INTRODUCTION:The aim of the Common factors, Responsiveness and Outcome in Psychotherapy (CROP) study is to identify client and psychologist characteristics and therapeutic processes associated with the outcome of psychotherapy delivered by psychologists employed in the Danish primary sector or fully self-employed. The study addresses two main questions. First, how are specific characteristics of clients and psychologists related to the outcome of therapy and do these characteristics moderate the outcome of different psychotherapeutic approaches? Second, to what extent do therapists adapt their approach to client characteristics and preferences and how does such responsiveness impact the process and outcome of therapy?METHODS AND ANALYSIS:The study is a naturalistic prospective cohort study carried out in collaboration with psychologists in private practice in Denmark. Self-reported data are collected from the participating psychologists and their participating clients before, during (weekly and postsession) and after psychotherapy (at end of treatment and 3 months follow-up). The estimated target sample size is 573 clients. The data are analysed using multilevel modelling and structural equation modelling approaches to capture predictors and moderators of the effect and rate of change in psychotherapy as well as session-to-session changes during the therapy process.ETHICS AND DISSEMINATION:The study has been approved by the IRB at the Department of Psychology, University of Copenhagen (IRB number: IP-IRB/01082018) and the Danish Data Protection Agency. All study data are fully anonymised and all clients have given informed consent to participation in the study. The study findings will be presented in articles in international, peer-reviewed journals as well as to psychotherapy practitioners and other professionals across Denmark.TRIAL REGISTRATION NUMBER:NCT05630560.

Artiklens udgangspunkt er, at psykologiens gentandsområde, psyken, er irreduktibel. Forfatterne er enige om udgangspunktet, men i øvrigt tilhængere af vidt forskellige psykologiske retninger. De enkelte forfattere bestemmer hver især de afgørende irreduktible træk ved psyken. Til sidst i artiklen forsøges en sammenkædning af de enkelte synspunkter, der argumenteres mod eklekticisme og der specificeres en række grundspørgsmål til yderligere bestemmelse af psyken.

Objective: A general lack of supervision outcome studies and new advancements within therapist training methods inspired us to develop a randomised controlled trial, Case formulation and ALLiance (CALL), testing the efficacy of a brief pre-treatment training session. CALL combines generic case formulation and alliance principles with the supervision of a specific client. This qualitative study acts as a preliminary to the randomised controlled trial and aims to explore psychologists' experiences of participating in CALL. Method: Semi-structured interviews were conducted with seven psychologists in private practice, who participated in CALL between January and May 2020. The transcribed interviews were analysed using thematic analysis. Results: The psychologists described CALL as a clinically useful and collegial experience but simultaneously conveyed a lack of recollection of the training session and doubts as to its enduring utilisation. Conclusion: CALL has the potential to positively influence the process and outcome of therapy through the fostering of case formulation and alliance management skills, as well as a strong supervisory alliance. However, the familiar content or brief format of the session, and participants' memory bias, may have limited the utilisation and recall of the intervention.

The purpose of this pilot study was to explore differences in the level of personality functioning, symptom severity, and personality pathology in patients with mixed sensory-motor functional neurological disorder (conversion disorder). Individuals with psychogenic nonepileptic seizures were not included. We recruited 15 patients, mean age of 33.5 years (SD, 11.4 years), 13 females and 2 males, from an outpatient clinic for psychotherapeutic treatment. We assessed the patients using the Structured Clinical Interview for DSM-4 Axis II Personality Disorders, the SCL-90-R, the Karolinska Psychodynamic Profile, and the Defense Style Questionnaire. We were able to distinguish two levels of difficulty in relation to personality functioning as distinct subgroups: 1) "neurotic" with less severe or moderate personality psychopathology and 2) "borderline" with severe personality psychopathology. Furthermore, we concluded that all patients showed severe deficits in personality functioning. The study points out the clinical relevance of identifying personality functioning as part of an assessment in the preparation of a treatment strategy.

Patients with borderline personality disorder (BPD) have deficits in neurocognitive function that could affect their ability to engage in psychotherapy and may be ameliorated by improvements in symptom severity. In the current study, 18 patients with BPD completed neurocognitive tests prior to beginning mentalization-based therapy and again after 6 months of treatment. Twenty-eight nonpsychiatric controls were tested over the same period of time but received no intervention. Before starting treatment, patients performed lower than controls on tests assessing sustained attention and visuospatial working memory. After 6 months of treatment, patients showed significantly greater increases in sustained attention and perceptual reasoning than controls, with initial deficits in sustained attention among patients resolving after treatment. Improved emotion regulation over the follow-up period was associated with increased auditory-verbal working memory capacity, whereas interpersonal functioning improved in parallel with perceptual reasoning. These findings suggest that changes in neurocognitive functioning may track improvements in clinical symptoms in mentalization-based treatment for BPD.

