Inledning: Syftet med föreliggande studie var att undersöka psykoterapeuters personliga upplevelse av egenterapins påverkan på professionell utveckling under psykodynamiskt inriktad psykoterapeututbildning. Frågeställningar: Vilken roll spelar egenterapin för kunskapsinhämtandet under psykoterapeututbildningen? På vilket sätt påverkar egenterapin under utbildningen utvecklandet av psykoterapeutisk kompetens?  Metod: En kvalitativ, explorativ ansats med vetenskapsteoretisk grund i hermeneutiken användes. Data samlades in via semistrukturerade intervjuer och analyserades med induktiv, tematisk analys. Resultat: Egenterapi visade sig ha en positiv effekt på lärande och professionell utveckling genom att främja framväxten av en teori- och kunskapsbaserad professionell subjektivitet, en personligt grundad, professionell hållning. Det handlade om ett sätt att förhålla sig till och integrera teori i det kliniska arbetet och att på ett djupare plan kunna relatera till sina patienter. Viktiga delar i denna utveckling var delad erfarenhet, personlig påverkan och kunskapsintegration. Diskussion: Framväxt av professionell subjektivitet var en avgörande faktor när det gällde yrkesmässig utveckling för blivande psykoterapeuter. Att hitta och förhålla sig till sin egen subjektivitet var avgörande i processen att utveckla en personligt grundad, professionell hållning i det kliniska arbetet. / The aim of this study was to investigate psychodynamic psychotherapists' experiences of the influence of personal therapy on professional development during training with a focus on acquisition of knowledge and development of psychotherapeutic skills. Semi structured interviews were conducted with eight former students at two training institutes for psychodynamic psychotherapy. Thematic analysis was conducted on the material. Personal therapy was found to have a positive effect on learning and professional development by promoting the emergence of a theory and knowledge based professional subjectivity, a personally founded, professional attitude. Important elements of this development were shared experience, personal influence and knowledge integration. The emergence of professional subjectivity proved to be a vital factor in terms of professional advancement for future psychotherapists. Finding and relating to their own subjectivity was crucial in the process of developing a personally founded, professional attitude in clinical work.

Who are the adolescents who purposely cut or burn their wrists, arms, or some other parts of their body? The fundamental question I raise in this dissertation is whether or not the portrait of self-harming adolescents as being exposed to others’ hostility in their everyday life environments and experiencing internal adjustment problems, particularly depressive symptoms, correctly represents their symptomology. I want to answer three questions: 1) What can be done to interrupt the maladaptive link that leads adolescents who experience internalizing symptoms to perform self-harming behaviors? 2) Are adolescent self-harmers typically exposed to others’ hostility or are they also involved in hostile interactions with other people? and, 3) What are the critical interpersonal and adjustment features of adolescent selfharmers? The results show that: 1) Adolescent girls with high depressive symptoms who feel at ease communicating with their parents do not use selfharm as a coping strategy when facing negative emotional experiences to the same extent as girls with high depressive symptoms who do not experience communication with parents as easy; 2) Adolescents who are involved in mutually hostile relationships with people who they meet in their daily life express more self-harming behaviors than adolescents who are exposed to others’ hostility; and, 3) Living in mutually hostile interactions with other people and experiencing both internalizing and externalizing problems seem to be key features of adolescents who harm themselves. Taken together, the results of this dissertation go beyond the traditional representation of selfharmers, and offer a holistic way of identifying a problem scenario under which adolescents self-harm. Implications for theory and practice are discussed.

