Mönster i terapeutinterventioner : En explorativ studie av terapeuters interventioner vid behadlingsetablering och avslutning i psykodynamiska långtidsterapier

Sammanfattning: From the Department of Psychotherapy, Karolinska Institutet, S-l 18 52 Stockholm, Sweden PATTERNS OF THERAPIST INTERVENTIONS An explorative study of therapists' interventions in establisbment and termination in long-term psychodynamic tberapies Gunnar Bohman The aim of the study was to identify and describe patterns of therapists' interventions in the establishment phase and the termination phase in psychodynamic long-term therapies with neurotic patients and conducted by experienced therapists. An explorative research strategy was used based on psychodynamic theory. Thereby features and qualities of therapists' patterns of interventions have been illustrated. The selection of methods used was based upon the study's theoretical frame of reference and the principle of using the same theoretical frame when describing patients, treatments and outcome (P-T-O congruence). A broad data collection was applied. All sessions were audiorecorded and transcribed. Independent evaluators calegorized therapists' interventions, and obtained a satisfying reliability when defining intervention patterns over sequences of sessions. A total of 8 888 interventions from 120 sessions were classified. Dialogue contents, therapists' successive observations and the frames of the treatments were mapped. In addition, data was gathered concerning the patients' core problems and progress after therapy, including a follow up after 6 and 36 months respectively. The results showed treatment-specific and consistent intervention patterns. In the establishment phases two types of patterns were identified. They were, from a theoretical point of view described as a systematic working through and a non systematic non working-through pattern. The former was characterized by the therapists' clearly and repeatedly focusing on different object relations and exploring and/or interpreting of the patients' experiences in the "here and now" and in the past. The patients' core problems were investigated and clarified when appearing in the therapeutic relationship. The systematic working-through pattern was connected with a delimited working-through, terminating pattern during the termination phase. The latter was characterized by the therapists' decreasing use of explorations in favour of careful investigations of the patients' experiences concerning termination of the therapy. The non systematic non working-through pattern was characlerized by the therapists' general attitude of handling the patients' material during the establishment phase. A repeatedly focusing and linking of different object relations was lacking. Therefore, the patients' core problems in the therapeutic relation were not systematically observed nor worked with as they manifested themselves. During the termination phase this patterns was linked-up with either a systematic working-through, terminating pattern in which the therapist continued to explore the patient's material, or with a non -working -through, non-terminating pattern in which the therapist paid no attention to the patient's experiences in connection with termination of the therapy. The patterns of therapists' inlerventions were analyzed against the background of therapists' session specific reports, the frames of the treatments, the session specific contents of the patient-therapist dialogues, and the descriptions of the patients before and after treatment. The study gave promising results in delineating the characteristics of psychodynamic psychotherapy in terms ol patterns of therapists' interventions over time in contrast to regarding such treatments as uniform units. Key words: long-term psychodynamic psychotherapy, therapist interventions, patterns, establishment phase, termination phase Published in Swedish with an English summary. ISBN 91-628-2538-0