The objective of this work was to investigate reflective-functioning (RF) as a measure of process in two independent studies that included three types of brief psychotherapy. RF is defined as the ability to recognize the existence and nature of mental processes taking place in the self and in others (e.g., intentions, beliefs, desires, and wishes). Theorists have suggested the ability for RF is crucial for predicting social causality and low RF has been found related to mental disorders. It has recently been suggested in the literature that improved ability for RF might be an important component of successful psychotherapy outcome, especially with respect to achieving structuralchange. RF was in this work investigated during the process through discourse analysis of the patients’ narratives of self-other interactions in the treatment sessions. The Psychotherapy Process Q-set (PQS) was implemented in order to isolate specific components of the process (process correlates) that identified high and low RF and to investigate the links between the process correlates and outcome. The first study investigated 29 cases of cognitive-behavioral therapy(CBT) and 35 cases of interpersonal psychotherapy (IPT) with an average treatment length of 16.2 sessions in a sample from the National Institute of Mental Health (NIMH) randomized clinical trial Treatment of Depression Collaborative Research Program (TDCRP). The sample in the first study consisted of 128 sessions in total, were one session from the early part (on average the 4th session) and one session in the later part of the treatment (on average the 12th session) were rated for RF. The second study investigated a sample of 30 cases of brief psychodynamic psychotherapy (BPDT) with an average treatment length of 15.8 sessions in a naturalistic designand obtained from the Mount Zion Psychotherapy Research Group. In total, the second study included 90 sessions of BPDT, and RF was assessed during the 1st, the 5th, and the 14th session of each treatment. The results from these two studies suggested that the patients’ ability for RF, as measured through the discourse from therapy sessions, is stable (in CBT and BPDT) or decreased(IPT) during the treatments. Furthermore, the process correlates defining high RF had a relation with good outcome, and process correlates defining low RF had a relation with poor outcome.The process correlates identified during the PQS-analysis suggested that both high and low RF was linked with personality characteristics in the patients. For example, high RF was linked to patients’ ability for introspection, expression of negative emotions, and commitment to treatment.Low RF was linked to patients’ expression of passivity, defensiveness, and suspiciousness. This work supported theorists’ suggestions that brief treatments are supportive in their nature and therefore do not promote structural changes (e.g., changes in RF). It is suggested that the abilityfor RF as assessed pre-treatment might be a useful predictor for success in brief psychotherapy and could therefore be used as a patient inclusion criteria for such treatments.

Evidence-based psychotherapeutic methods compete with each other, while meta-analysis have shown that variability due to different methods related to outcome is remarkably low. In this qualitative study six former patients were interviewed about experiences of method and technique in Affect-focused therapy, with a slight overweight towards unsatisfactory experiences. Responses were analysed and categorised in emergent themes. Methodological focus on affect showed to be a much appreciated, as well as insufficient, element. Alongside positive experiences or summaries of therapy, methodological frames were felt to be at times restrictive, even invalidating, as far as not allowing focus on what was felt to be the more predominant need. These needs were varied and individual; e.g. more/less of undetermined space free of preconceptions, more/less focus on affect, more direction forward, or more space for existentially oriented aspects. Results found good support in previous research except for a strong validation of therapists, even when aspects of therapy had been severely problematic. Experiences of applied method differed extremely among participants. The study highlighted lack of relation between method and outcome, and that positive regard of therapy and alliance were not synonymous with good outcome. Prominent themes were quality of methodological focus on affect and of therapeutic relationship, basic humanistic values, and individual factors of variance. Future research was suggested to focus on integration of methods, on therapists’ common factors, as well as on issues of power in the therapeutic relationship.

The overarching goal of this thesis has been to enhance Internet-delivered psychological treatments for depression and its comorbidity. To this end, three randomized controlled trials (Study II, III and IV) with a total of 313 participants were conducted. A prevalence study (Study I) was also conducted to provide an up-to-date estimate of the prevalence of depression, anxiety disorders, and their comorbidity in the Swedish general population. Study I showed that more than every sixth individual in Sweden suffers from symptoms of depression and/or anxiety. Comorbidity between depression and anxiety was substantial and associated with higher symptom burden and lower health-related quality of life. Study II showed that a tailored Internet-based CBT protocol (ICBT) was effective in reducing symptoms of depression when compared to a control group. Among individuals with more severe depression and comorbidities, the tailored ICBT treatment worked better than standardized ICBT. Study III showed that a psychodynamic Internet-based psychotherapy was highly effective in the treatment of depression, when compared to a group who received psychoeducation and online support. In Study IV, an Internet-delivered affect-focused psychodynamic psychotherapy proved to have a large effect on depression and a moderately large effect on anxiety disorders. In conclusion, this thesis shows that in the context of treating depression and its comorbidity, Internet-delivered psychological treatments can be potentially enhanced by psychodynamic psychotherapy and by individualization. / Det övergripande syftet med denna avhandling har varit att vidareutveckla internetbaserad psykologisk behandling för depression och dess komorbiditet. Tre randomiserade kontrollerade studier (Studie II, III och IV) med totalt 313 deltagare genomfördes i linje med detta syfte. En prevalensstudie (Studie I) genomfördes också för att tillhandahålla ett uppdaterat estimat av prevalensen av depression, ångest och deras komorbiditet i Sverige. Studie I visade att mer än var sjätte individ i Sverige lider av symptom på depression och/eller ångest. Det fanns påtaglig komorbiditet mellan depression och ångest, vilket var associerat med högre symptombörda och lägre livskvalitét. Studie II visade att en skräddarsydd internetbaserad KBT-behandling var effektiv för att reducera symptom på depression, i jämförelse med en kontrollgrupp. Bland individer med svårare depression och komorbiditet, fungerade den skräddarsydda interventionen bättre än en standardiserad. Studie III visade att psykodynamisk internetbehandling var effektiv vid behandling av depression, i jämförelse med en grupp som fick psykoedukation och stödsamtal online. I Studie IV visades att en affektfokuserad psykodynamisk internetbehandling hade stor effekt vad gällde att reducera symptom på depression, och medelstor effekt vad gällde att reducera symptom på ångest. Sammanfattningsvis visar denna avhandling att internetbaserad psykologisk behandling kan potentiellt vidareutvecklas av psykodynamisk psykoterapi och individanpassning, vid behandling av depression och dess komorbiditet.

