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Does Interpretation of Transference Affect Psychotherapy Outcome?

Transference interpretations may benefit patients with poorer object relations.

Scientific examination of the effective ingredients of psychodynamic psychotherapy is notoriously difficult to conduct. These Swedish researchers randomized 100 patients deemed suitable for exploratory psychodynamic psychotherapy to receive 1 year of psychotherapy (45-minute weekly sessions) with a "moderate" level of transference interpretations (1–3 per session) or psychotherapy without such interpretations.

Patients had depressive, anxiety, or personality disorders, interpersonal problems, or combinations of these. Therapists had 10 to 25 years of experience. To achieve treatment fidelity, therapists were trained in the two modes for up to 4 years, and taped sessions were evaluated by raters blinded to assignment. Assessments were indexes of self-reported symptom distress and interpersonal problems as well as scales measuring insight, tolerance of affect, problem-solving capacity, and quality of family, friend, and romantic/sexual relationships.

Overall, change on psychodynamic, interpersonal, or global scales did not differ between groups. Contrary to theory, however, patients who scored low on object relationship quality (i.e., history, maturity, and stability of adult relationships) showed a trend toward more clinically significant change with psychotherapy that used transference interpretations than with psychotherapy that did not — unlike patients with better object relationships.

Comment: This study was underpowered for small-to-medium effect sizes, and the researchers did not rigorously assess patients for axis I conditions or for the effect of shifts in depression. Thus, the results must be seen as tentative. Nevertheless, the unexpected, counterintuitive, finding that patients with initially poorer object relationships were more likely to benefit from transference interpretations is of interest. An editorialist suggests that because these patients may have difficulty viewing therapists as trustworthy, addressing the therapeutic relationship directly might help them set aside distortions and remain in collaborative treatment.

— Joel Yager, MD

Published in Journal Watch Psychiatry November 13, 2006

Citation(s):

Høglend P et al. Analysis of the patient-therapist relationship in dynamic psychotherapy: An experimental study of transference interpretations. Am J Psychiatry 2006 Oct; 163:1739-46.

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Gabbard GO. When is transference work useful in dynamic psychotherapy? Am J Psychiatry 2006 Oct; 163:1667-9.

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• Medline abstract (Free)