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I den här avsnittet intervjuar vi Jonas Lindblom som är docent i sociologi vid Mälardalens universitet. I sin forskning har Jonas bland annat studerat massmedias hantering av ADHD-medicin. Nyligen är han även aktuell med boken Psykiatrins kris (2023) där han kritiserar hur den medicinska modellen appliceras inom psykiatrin och i samhället. I avsnittet går vi igenom Jonas kritik av hur den medicinska modellen, med sitt fokus på diagnoser, medicin och symtomreduktion, används inom dagens psykiatri och i samhället i stort.
Referenser
Kirk, S., Gomory, T. & Cohen, D. (2013). Mad Science – Psychiatric Coercion, Diagnosis, and Drugs. New Brunswick: Transaction.
Kirk, SA. & Kutchins, H. (1992). The Selling of DSM – The Rhetoric of Science in Psychiatry. New York: de Gruyter.
Moncrieff, J., Cooper, RE., Stockmann, T.,Amendola, S., Hengartner, MP & Horowitz, MA. (2022). “The Serotonin Theory of Depression – A Systematic Umbrella Review of the Evidence”, Molecular Psychiatry.
WHO. (2021). Guidance on Community Mental Health Services – Promoting Person-Centred and Rights-Based Approaches. Geneva: World Health Organization.
WHO (2023). Mental Health, Human Rights and Legislation: Guidance and Practice. World Health Organization & United Nations. Office of the High Commissioner for Human Rights.
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ÅTGÄRDAT: Ragnars röst var svår att höra. Detta är nu åtgärdat.
I det här avsnittet får vi äran att intervjua Elin Lindsäter, som är leg. psykolog och medicine doktor vid institutionen för klinisk neurovetenskap vid karolinska institutet. Elin doktorerade under 2020 med en avhandling om KBT för stress-relaterad ohälsa. Idag håller hon en postdoktor tjänst vid karolinska institutet och arbetar förutom med forskning även med utbildning, metodutveckling och implementering vid Gustavsbergs vårdcentral i stockholm.
I avsnittet får vi chans att ställa våra ocensurerade frågor till Elin och vi får en klarare bild av forskningsläget kring, den för Sverige unika, diagnosen utmattningssyndrom samt även en del spaningar från kunskapslägets frontlinje.
Referenser
Lindsäter, E., Axelsson, E., Salomonsson, S., Santoft, F., Ejeby, K., Ljótsson, B., Åkerstedt, T., Lekander, M., & Hedman-Lagerlöf, E. (2018). Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial. Psychotherapy and psychosomatics, 87(5), 296–305. https://doi.org/10.1159/000490742
Lindsäter, E., Axelsson, E., Salomonsson, S., Santoft, F., Ljótsson, B., Åkerstedt, T., Lekander, M., & Hedman-Lagerlöf, E. (2021). The mediating role of insomnia severity in internet-based cognitive behavioral therapy for chronic stress: Secondary analysis of a randomized controlled trial. Behaviour research and therapy, 136, 103782. https://doi.org/10.1016/j.brat.2020.103782
Lindsäter, E., Svärdman, F., Wallert, J., Ivanova, E., Söderholm, A., Fondberg, R., Nilsonne, G., Cervenka, S., Lekander, M., & Rück, C. (2022). Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis. BJPsych open, 8(5), e159. https://doi.org/10.1192/bjo.2022.559
Van den Block, L., Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B. D., van Hout, H., Pasman, H. R. W., Oosterveld-Vlug, M., Ten Koppel, M., Piers, R., Van Den Noortgate, N., Engels, Y., Vernooij-Dassen, M., Hockley, J., Froggatt, K., Payne, S., Szczerbinska, K., Kylänen, M., Gambassi, G., Pautex, S., … PACE trial group (2020). Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial. JAMA internal medicine, 180(2), 233–242. https://doi.org/10.1001/jamainternmed.2019.5349
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Vi gästas av Malin Fors för att diskutera makt och privilegier samt deras relevans i psykoterapi. Malin Fors är leg. psykolog, fil. dr. i psykologi och specialist i klinisk psykologi och psykoterapi. Under dagtid är hon verksam inom Vuxenpsykiatrin i Hammerfest i Norge men har också en privat mottagning. Vid sidan av detta är hon dessutom aktiv som forskare och har publicerat flera artiklar, bland annat om geografisk narcissism, och skrivit en bok vid namn Makt och privilegier i psykoterapi som har givits ut i flera länder, den svenska versionen gavs ut på Studentlitteratur 2020. Hon har också spelat in en psykoterapifilm för APA på temat, referenser och länkar till samtliga nämnda verk finner du i referenslistan här under.