Inledning: En prematur födsel framkallar ofta en kris i en familj, syskon blir oftast inte tillräckligt sedda i samband med att ett barn föds mycket för tidigt. Syftet med denna studie var att undersöka syskons och föräldrars upplevelse med ett särskilt fokus på syskonens upplevelse av att få ett extremt för tidigt fött syskon d.v.s. född v 28 och tidigare med en födelsevikt under ett kilo - v < 28 < 1000 g. Frågeställningarna i undersökningen fokuserade på förväntningar på att få ett syskon, vad som präglade tiden på neonatalavdelningen för föräldrar och syskon och hur har familjen föräldrar och syskon påverkats av att få ett extremt för tidigt fött barn. En kvalitativ metod valdes, studien bygger på fyra semistrukturerade intervjuer med syskon i åldrarna tio till femton år och fem kvalitativa föräldraenkäter. Resultatet min studie överensstämmer med vad tidigare forskning kommit fram till inom flera områden. Den neonatala tiden präglades av många känslor alltifrån stark förtvivlan till glädje och lycka. En tid som kom att innefatta mycket av oro för såväl syskon som föräldrar. Starka konfliktkänslor väcktes hos föräldrarna av att inte räcka till för både hemmavarande syskon och för det prematurfödda barnet. Separation och en splittrad familj upplevdes av alla respondenter. Syskonen beskriver en stark avsaknad utav sin mamma. Vardagen för familjerna blev kaotisk, stressig och rörig med lite tid för återhämtning. Diskussion: Flera studier påvisar, sårbarhet av att syskon inte tillräckligt uppmärksammas i samband med en prematur födsel. Vidare forskning inom området utifrån ett familjeperspektiv behövs. Med hänsyn till familjemedlemmars olika behov att hantera och bearbeta, en ofta traumatisk upplevelse som av att få ett mycket förtidigt fött barn. / Introduction A premature birth often provoke a crisis in the family, siblings are often not sufficiently taken in connection with a child is born very prematurely. The purpose of this study was to investigate the siblings and parents 'experience with a particular focus on the siblings' experience of getting an extremely premature siblings, that is, Born rows 28 and earlier with a birth weight under one kilogram - v <28 <1000 g. The questions in the survey focused on expectations about getting a sibling, what marked time in the neonatal unit, and how the family can be affected by getting an extremely prematurely given birth. A qualitative method was chosen, the study is based on four semi-structured interviews with siblings between the ages of ten to fifteen years and five qualitative parental questionnaires. The results my study correspond well with earlier research findings. The neonatal period was characterized by many emotions from strong despair to joy and happiness. A time that was to include a lot of concern for both siblings and parents. Strong conflicting emotions aroused in the parents by not being good enough for both at home and siblings of the prematurely born child. Separation and a broken family experienced by all respondents. Siblings describe a strong absence out of her mother. Everyday life for the families became chaotic, stressful and chaotic with little time for recovery. Discussion several studies demonstrate the vulnerability of the siblings are not sufficiently addressed in the context of a premature birth. Further research in this area from a family perspective is needed. With regard to the family members of the need to manage and process, an often traumatic experience of getting a very premature baby.