Individuals with borderline personality disorder (BPD) frequently display impairments in the identification of emotional facial expressions paralleled by a negativity bias. However, it remains unclear whether misperception of facial expressions is a key psychopathological marker of BPD. To address this question, the authors examined 43 women diagnosed with BPD and 56 healthy female controls using an emotion face identification task and a face dot-probe task together with measures on psychopathology. Compared to controls, women with BPD showed impaired identification of disgusted and angry faces concurrent with a bias to misclassify faces as angry, and a faster preconscious vigilance for fearful relative to happy facial expressions. Increased severity of borderline symptoms and global psychopathology in BPD patients were associated with reduced ability to identify angry facial expressions and a stronger negativity bias to anger. The findings indicate that BPD patients who misperceive face emotions have the greatest mental health issues.

The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.

This study compares maladaptive coping, measured as substance use, behavioral disengagement, self-blame, and emotional eating, among adults (>18 years) who have experienced early parental loss ( N = 1465 women, N = 331 men) with non-bereaved controls ( N = 515 women, N = 115 men). We also compared bereaved adults who received grief counseling ( N = 822 women, N = 190 men) with bereaved controls who had not ( N = 233 women, N = 66 men). Bereaved adults reported significantly more substance use, behavioral disengagement, and emotional eating than non-bereaved adults. Counseling participants reported significantly more substance use and self-blame than non-participants. Our results suggest that early loss may negatively impact the development of adulthood coping.

Objective: The aim of this study was to examine the general psychological functioning of patients suffering from bulimia nervosa (BN) using the Karolinska Psychodynamic Profile (KAPP). Furthermore, KAPP data and data from the Reflective Functioning scale (RF), measuring the ability to mentalize, were combined in order to examine differences in alexithymia, impulse control and affect regulation in patients with high or low RF.Method: Seventy patients with BN were interviewed with both the KAPP and the Adult Attachment Interview (AM) from which RF is coded. Differences in KAPP scores of patients with high or low RF were analyzed.Results: Most of the patients with BN were found to have a personality structure within the normal or neurotic range (n = 50 of 70). BN patients with a high RF had significantly lower scores on KAPP's alexithymia scale than patients with a low RF score, demonstrating that poor mentalizing is related to alexithymia. Concurrently, patients with high RF showed problems with impulse control and coping with aggressive affects according to KAPP scores.Conclusion: Although BN patients with high RF showed good capacities for describing their mental states, they still had difficulties regulating the emotions and impulses related to these states. Significant outcome: Among patients suffering from BN, patients with high RF were significantly less alexithymic than low RF patients.Limitations: The findings of this study are limited by the relatively small numbers of participants especially in the RF subgroups, posing a danger of not finding as significant existing differences in character pathology between high and low RF groups. (C) 2015 Elsevier Inc. All rights reserved.

Introduction Previous research has shown that brain injury patients with Organic Personality Disorder (OPD) may display “borderline” traits due to prefrontal damage, and their personality structure may be unstable and close to a borderline personality organisation. They may have few general neuropsychological dysfunctions but specific executive deficits. Similar deficits have been found in patients with Borderline Personality Disorder (BPD). The objective of this study was to identify differences and similarities between the neuropsychological and personality profiles of BPD and OPD patients. Methods Twenty BPD patients and 24 OPD patients were assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Karolinska Psychodynamic Profile (KAPP), and a comprehensive neuropsychological test battery. Results Very few neuropsychological differences were found between the two patient groups. However, the verbal fluency, verbal intelligence, verbal memory, and immediate auditory memory/attention of the BPD patients were significantly poorer than the OPD patients'. The KAPP profiles of the BPD patients showed significantly poorer functioning in three areas: frustration tolerance, the body as a factor of self-esteem, and overall personality organisation. Conclusions These results support our clinical experience and expectations concerning the severity of symptoms of both patient groups. We suggest considering in depth assessments of both neuropsychological and personality-related problems for each of these patients in order to inform treatment.

OBJECTIVE The authors compared psychoanalytic psychotherapy and cognitive-behavioral therapy (CBT) in the treatment of bulimia nervosa. METHOD A randomized controlled trial was conducted in which 70 patients with bulimia nervosa received either 2 years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months. The main outcome measure was the Eating Disorder Examination interview, which was administered blind to treatment condition at baseline, after 5 months, and after 2 years. The primary outcome analyses were conducted using logistic regression analysis. RESULTS Both treatments resulted in improvement, but a marked difference was observed between CBT and psychoanalytic psychotherapy. After 5 months, 42% of patients in CBT (N=36) and 6% of patients in psychoanalytic psychotherapy (N=34) had stopped binge eating and purging (odds ratio=13.40, 95% confidence interval [CI]=2.45-73.42; p<0.01). At 2 years, 44% in the CBT group and 15% in the psychoanalytic psychotherapy group had stopped binge eating and purging (odds ratio=4.34, 95% CI=1.33-14.21; p=0.02). By the end of both treatments, substantial improvements in eating disorder features and general psychopathology were observed, but in general these changes took place more rapidly in CBT. CONCLUSIONS Despite the marked disparity in the number of treatment sessions and the duration of treatment, CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy and was generally faster in alleviating eating disorder features and general psychopathology. The findings indicate the need to develop and test a more structured and symptom-focused version of psychoanalytic psychotherapy for bulimia nervosa.