Referenser
Fors, M. (2018). Malin Fors: The Dynamics of Power and Privilege in Psychotherapy with Malin Fors. DVD for APA: Series 1 – Systems of Psychotherapy. Washington DC: APA Publications. https://www.apa.org/pubs/videos/4311002
Fors, M. (2021). Power dynamics in the clinical situation: A confluence of perspectives. Contemporary Psychoanalysis, 242-269.
https://www.tandfonline.com/doi/full/10.1080/00107530.2021.1935191
Fors, M. (2020). Makt och privilegier i psykoterapi. [Power and privileges in psychotherapy. Swedish translation of A Grammar of Power in psychotherapy: Exploring the dynamics of privilege.] Lund, Sweden: Studentlitteratur
Offman, H. (2020) The Otherness of Fat: An Intersectional Enactment of Epic Proportions. Psychoanalytic Perspectives 17:342-365
länk till Paul Piffs publikationer: https://paulpiff.wixsite.com/meshlab/publications
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Osame är tillbaka och vi pratar vidare utifrån de, kanske något dystra, forskningsfynden som vi går igenom i avsnitt 11. I detta avsnittet fokuserar vi på terapeutens bidrag till terapins effektivitet och vad som kännetecknar riktigt effektiva terapeuter.
Referenser
Anderson, T., McClintock, A. S., Himawan, L., Song, X., & Patterson, C. L. (2016). A Prospective Study of Therapist Facilitative Interpersonal Skills as a Predictor of Treatment Outcome. Journal of Consulting and Clinical Psychology, 84(1), 57–66. https://doi.org/10.1037/ccp0000060
Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755–768. https://doi.org/10.1002/jclp.20583
Delgadillo, J., Saxon, D., & Barkham, M. (2018). Associations between therapists’ occupational burnout and their patients’ depression and anxiety treatment outcomes. Depression and Anxiety, 35(9), 844–850. https://doi.org/10.1002/da.22766
Fried, E. I., & Nesse, R. M. (2015). Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study. Journal of Affective Disorders, 172, 96–102. https://doi.org/10.1016/j.jad.2014.10.010
Goldberg, S. B., Babins-Wagner, R., Rousmaniere, T., Berzins, S., Hoyt, W. T., Whipple, J. L., Miller, S. D., & Wampold, B. E. (2016). Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice. Psychotherapy, 53(3), 367–375. https://doi.org/10.1037/pst0000060
Goldberg, S. B., Hoyt, W. T., Nissen-Lie, H. A., Nielsen, S. L., & Wampold, B. E. (2018). Unpacking the therapist effect: Impact of treatment length differs for high- and low-performing therapists. Psychotherapy Research, 28(4), 532–544. https://doi.org/10.1080/10503307.2016.1216625
Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11. https://doi.org/10.1037/cou0000131
Heinonen, E., & Nissen-Lie, H. A. (2020). The professional and personal characteristics of effective psychotherapists: a systematic review. Psychotherapy Research, 30(4), 417–432. https://doi.org/10.1080/10503307.2019.1620366
Johns, R. G., Barkham, M., Kellett, S., & Saxon, D. (2019). A systematic review of therapist effects: A critical narrative update and refinement to review. Clinical Psychology Review, 67, 78–93. https://doi.org/10.1016/j.cpr.2018.08.004
Kobak, K. A., Wolitzky-Taylor, K., Craske, M. G., & Rose, R. D. (2017). Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders Using Internet-Based Technologies. Cognitive Therapy and Research, 41(2), 252–265. https://doi.org/10.1007/s10608-016-9819-4
Lutz, W., Schwartz, B., & Delgadillo, J. (2022). Measurement-Based and Data-Informed Psychological Therapy. Annual Review of Clinical Psychology, 18(1). https://doi.org/10.1146/annurev-clinpsy-071720-014821
Magnusson, K., Andersson, G., & Carlbring, P. (2018). The consequences of ignoring therapist effects in trials with longitudinal data: A simulation study. Journal of Consulting and Clinical Psychology, 86(9), 711–725. https://doi.org/10.1037/ccp0000333
Moe, F. D., & Thimm, J. (2021). Personal therapy and the personal therapist. Nordic Psychology, 73(1), 3–28. https://doi.org/10.1080/19012276.2020.1762713