The process and outcome of psychoanalytic psychotherapy have been studied for a long time. However, the experiences of patients, particularly in therapies where goals were not met, have not yet been the target of extensive research. Psychoanalytic psychotherapy with young adults might face particular challenges. The overall aim of this thesis was to explore the experiences of young adults in psychoanalytic psychotherapy, with a particular focus on differences between suboptimal therapies and therapies with generally good outcome. The setting was naturalistic, and perspectives of the patient, therapist and observer were combined. Qualitative and quantitative methods were used. Study I explored experiences of psychotherapy process and outcome among seven patients in psychoanalytic psychotherapy, who expressed dissatisfaction. Interviews at termination and 18 months later were analysed using grounded theory and compared to therapist experiences. Patients experienced abandonment with their problems in and after therapy, since therapy according to the patients lacked connections to daily life, as well as flexibility, activity and understanding from the therapist. Therapists presented a different picture of the same therapies, mainly focused on the difficulties of the patients. Study II analysed the experiences of 20 non-improved or deteriorated young adult psychotherapy patients at termination of therapy and 36 months later. Non-improvement and deterioration were calculated based on the reliable change index on self-rating scores. The grounded theory analysis of interviews established spinning one’s wheels as a core category. The relationship to the therapist was described as artificial, although at times helpful. Participants experienced their own activity in life and active components of therapy as helpful, but thought focus in therapy was too much on past experiences. Study III explored the experiences of 17 young adult patients, in psychoanalytic individual or group therapy, overcoming depression. The analysis of interviews from therapy termination and 18 months later indicated that finding an identity and a place in life were perceived as intertwined with symptom relief. Negative experiences included difficulties to change oneself, fear of change, and problems in therapy, such as too little activity on the therapist’s part. The results were discussed in relation to young adulthood, therapeutic alliance, mentalization, and attachment. The conclusion was expressed in a comprehensive process model of suboptimal therapy with young adults, with suggested ways to prevent such a development. The therapist’s meta-communication and correct assessment of the patient’s mentalization capacity from moment to moment are proposed as crucial. Regarding clinical implications, therapists of young adult patients need to establish meta-communication on therapy progress, as even experienced therapists might be unaware of dissatisfaction or deterioration. Meta-communication could be considered part of the treatment itself, as it may foster mentalization and good outcome. Further, the period of young adulthood entails decisions and developing an adult life, and therapists need to make room for this by active interventions.

It is increasingly clear that pain and emotions are closely interconnected. Pain does not only cause psychological distress, but psychological distress also amplifies pain through neurological mechanisms. Treatment of both chronic and acute pain would benefit from acknowledging the psychological mechanisms of pain neurophysiology. Psychological acceptance predicts increased pain tolerance and decreased pain intensity and discomfort in experimentally induced pain and improved physical and psychosocial functioning for persons with chronic pain. The overall aim of this thesis was to evaluate acceptance-based interventions for persons suffering from pain. In Study I the effect of a manualised ACT-based self-help intervention for adults with chronic pain was evaluated in an RCT (n=90). The results showed improvements in satisfaction with life, physical functioning and pain intensity for the ACT group. Both the ACT and the control group improved regarding depression and anxiety. In Study II the mediating effect of acceptance for treatment change was evaluated, using data from Study I (n=64). The results showed indirect effects of treatment via acceptance for physical functioning but not for satisfaction with life. In Studies III and IV, instruments to measure psychological flexibility in relation to pain were developed for children with cancer, and their parents respectively, using factor analysis. The results showed that a two-factor solution for the child scale (n=61) and a three-factor solution for the parent scale (n=243), best represented the data. In Study V, an acceptance-based intervention was preliminarily evaluated in a single-subject study (n=5) for children reporting pain during cancer treatment. The intervention consisted of an approximately 15-minute long pain exposure exercise. All participants reported reduced discomfort of pain, and three of the participants reported reduced pain intensity. The results suggest that a manualised ACT-based self-help intervention is a valuable addition to the treatment repertoire for persons with chronic pain and that acceptance may mediate the effect of treatment on physical functioning. Furthermore, instruments to measure acceptance in the context of acute pain in children with cancer are now available, although further validation is needed. Lastly, the results indicate that an acceptance-based intervention may help children undergoing cancer treatment to cope with pain.

