frontiers in Psychiatry, 2022
BackgroundExternalising behaviours are becoming a remarkably prevalent problem during adolescence... more BackgroundExternalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old).MethodsA systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers fro...
Frontiers in Psychology, 2021
Introduction Anxiety and depressive disorders are a significant problem that starts in childhood ... more Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with d...
BMJ Open, 2021
IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than... more IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The ‘European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders’, funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents.MethodA systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer...
Journal of affective disorders, 2018
Childhood adversities are frequent among adults who seek treatment for depression or anxiety. The... more Childhood adversities are frequent among adults who seek treatment for depression or anxiety. These disorders are commonly treated by psychotherapy. Yet it is not known if specific types or durations of psychotherapy are particularly suited for patients who have suffered various early adversities. 221 depressed and anxious adult outpatients from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire. They were randomly assigned to short- (solution-focused or psychodynamic) or long-term (psychodynamic) psychotherapy. Outcome was assessed via patient questionnaires and clinician interviews of psychiatric symptoms and global functioning during a 5-year follow-up. Linear regression analyses were conducted. Less separations from caregivers expectedly predicted better outcomes in all therapies; unexpectedly, so did greater abuse. Family unhappiness and parental problems predicted faster or greater improvement when patients we...
Psychology and Psychotherapy: Theory, Research and Practice, 2016
Objectives. How level of personality organization (LPO) predicts psychiatric symptoms and work ab... more Objectives. How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short-versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. Design. A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). Methods. The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. Results. For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. Conclusions. In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. Practitioner points Level of personality organization is relevant for selection between short-and long-term psychotherapies.
Psychiatry Research, 2016
Information on how the patient's interpersonal problems predict alliance development during long-... more Information on how the patient's interpersonal problems predict alliance development during long-term therapy is lacking. The aim of this study was to explore how the patient's pre-treatment interpersonal problems predict the development of alliance in long-term psychotherapy. Altogether 128 adult outpatients experiencing mood or anxiety disorder were assigned to long-term psychodynamic psychotherapy in the Helsinki Psychotherapy Study. The Inventory of Interpersonal Problems (IIP) total score and the eight octant scores, assessed at baseline, were used as predictors. The trajectories of change in patient-and therapist-rated Working Alliance Inventory (WAI) were used as outcome measures at 7, 12, and 36 months of follow-up after baseline. Study of the changes by time showed that the patient-rated alliance was significantly improved by the 36-month follow-up, i.e. the most usual end-point of therapy, in persons with higher pre-treatment level of the IIP total score. Low total IIP score and low to moderate level of hostile type problems showed no slope of improvement of patient-rated alliance during followup. The therapist-rated alliance showed a similar course as the patient-rated alliance with the exception of a faster improvement for higher IIP scores. In conclusion, a higher level of patients' interpersonal problems predicted favorable alliance development.
Journal of affective disorders, 2015
Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in... more Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in personality functioning are available. In this study we compared the effects of two short-term therapies and long-term psychodynamic psychotherapy on patients' personality functioning during a 5-year follow-up. Altogether 326 patients of the Helsinki Psychotherapy Study, with anxiety or mood disorder, were randomly assigned to either short-term psychotherapy of about six months (solution-focused therapy (SFT, n=97) or short-term psychodynamic psychotherapy (SPP, n=101)), or to long-term psychodynamic psychotherapy (LPP, n=128), lasting on average three years. Outcomes in personality functioning (i.e., self-concept, defense style, interpersonal problems, and level of personality organization) were assessed five to seven times using, respectively, questionnaires (SASB, DSQ, IIP) and interview (LPO) during the 5-year follow-up from randomization. Personality functioning improved in all...
