title: Effects of transference work in the context of therapeutic alliance and quality of object relations.
abstract: OBJECTIVE
  Transference interpretation is considered as a core active ingredient in dynamic psychotherapy. In common clinical theory, it is maintained that more mature relationships, as well as a strong therapeutic alliance, may be prerequisites for successful transference work. In this study, the interaction between quality of object relations, transference interpretation, and alliance is estimated.
  
  
  METHODS
  One hundred outpatients seeking psychotherapy for depression, anxiety, and personality disorders were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment, but without the use of transference interpretation. Quality of Object Relations (QOR)-lifelong pattern was evaluated before treatment (P. Høglend, 1994). The Working Alliance Inventory (A. O. Horvath & L. S. Greenberg, 1989; T. J. Tracey & A. M. Kokotovic, 1989) was rated in Session 7. The primary outcome variable was the Psychodynamic Functioning Scales (P. Høglend et al., 2000), measured at pretreatment, posttreatment, and 1 year after treatment termination.
  
  
  RESULTS
  A significant Treatment Group × Quality of Object Relations × Alliance interaction was present, indicating that alliance had a significantly different impact on effects of transference interpretation, depending on the level of QOR. The impact of transference interpretation on psychodynamic functioning was more positive within the context of a weak therapeutic alliance for patients with low quality of object relations. For patients with more mature object relations and high alliance, the authors observed a negative effect of transference work.
  
  
  CONCLUSIONS
  The specific effects of transference work was influenced by the interaction of object relations and alliance, but in the direct opposite direction of what is generally maintained in mainstream clinical theory.
authors.affiliation: Department of Psychiatry, University of Oslo, Norway. p.a.hoglend@medisin.uio.no
authors.forename: Per
authors.initials: P
authors.lastname: Høglend
authors.forename: Anne Grete
authors.initials: AG
authors.lastname: Hersoug
authors.forename: Kjell-Petter
authors.initials: KP
authors.lastname: Bøgwald
authors.forename: Svein
authors.initials: S
authors.lastname: Amlo
authors.forename: Alice
authors.initials: A
authors.lastname: Marble
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Sørbye
authors.forename: Jan Ivar
authors.initials: JI
authors.lastname: Røssberg
authors.forename: Randi
authors.initials: R
authors.lastname: Ulberg
authors.forename: Glen O
authors.initials: GO
authors.lastname: Gabbard
authors.forename: Paul
authors.initials: P
authors.lastname: Crits-Christoph
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D009769:Object Attachment; D010554:Personality Disorders / Q000628:therapy; D011572:Psychoanalysis / Q000379:methods*; D011613:Psychotherapy / Q000379:methods*; D014167:Transference, Psychology; D016896:Treatment Outcome