Compared to other children, children with Autism Spectrum Disorder (ASD) are known to engage less in joint attention - the sharing of attention between two individuals toward a common object or event. Joint attention behaviors - for example gaze following, alternating gaze, and pointing - play an important role in early development, as they provide a foundation for learning and social interaction. Study I and Study II focused on infant siblings of children with ASD. These infants, often termed high risk (HR) infants, have an increased probability of receiving a later ASD diagnosis. Studying them therefore allows for the detection of early signs of ASD. Live eye tracking was used to investigate different joint attention behaviors at 10 months of age. Study I showed that omitting the head movement that usually accompany experimenters’ eye gaze shifts in similar designs reduced gaze following performance in the HR group, but not in a group of infants at low risk (LR) for ASD. HR infants may thus be less sensitive to eye information, or may need more salient cues in order to follow gaze optimally. Study II focused on the infants’ tendency to initiate joint attention by alternating their gaze between a person and an event. LR infants engaged more in alternating gaze than HR infants, and less alternating gaze in infancy was associated with more ASD symptoms at 18 months. This relation remained when controlling for visual disengagement and general social interest in infancy. Study III explored the role of joint attention later in development, by investigating the microstructure of the looking behaviors of autistic and typically developing children (~6 years old). The results indicated that seeing somebody look at an object influenced the processing of that object less in autistic children than in the typically developing controls. Both groups followed gaze effectively, suggesting that differences in joint attention at this age may be subtle, but detectable with eye tracking technology. Together, the studies contribute to our understanding of the role that joint attention atypicalities play both in the early development of infants at risk for ASD, and later in the development of children with a confirmed diagnosis.

The aim of the present study was to investigate if individuals with high-functioning autism differ from typically developing (TD) individuals in judgments of social dimensions from faces. Thirty-two individuals with high functioning autism and sixty-seven TD individuals rated 196 synthetic faces representing 7 social dimensions. Overall, both groups performed similarly on the judgment tasks. However, some group differences emerged for ratings of Competence and Likeability in the Autism Spectrum Disorder (ASD) group. Furthermore, alexithymia, or emotion-blindness, was found to be a possible indicator of ability to judge social dimensions in the ASD group. Implications of present results in relation to prior and future research on social interaction on the autism spectrum are discussed.

Föreliggande kvantitativa studie ämnade undersöka om det fanns några skillnader i prokrastinering och upplevd stress mellan heltidsstuderande kvinnor och män vid högskola/universitet med eller utan arbete vid sidan om studierna, samt sambandet mellan prokrastinering och upplevd stress. Som mätinstrument utformades en internetenkät utifrån Pure Procrastination Scale (PPS) och Perceived Stress Scale (PSS-14). Enkäten spreds via Facebook där deltagarna, 164 studenter varav 82 kvinnor och 82 män, valdes ut genom ett bekvämlighetsurval. Resultatet visade att studenter som arbetar extra prokrastinerar i mindre utsträckning än de som inte arbetar, samt att kvinnor prokrastinerar mer än män. Resultatet visade även att studenter som arbetar extra upplevde sig vara mindre stressade än de som inte arbetar, samt att kvinnor upplevde sig mer stressade än män. Det förelåg ett starkt positivt samband mellan prokrastinering och upplevd stress för samtliga undersökningsgrupper, och när det kontrollerades för stress försvann effekterna av kön och att arbeta extra. Upplevd stress är därmed en av flera bakomliggande faktorer som spelar en viktig roll när det kommer till om individen prokrastinerar eller inte. / The purpose of this quantitative study was to examine if there were any differences regarding procrastination and perceived stress between full-time female and male college students with or without work parallel to their studies, as well as the relationship between procrastination and perceived stress. A web-based questionnaire was designed based on Pure Procrastination Scale (PPS) and Perceived Stress Scale (PSS-14). The survey was shared on Facebook where the participants, 164 students of which 82 women and 82 men, were selected by convenience sampling. The result of the study showed that students who worked extra procrastinates less than students without work, and that women procrastinates more than men. The result also showed that students who worked extra were less stressed than students without work, and that women were more stressed than men. There was a strong positive correlation between procrastination and perceived stress for all groups in the study. Moreover, the effects of gender and extra work on procrastination disappeared when stress was statistically controlled for. This indicate that underlying factors, such as stress, can play an important role in procrastination.