Journal of Affective Disorders, 2014
Background: Quality of object relations and self-concept reflect clinically relevant aspects of p... more Background: Quality of object relations and self-concept reflect clinically relevant aspects of personality functioning, but their prediction as suitability factors for psychotherapies of different lengths has not been compared. This study compared their prediction on psychiatric symptoms and work ability in shortand long-term psychotherapy. Methods: Altogether 326 patients, 20-46 years of age, with mood and/or anxiety disorder, were randomized to short-term (solution-focused or short-term psychodynamic) psychotherapy and longterm psychodynamic psychotherapy. The Quality of Object Relations Scale (QORS) and the Structural Analysis of Social Behavior (SASB) self-concept questionnaire were measured at baseline, and their prediction on outcome during the 3-year follow-up was assessed by the Symptom Check List Global Severity Index and the Anxiety Scale, the Beck Depression Inventory and by the Work Ability Index, Social Adjustment Scale work subscale and the Perceived Psychological Functioning scale. Results: Negative self-concept strongly and self-controlling characteristics modestly predicted better 3year outcomes in long-term therapy, after faster early gains in short-term therapy. Patients with a more positive or self-emancipating self-concept, or more mature object relations, experienced more extensive benefits after long-term psychotherapy. Limitations: The importance of length vs. long-term therapy technique on the differences found is not known. Conclusions: Patients with mild to moderate personality pathology, indicated by poor self-concept, seem to benefit more from long-term than short-term psychotherapy, in reducing risk of depression. Longterm therapy may also be indicated for patients with relatively good psychological functioning. More research is needed on the relative importance of these characteristics in comparison with other patientrelated factors.
Journal of Clinical Psychology, 2019
Objective: The personal self of psychotherapists, i.e., experiences of self in close personal rel... more Objective: The personal self of psychotherapists, i.e., experiences of self in close personal relationships and its association with therapists' individual and professional attributes is explored. The study aimed to: (a) describe therapists' self-ratings on specific self-attributes; (b) determine their dimensionality; (c) explore demographic, psychological, and professional correlates; and (d) assess the convergence with professional self. Method: Data from the Development of Psychotherapists Common Core Questionnaire were available for >10,000 psychotherapists of various professions, theoretical orientations, career levels, and nations. Results: Most psychotherapists described themselves in close relationships in affirming terms (e.g., warm/friendly), although a substantial minority also described themselves in negative terms. Factor analyses yielded four dimensions: Genial/Caring, Forceful/Exacting, Reclusive/Remote, and Ardent/Expressive. Being Genial/Caring was associated with life satisfaction. Among professional attributes, personal self-experiences and parallel dimensions of relationship with clients correlated strongly. Conclusions: Analyses of >10,000 psychotherapists revealed meaningful variations in personal self relevant to personal and professional life.
Journal of Clinical Psychology, 2021
Objectives: We investigated how patients' psychological capacities to engage in psychotherapy pre... more Objectives: We investigated how patients' psychological capacities to engage in psychotherapy predict changes in work ability in short-and long-term psychotherapy. Methods: A cohort study of 326 patients, aged 20-46 years and suffering from mood and anxiety disorders, treated by short-term solution-focused, short-term psychodynamic, or long-term psychodynamic psychotherapy, followed-up for 5 years. The Suitability for Psychotherapy Scale, assessed at baseline, was the predictor. Outcomes were assessed at baseline and at six follow-up occasions using the Work Ability Index as the primary indicator. Results: Patients with good pretreatment psychological suitability for psychotherapy, good reflective ability in particular, improved more than patients with poor suitability in short-term psychodynamic psychotherapy. Comparisons between therapy groups showed poorer suitability to predict more improvement in solutionfocused and in long-term psychodynamic psychotherapy than in short-term psychodynamic psychotherapy. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Patient Education and Counseling
Psychiatry Research, 2015
Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term ther... more Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.
OBJECTIVES. Dispositional optimism predicts various beneficial outcomes in somatic health and tre... more OBJECTIVES. Dispositional optimism predicts various beneficial outcomes in somatic health and treatment, but has been little studied in psychotherapy. This study investigated whether an optimistic disposition differentially predicts patients’ ability to benefit from short-term versus long-term psychotherapy.
DESIGN. A total of 326 adult outpatients with mood and/or anxiety disorder were randomized into short-term (solution-focused or short-term psychodynamic) or long-term psychodynamic therapy and followed up for 3 years.
METHODS. Dispositional optimism was assessed by patients at baseline with the self-rated Life Orientation Test (LOT) questionnaire. Outcome was assessed at baseline and seven times during the follow-up, in terms of depressive (BDI, HDRS), anxiety (SCL-90-ANX, HARS), and general psychiatric symptoms (SCL-90-GSI), all seven follow-up points including patients’ self-reports and three including interview-based measures.