Nordahl, H. M., Borkovec, T. D., Hagen, R., Kennair, L. E. O., Hjemdal, O., Solem, S., Hansen, B., Haseth, S., & Wells, A. (2018). Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder. BJPsych Open, 4(5), 393–400. https://doi.org/10.1192/bjo.2018.54
Nidich, S., Mills, P. J., Rainforth, M., Heppner, P., Schneider, R. H., Rosenthal, N. E., Salerno, J., Gaylord-King, C., & Rutledge, T. (2018). Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial. The lancet. Psychiatry, 5(12), 975–986. https://doi.org/10.1016/S2215-0366(18)30384-5
Saxon, D., Firth, N., & Barkham, M. (2017). The Relationship Between Therapist Effects and Therapy Delivery Factors: Therapy Modality, Dosage, and Non-completion. Administration and Policy in Mental Health and Mental Health Services Research, 44(5), 705–715. https://doi.org/10.1007/s10488-016-0750-5
Schöttke, H., Flückiger, C., Goldberg, S. B., Eversmann, J., & Lange, J. (2017). Predicting psychotherapy outcome based on therapist interpersonal skills: A five-year longitudinal study of a therapist assessment protocol. Psychotherapy Research, 27(6), 642–652. https://doi.org/10.1080/10503307.2015.1125546
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Vi diskuterar betydelsen av bland annat utbildning, kompetens och följsamhet till manualer när det kommer till psykoterapi tillsammans med vår gäst Osame Salim. Vi berör bland annat frågor som; blir man en bättre terapeut av att fortbilda sig? Får man bättre resultat av att bli bättre på specifika manualer? Är psykologer bättre än exempelvis gymnasielärare på att bedriva psykoterapi? Vad är överhuvudtaget psykoterapi och hur kan man lära sig det?
Referenser
Anderson, T., Crowley, M. E. J., Himawan, L., Holmberg, J. K., & Uhlin, B. D. (2016). Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome. Psychotherapy Research, 26(5), 511–529. https://doi.org/10.1080/10503307.2015.1049671
Anderson, T., Finkelstein, J. D., & Horvath, S. A. (2020). The facilitative interpersonal skills method: Difficult psychotherapy moments and appropriate therapist responsiveness. Counselling and Psychotherapy Research, 20(3), 463–469.
Bennett-Levy, J. (2019). Why therapists should walk the talk: The theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145. https://doi.org/10.1016/j.jbtep.2018.08.004
Boswell, J. F., Gallagher, M. W., Sauer-Zavala, S. E., Bullis, J., Gorman, J. M., Shear, M. K., Woods, S., & Barlow, D. H. (2013). Patient characteristics and variability in adherence and competence in cognitive-behavioral therapy for panic disorder. Journal of Consulting and Clinical Psychology, 81(3), 443–454. https://doi.org/10.1037/a0031437
Burlingame, G. M., & Barlow, S. H. (1996). Outcome and Process Differences Between Professional and Nonprofessional Therapists in Time-Limited Group Psychotherapy. International Journal of Group Psychotherapy, 46(4), 455–478. https://doi.org/10.1080/00207284.1996.11491505
Erekson, D. M., Janis, R., Bailey, R. J., Cattani, K., & Pedersen, T. R. (2017). A longitudinal investigation of the impact of psychotherapist training: Does training improve client outcomes? Journal of Counseling Psychology, 64(5), 514–524. https://doi.org/10.1037/cou0000252
Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11. https://doi.org/10.1037/cou0000131
Hill, C. E., Baumann, E., Shafran, N., Gupta, S., Morrison, A., Rojas, A. E. P., Spangler, P. T., Griffin, S., Pappa, L., & Gelso, C. J. (2015). Is training effective? A study of counseling psychology doctoral trainees in a psychodynamic/interpersonal training clinic. Journal of Counseling Psychology, 62(2), 184–201. https://doi.org/10.1037/cou0000053
Hill, C.E & Knox, S. (2013) Training and supervision in psychotherapy. In Lambert, M. J. (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed). John Wiley & Sons.