Depression är en funktionsnedsättande problematik som påverkar en stor del av den vuxna populationen varje år. Trots ett omfattande behov av hjälp så råder det brist på tillgång till effektiv behandling. Kognitiv Beteendeterapi (KBT) är en evidensbaserad metod som har stöd vid behandling av depression och förmedlad via internet skulle metoden kunna tillgängliggöras för fler. Dock är det i dagsläget oklart vilka format och vilket innehåll som kan användas när behandlingen förmedlas via internet, samt vilken betydelse den terapeutiska alliansen har för en behandling som till största del sker på distans. Syftet med denna avhandling var att undersöka effekterna för olika format av internetbehandling (epostterapi, guidad självhjälp och blended treatment) vid depression, samt alliansens roll i dessa format. Studiernas resultat visar på att epostterapi och internetförmedlade självhjälpsprogram med behandlarstöd var effektiva metoder för att behandla depression. Alliansskattningar var höga, vilket visar att en positiv terapeutisk allians kan uppnås i internetbehandling. Patientskattningar av allians kunde inte predicera utfallet i någon av behandlingarna, men behandlarskattad allians predicerade förbättring på depressionsskattningar i blended treatment. Den här avhandlingen innehåller den första randomiserade kontrollerade studien på KBT-baserad epostterapi vid depression, samt det första internet-förmedlade självhjälpsprogrammet baserat på beteendeaktivering och ACT. / Depression is a debilitating disorder that affects a large part of the adult population every year. Yet there is still a lack of access to effective care for people in need. Cognitive Behaviour therapy (CBT) is an evidence-based method for treating depression that together with the increased availability of Internet services provides an opportunity to increase access to effective treatment. Internet-based interventions can be effective in the treatment of depression, but there is a lack of knowledge concerning which formats of delivery that can be used and if therapeutic alliance is of equal importance when providing treatment over the Internet. The overall aim of this thesis was to examine the effects of different treatment formats (email therapy, guided self-help, and blended treatment) in internet-based CBT for depression and to further examine the role of alliance in these treatment modalities. Findings from this thesis show that email therapy and internetbased treatment programs were effective methods for treating depression. Alliance ratings were high, showing that a positive therapeutic alliance can be achieved in internet-based treatments. Patient-rated alliance could not predict outcome in any of the different treatment formats. However, therapist-rated alliance predicted change in depression during blended treatment. This thesis includes the first randomized controlled study on CBTbased email therapy, and the first internet-based behavioral activation program with ACT-components, for adult depression.

Studier inom åldersbedömning har ofta gjorts med stillbilder av ansikten. Denna studiesyftade till att undersöka om åldersskattningar mellan helkroppsbilder av stillbilder ochrörliga bilder skiljer sig åt. Vidare undersöktes om män bedöms med bättre precision änkvinnor, om precisionen är bättre då bedömaren är av samma kön som den som blir bedömdsamt om åldern underskattas på personer över 40 år och överskattas på personer under 40 år.Datainsamlingen skedde via en webbaserad plattform för enkätundersökningar som för engrupp visade stillbilder och för en annan grupp visade rörliga bilder. Resultatet visade intenågra skillnader i precisionen för bedömning mellan stillbilder och rörliga bilder eller dåbedömningen gjordes inom samma kön (kvinna-kvinna och man-man). Däremot visade detsig att män bedöms med högre precision än kvinnor och att åldern på personer över 40 årunderskattas och att åldern på personer under 40 år överskattas. / Studies within age estimation have often used still pictures of faces. The purpose of this studywas to investigate if there is a difference in the precision of age estimation between still andmoving pictures of full bodies. It was also investigated if the precision is higher whenestimating males rather than females, if the precision is higher when the estimation is done bya individual with same sex as the one getting estimated, if the age of people over the age offorty is underestimated and if the age of people under the age of forty is overestimated. Thecollection of data was done through a web based platform for surveys, from which one groupwas showed still full body pictures and the other group was showed moving full bodypictures. The results showed no difference in estimation precision between still pictures andmoving pictures or when the estimation was done within the same gender (female-female andmale-male). However the results showed that males are estimated with higher precision thanfemales as well as that the age of people over the age of forty is underestimated and the age ofpeople under the age of forty is overestimated.