RESULTS. Lower dispositional optimism predicted faster symptom reduction in short-term than in long-term psychotherapy. Higher optimism predicted equally rapid and eventually greater benefits in long-term, as compared to short-term, psychotherapy.
CONCLUSIONS. Weaker optimism appeared to predict sustenance of problems early in long-term therapy. Stronger optimism seems to best facilitate engaging in and benefiting from a long-term therapy process. Closer research might clarify the psychological processes responsible for these effects and help fine-tune both briefer and longer interventions to optimize treatment effectiveness for particular patients and their psychological qualities.
PRACTITIONER POINTS.
Weaker dispositional optimism does not appear to inhibit brief therapy from effecting symptomatic recovery. Patients with weaker optimism do not seem to gain added benefits from long-term therapy, but instead may be susceptible to prolonged psychiatric symptoms in the early stages of long-term therapy.
Journal of The Society for Information Display, 2008
The benefits of stereoscopic viewing were explored in searching in words superimposed over a back... more The benefits of stereoscopic viewing were explored in searching in words superimposed over a background. In the first experiment, eight participants searched for text in a normal 2-D display, a 3-D display using a parallax barrier, and a darkened 2-D display of equivalent brightness to the 3-D display. Word-search performance was significantly faster for the bright 2-D display vs. the 3-D display, but when brightness was controlled, performance on the 3-D display was better relative to the 2-D (dim) display. In a second experiment, the effect of floating text vs. sinking background disparity was assessed across four background conditions. Twenty participants saw only the floating-text (FT) condition and 20 participants saw only the sinking-background (SB) condition. Performance of the SB group was significantly better than that of FT group, and the advantage of SB disparity was greater with the more-complex backgrounds. Thus, when a parallax-barrier 3-D display is used to view text or other figural information overlaid on a background, it is proposed that the layer of primary interest (foreground) should be displayed with zero disparity (on the physical display surface) with the secondary layer (background) appearing to be sunk beneath that surface.
International Encyclopedia of the Social & Behavioral Sciences, 2015
ABSTRACT Psychotherapy process research examines the interactions and experiences of patients and... more ABSTRACT Psychotherapy process research examines the interactions and experiences of patients and therapists in psychosocial mental health treatments. Early psychotherapy researchers differentiated between ‘outcome’ studies that focus on the impact of treatment on patients, and ‘process’ studies that examine the events of therapy. Process studies typically focus on verbal and nonverbal communications between patients and therapists in sessions, treatment methods, qualities of the patient–therapist relationship, and experiences of patients and therapists during and between therapy sessions. This article discusses basic concepts and methods of process research, the main findings linking process to outcome, and new areas of research.
Journal of affective disorders, 2015
Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in... more Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in personality functioning are available. In this study we compared the effects of two short-term therapies and long-term psychodynamic psychotherapy on patients' personality functioning during a 5-year follow-up. Altogether 326 patients of the Helsinki Psychotherapy Study, with anxiety or mood disorder, were randomly assigned to either short-term psychotherapy of about six months (solution-focused therapy (SFT, n=97) or short-term psychodynamic psychotherapy (SPP, n=101)), or to long-term psychodynamic psychotherapy (LPP, n=128), lasting on average three years. Outcomes in personality functioning (i.e., self-concept, defense style, interpersonal problems, and level of personality organization) were assessed five to seven times using, respectively, questionnaires (SASB, DSQ, IIP) and interview (LPO) during the 5-year follow-up from randomization. Personality functioning improved in all...
Psychodynamic Psychotherapy Research, 2011
Psychotherapy Research, 2013
Research shows psychotherapists espousing different theoretical approaches differ in mentality (e... more Research shows psychotherapists espousing different theoretical approaches differ in mentality (e.g., cognitive styles, beliefs and epistemologies) and personality (e.g., neuroticism). However, studies have not investigated the association between professional relational style prescribed by therapists' theoretical orientations and therapists' manner of relating in personal life. Analyses of over 4000 therapists of varied nationalities, professions and career levels having different theoretical preferences indicate: (i) therapists' self-experience in close personal relationships was significantly associated with the manner their theoretical orientations prescribed for relating with clients; (ii) therapists were less accepting, less tolerant and more demanding in their personal relationships than with clients; and (iii) therapists adjusted their professional relational manner in practice to meet the specific expectations of their preferred orientations.