The debut as a clinical supervisor is still rather unknown. The aim of this study is to explore what kind of tasks novice supervisors undertake and how they are prepared for these. During 20092010, 350 Danish clinical psychologists have responded to the Development of Psychotherapists Common Core Questionnaire covering a wide range of items on professional development, experience and practice. In this paper, we focus on background data (experience, training and practice), specifically the tasks and training of the respondents as novice supervisors. The results show that a majority of novice supervisors were confronted with complicated tasks, e. g. group, internal and interdisciplinary supervision, but were not prepared, i.e. trained, prior to these tasks. These findings imply that more training is needed for novice supervisors. Preferably, this training should be introduced before, or at least parallel to, the first supervisor tasks, preparing the novice supervisors for the often complicated tasks they are meeting.

The debut as a clinical supervisor is still rather unknown. The aim of this study is to explore what kind of tasks novice supervisors undertake and how they are prepared for these. During 2009–2010, 350 Danish clinical psychologists have responded to the Development of Psychotherapists Common Core Questionnaire covering a wide range of items on professional development, experience and practice. In this paper, we focus on background data (experience, training and practice), specifically the tasks and training of the respondents as novice supervisors. The results show that a majority of novice supervisors were confronted with complicated tasks, e.g. group, internal and interdisciplinary supervision, but were not prepared, i.e. trained, prior to these tasks. These findings imply that more training is needed for novice supervisors. Preferably, this training should be introduced before, or at least parallel to, the first supervisor tasks, preparing the novice supervisors for the often complicated tasks they are meeting.

Denne artikel gennemgår de senere års udforskning af psykoterapeuters faglige udvikling, idet der anlægges et udviklingspsykopatologisk perspektiv. Her inddrages psykoterapeuters personlige karakteristika og på baggrund af foreliggende forskningsresultater diskuteres begrebet ’psykoterapeut-egnethed’. Endvidere fremlægges parametre, som den empiriske forskning har fundet er de væsentlige faktorer i psykoterapeuters professionelle udvikling: udført praksis, supervision, egenterapi samt personlige hændelser igennem livet. Artiklen udgør endelig en teoretisk baggrund for en kommende afrapportering fra en større dansk spørgeskemaundersøgelse af ca. 350 psykoterapeuters faglige udvikling.

Neuro-psykoanalyse er betegnelsen for et tværvidenskabeligt samarbejde, der principielt havde sin begyndelse hos Freud. Siden 1990’erne er der dukket centre, verdenskongresser og publikationer op, hvor neurovidenskaberne går i dialog med psykoanalysen. Der er bestræbelser inden for (mindst) tre ret ninger: At afklare den neuro-psyko-dynamiske udvikling af personligheden fra spædbarnsalderen, at finde det cerebrale grundlag for ‘det psykiske apparat’ og at forstå processerne bag bevidsthed og subjektiv oplevelse.

Personality change after injury to the orbitofrontal cortex has frequently been described in the literature. However, there are only a few specific and reliable methods available for the assessment of personality change after brain injury. Here we present a patient, LP, whose personality has changed due to a ruptured aneurysm of the anterior communicating artery that resulted in bilateral ventromesial prefrontal lesions. Although his performance on extensive conventional neuropsychological tests was within normal range, he exhibited severe behavioral problems characterized by lack of initiative, inappropriate social timing, and blunt affect. The patient’s behavioral problems were measured with extensive assessment of personality characteristics and traits using methods from psychodynamic and psychometric traditions. Although no general signs of psychopathology were found, there were some indications that he was suffering from personal problems that fluctuated, as cognitive functions sometimes do after frontallobe injury. Intensive psychoanalytic psychotherapy allows us to hypothesize about some of the dynamics behind his acquired “loss of initiative,” although the very nature of his problems appears to be an obstacle to this kind of psychotherapy. This case study, like similar ones presented in the literature, reminds us to be cautious of accepting negative findings concerning standardized test performance as evidence of the absence of real-life problems after frontal-lobe injury.

INTRODUCTION:In neuropsychological research, "organic personality disorder", lack of social insight, and executive dysfunctions have been identified in patients with prefrontal brain injury. The assessment of personality change has, in particular, been a methodological challenge in this field of research. The aim of the present pilot study was to examine personality aspects in patients with prefrontal brain injury from a neuropsychological as well as a psychodynamic point of view.METHODS:A total of 13 adults with personality change as a manifest sequel after sudden onset brain injury were assessed with neuropsychological tests of executive functions, with the European Brain Injury Questionnaire (EBIQ), and with the Karolinska Psychodynamic Profile (KAPP), which to our knowledge has not previously been used as part of a neuropsychological assessment. The personality profiles of the brain-injured patients were compared to the personality profile of a group of 65 brain-healthy individuals.RESULTS:The personality organisation of the prefrontally brain-injured patients was significantly disturbed and close to a borderline personality organisation, as defined by the KAPP.CONCLUSIONS:The results of the pilot study suggest that prefrontal brain systems may support the integration of self-functions and play a central role for inter-personal relations. Future research regarding the relation between brain dysfunction, executive and cognitive deficit, and personality disorder needs to be carried out in larger samples to substantiate the hypothesis of a relationship between prefrontal brain systems and self-functions.