The mediating role of insight for long-term improvements in psychodynamic therapy.
OBJECTIVE
According to psychoanalytic theory, interpretation of transference leads to increased insight that again leads to improved interpersonal functioning over time. In this study, we performed a full mediational analysis to test whether insight gained during treatment mediates the long-term effects of transference interpretation in dynamic psychotherapy.


METHODS
This study is a randomized clinical trial with a dismantling design. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment with the same therapists but without the use of transference interpretation. Interpersonal functioning and insight were measured pretreatment, posttreatment, and 1 year and 3 years after treatment termination.


RESULTS
Contrary to common expectation, patients with a life-long pattern of low quality of object relations and personality disorder pathology profited more from therapy with transference interpretation than from therapy with no transference interpretation. This long-term effect was mediated by an increase in the level of insight during treatment.


CONCLUSIONS
Insight seems to be a key mechanism of change in dynamic psychotherapy. Our results bridge the gap between clinical theory and empirical research.
Department of Psychiatry, University of Oslo, Vinderen, N-0319 Oslo, Norway. p.n.johansson@medisin.uio.no
Paul
P
Johansson
Per
P
Høglend
Randi
R
Ulberg
Svein
S
Amlo
Alice
A
Marble
Kjell-Petter
KP
Bøgwald
Oystein
O
Sørbye
Mary Cosgrove
MC
Sjaastad
Oscar
O
Heyerdahl
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001364:Awareness; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D010043:Outcome and Process Assessment, Health Care; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011573:Psychoanalytic Interpretation; D011574:Psychoanalytic Theory; D011575:Psychoanalytic Therapy / Q000379:methods*; D014167:Transference, Psychology