Hoyer, J., Čolić, J., Pittig, A., Crawcour, S., Moeser, M., & Ginzburg, D. et al. (2017). Manualized cognitive therapy versus cognitive-behavioral treatment-as-usual for social anxiety disorder in routine practice: A cluster-randomized controlled trial. Behaviour Research And Therapy, 95, 87-98. doi: 10.1016/j.brat.2017.05.012
Nissen-Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., & Monsen, J. T. (2017). Love Yourself as a Person, Doubt Yourself as a Therapist?: Relationship of Therapist Professional and Personal Functioning to Therapeutic Outcome. Clinical Psychology & Psychotherapy, 24(1), 48–60. https://doi.org/10.1002/cpp.1977
Okiishi, J., Lambert, M. J., Nielsen, S. L., & Ogles, B. M. (2003). Waiting for supershrink: An empirical analysis of therapist effects. Clinical Psychology & Psychotherapy, 10(6), 361– 373. https://doi.org/10.1002/cpp.383
Owen, J., Wampold, B. E., Kopta, M., Rousmaniere, T., & Miller, S. D. (2016). As good as it gets? Therapy outcomes of trainees over time. Journal of Counseling Psychology, 63(1), 12–19. https://doi.org/10.1037/cou0000112
Rapley, H. A., & Loades, M. E. (2019). A systematic review exploring therapist competence, adherence, and therapy outcomes in individual CBT for children and young people. Psychotherapy Research, 29(8), 1010–1019. https://doi.org/10.1080/10503307.2018.1464681
Schöttke, H., Flückiger, C., Goldberg, S. B., Eversmann, J., & Lange, J. (2017). Predicting psychotherapy outcome based on therapist interpersonal skills: A five-year longitudinal study of a therapist assessment protocol. Psychotherapy Research, 27(6), 642–652. https://doi.org/10.1080/10503307.2015.1125546
Stiles, W. B. (2009). Responsiveness as an Obstacle for Psychotherapy Outcome Research: It’s Worse Than You Think. Clinical Psychology: Science and Practice, 16(1), 86–91. https://doi.org/10.1111/j.1468-2850.2009.01148.x
Strupp, H. H & Hadley, S. W. (1979). Specific vs Nonspecific Factors in Psychotherapy: A Controlled Study of Outcome. Archives of General Psychiatry, 36(10), 1125. https://doi.org/10.1001/archpsyc.1979.01780100095009
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (Second edition). Routledge.
Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 200–211. https://doi.org/10.1037/a0018912
Zarafonitis-Müller, S., Kuhr, K., & Bechdolf, A. (2014). [The relationship between therapist's competence and adherence to outcome in cognitive-behavioural therapy - results of a metaanalysis]. Fortschritte der Neurologie · Psychiatrie, 82(09), 502–510. https://doi.org/10.1055/s-0034-1366798
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Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49-53.
Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4(1), 21-29.
Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing Treatment Outcome of Patients at Risk of Treatment Failure: Meta-Analytic and Mega-Analytic Review of a Psychotherapy Quality Assurance System. Journal Of Consulting And Clinical Psychology, 78(3), 298-311.
Waller, G., Stringer, H., & Meyer, C. (2012). What Cognitive Behavioral Techniques Do Therapists Report Using When Delivering Cognitive Behavioral Therapy for the Eating Disorders? Journal of Consulting and Clinical Psychology, 80(1), 171–175
Waller, G., Stringer, H., & Meyer, C. (2012). What Cognitive Behavioral Techniques Do Therapists Report Using When Delivering Cognitive Behavioral Therapy for the Eating Disorders? Journal of Consulting and Clinical Psychology, 80(1), 171–175
Walfish, S., McAlister, B., O'Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110(2), 639-644.
