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Kvarstein EH, Zahl KE, Stänicke LI, Pettersen MS, Baltzersen ÅL, Johansen MS, Eikenaes IUM, Arnevik EA, Hummelen B, Wilberg T, Pedersen G. Vulnerability of personality disorder during the Covid-19 crises - a multicenter survey of treatment experiences among patients referred to treatment. Nord J Psychiatry 2022; 76:52-63. [PMID: 34126854 DOI: 10.1080/08039488.2021.1934110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementation of treatment modifications was required for patients typically characterized by insecure attachment and vulnerability to separation. AIM To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD. DESIGN A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs. RESULTS The response-rate was 12% (N = 133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly telephone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations. CONCLUSION The survey confirms a radical modification from comprehensive group-based PD programs to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable concern about treatment progress.
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Affiliation(s)
- Elfrida Hartveit Kvarstein
- Department for National and Regional Functions, Division of Mental Health and Addiction, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell-Einar Zahl
- Group Therapy Section, Follo District Psychiatric Centre, Akershus University Hospital, Nordbyhagen, Norway
| | - Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway.,Nic Waals Institute, Lovisenberg Deacon Hospital, Oslo, Norway
| | - Mona Skjeklesaether Pettersen
- Department of Substance Abuse, Clinic for Mental Health and Addiction Treatment, University Hospital of North Norway, Tromsø, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Åse-Line Baltzersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Merete Selsbakk Johansen
- Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Ingeborg Ulltveit-Moe Eikenaes
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Espen Ajo Arnevik
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
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Folmo EJ, Stänicke E, Johansen MS, Pedersen G, Kvarstein EH. Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder. Psychother Res 2020; 31:604-618. [DOI: 10.1080/10503307.2020.1831097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- E. J. Folmo
- Norwegian National Advisory Unit on Personality Psychiatry, Section for Personality Psychiatry & Specialized Treatments, Division of Mental Health & Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - E. Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
| | - M. S. Johansen
- Section for Personality Psychiatry & Specialized Treatments, Division of Mental Health & Addiction, Oslo University Hospital, Oslo, Norway
| | - G. Pedersen
- Section for Personality Psychiatry & Specialized Treatments, Division of Mental Health & Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E. H. Kvarstein
- Section for Personality Psychiatry & Specialized Treatments, Division of Mental Health & Addiction, Oslo University Hospital, Oslo, Norway
- Adult Psychiatry Unit, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Nissen-Lie HA, Dahl HSJ, Høglend PA. Patient factors predict therapists' emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy. Psychother Res 2020; 32:3-15. [PMID: 32404003 DOI: 10.1080/10503307.2020.1762947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractObjective: Recently, studies have reported systematic relationships between the therapists' emotional response/countertransference (CT) during therapy and a variety of patient characteristics, speaking to the communicative potential of CT. Within an RCT assessing the role of transference work (TW) in psychodynamic therapy, we investigated whether therapist CT was related to patients' pre-treatment interpersonal problems, degree of personality pathology and motivation for psychodynamic therapy. Secondly, we explored if these relationships depended on whether the therapists used TW or not in sessions. Method: One hundred outpatients were treated with psychodynamic psychotherapy (with or without TW) for one year. Their therapists' emotional reactions after sessions (CT) were assessed with the Feeling Word Checklist-58 (FWC-58). Results: Four subscales of the FWC-58; Inadequate, Confident, Disengaged and Parental feelings were differentially predicted by patient characteristics. Some of the associations depended on treatment condition such that degree of PD pathology was associated with therapists feeling more inadequate in the non-TW-group. Patients' motivation for treatment was associated with less disturbing CT feelings, such as Inadequate and Disengaged CT (the latter especially in the TW group), and feeling more Confident CT. Conclusion: Patient factors predict therapists' emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy.Trial registration: ClinicalTrials.gov identifier: NCT00423462.
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Affiliation(s)
| | - Hanne-Sofie Johnsen Dahl
- Department of Psychology, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Per A Høglend
- Insitute of Clinical Medicine, University of Oslo, Oslo, Norway
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