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Vi diskuterar reproducerbarhetskrisen inom psykologin och om det borde anses vara någon form av kris inom den kliniska (empiriska) psykologin.
Referenslista (i omnämnd ordning)
Driessen, E., Hollon, S. D., Bockting, C. L., Cuijpers, P., and Turner, E. H. (2015). Does publication bias inflate the apparent efficacy of psychological treatment for major depressive disorder? a systematic review and meta-analysis of us national institutes of health-funded trials. PLoS ONE 10:e0137864. doi: 10.1371/journal.pone.0137864
Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., and Andersson, G. (2010a). Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br. J. Psychiatry 196, 173–178. doi: 10.1192/bjp.bp.109.066001
Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., and Cuijpers, P. (2017a). Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry 74, 319–328. doi: 10.1001/jamapsychiatry.2016.4287
Dwan, K., Altman, D. G., Arnaiz, J. A., Bloom, J., Chan, A. W., Cronin, E., et al. (2008). Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS ONE 3:e3081. doi: 10.1371/journal.pone.0003081
Kirkham, J. J., Dwan, K. M., Altman, D. G., Gamble, C., Dodd, S., Smyth, R., et al. (2010). The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 340:c365. doi: 10.1136/bmj.c365
Luborsky, L., Diguer, L., Seligman, D. A., Rosenthal, R., Krause, E. D., Johnson, S., … Schweizer, E. (2006). The Researcher’s Own Therapy Allegiances: A “Wild Card” in Comparisons of Treatment Efficacy. Clinical Psychology: Science and Practice, 6(1), 95–106. doi:10.1093/clipsy.6.1.95
Ferguson, C. J., and Heene, M. (2012). A Vast Graveyard of undead theories: publication bias and psychological science's aversion to the null. Perspect. Psychol. Sci. 7, 555–561. doi: 10.1177/1745691612459059
Pereira, T. V., and Ioannidis, J. P. (2011). Statistically significant meta-analyses of clinical trials have modest credibility and inflated effects. J. Clin. Epidemiol. 64, 1060–1069. doi: 10.1016/j.jclinepi.2010.12.012
Tolin, D. F. (2010). Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin. Psychol. Rev. 30, 710–720. doi: 10.1016/j.cpr.2010.05.003
Leichsenring, F., and Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. Br. J. Psychiatry 199, 15–22. doi: 10.1192/bjp.bp.110.082776
Smit, Y., Huibers, M. J., Ioannidis, J. P., van Dyck, R., van Tilburg, W., and Arntz, A. (2012). The effectiveness of long-term psychoanalytic psychotherapy–a meta-analysis of randomized controlled trials. Clin. Psychol. Rev. 32, 81–92. doi: 10.1016/j.cpr.2011.11.003
Coyne, J. C., & Kok, R. N. (2014). Salvaging Psychotherapy Research: A Manifesto. Journal of Evidence-Based Psychotherapies, 14(2), 105-124
Cuijpers, P., Turner, E. H., Mohr, D. C., Hofmann, S. G., Andersson, G., Berking, M., et al. (2014b). Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis. Psychol. Med. 44, 685–695. doi: 10.1017/S0033291713000457
Cuijpers, P., Turner, E. H., Mohr, D. C., Hofmann, S. G., Andersson, G., Berking, M., et al. (2014b). Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis. Psychol. Med. 44, 685–695. doi: 10.1017/S0033291713000457
Weisz, J. R., Donenberg, G. R., Han, S. S., and Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. J. Consult. Clin. Psychol. 63, 688–701. doi: 10.1037/0022-006X.63.5.688
Westen, D., Novotny, C. M., and Thompson-Brenner, H. (2004). The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol. Bull. 130, 631–663. doi: 10.1037/0033-2909.130.4.631
Hallfors, D., & Cho, H. (2007). Moving behavioral science from efficacy to effectiveness. International Journal of Behavioral Consultation and Therapy, 3(2), 236-250. http://dx.doi.org/10.1037/h0100801
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