Introdução - Pesquisas em relação à análise e à psicoterapia com orientação psicanalítica são fundamentais e tem demonstrado a eficácia destas práticas psicoterapêuticas. Estas são hoje entendidas, por algumas abordagens teóricas, como decorrentes da relação estabelecida entre o profissional e o paciente, estabelecendo assim um processo interrelacional. O funcionamento psicológico deste par é absolutamente presente e dominante no desenrolar deste processo, expresso através de inúmeros fenômenos, como transferência, contratransferência, identificação projetiva, campo analítico e, mais recentemente, enactment. Este último é definindo, no conteúdo psicanalítico, como um fenômeno inconsciente que ocorre entre a dupla terapêutica, analista e paciente, na qual ambos atuam conjuntamente (“encenam”) o conflito inconsciente que se manifesta. Evidencia-se como um ato que leva o outro a também agir reciprocamente, sem o predomínio da reflexão. Objetivo – Descrever como psicanalistas entendem, conceituam, identificam e elaboram o fenômeno encatment em sua prática profissional. Participantes - dois analistas em formação psicanalítica, quatro psicanalistas membros associados e dois analistas didatas vinculados a uma instituição de formação psicanalítica associada à IPA (International Psychoanalytical Association) no Rio Grande do Sul/Brasil. Constitui-se uma amostra não-probabilística, intencional e por conveniência, utilizando o método de saturação para a sua totalização. O anonimato dos participantes está garantido através do Termo de Consentimento Livre e Esclarecido-TCLE. Método - Estudo descritivo qualitativo. A interpretação dos dados é realizada pela Análise de Conteúdo, conforme Bardin. Foram realizadas oito entrevistas semi-estruturadas, face-a-face, gravadas e transcritas pelo pesquisador, utilizando como guia um questionário misto (questões fechadas e abertas), elaborado pelos autores do presente trabalho, com o qual os psicanalistas expressaram suas ideias e experiências. Esta pesquisa está aprovada pelo Comitê de Ética em Pesquisa com Seres Humanos (CEP/PROPESQ/UFRGS/Brasil) sob o número 443.358 em 01 de novembro de 2013 e está registrada na Plataforma Brasil. Resultados e Conclusões - São apresentados em três categorias finais de respostas: Fundamentação Teórica, Fundamentação Técnica e Nível de Experiência. Enactment é entendido conforme fundamentação psicanalítica teórico-técnica. Psicanalistas responderam que é um fenômeno inconsciente, expresso através da ‘encenação’ de conflitos psíquicos, do paciente e do analista, que se entrecruzam no campo analítico. Sua manifestação possibilita identificar padrão das relações objetais, atualizadas na relação transferencial/contratransferencial, através da identificação projetiva. Se não identificados e interpretados, impedem a evolução terapêutica, desenvolvendo conluios ou impasses entre o par analítico. Identificam o fenômeno como conceito psicanalítico atual, em amadurecimento, também considerado como útil do ponto de vista técnico/terapêutico, favorecendo a interpretação no aqui-agora da situação analítica. O tempo de exercício profissional, associado à formação e ao investimento pessoal para ampliação do conhecimento, favorece, ao analista, atitude na qual a técnica apreendida passa a ser utilizada com mais segurança. Sugere que as vivências têm valor na construção da noção do que constitui o psíquico humano. O conjunto destas respostas sugere a existência, nas sociedades psicanalíticas, de formação profissional sólida e congruente. O fenômeno enactment é caracterizado como um dos mais atuais que reflete a ênfase contemporânea da Psicanálise à relação da dupla terapêutica, justificando a continuidade de estudos que ampliem as noções de desenvolvimento teórico e técnico psicanalíticos. / Introduction - Research in relation to analysis and psychoanalytically oriented psychotherapy are fundamental and have demonstrated the effectiveness of these psychotherapeutic practices. These are nowadays understood, by some theoretical approaches, as deriving from the relationship established between the professional and the patient, creating in this way an inter-relational process. The psychological functioning of this pair is absolutely present and dominant in the unwinding of this process, expressed through innumerable phenomena, such as transference, counter-transference, projective identification, analytic field and, more recently, enactment. This latter is defined, in the psychoanalytic realm, as an unconscious phenomenon that occurs in the therapeutic relationship between the analyst and the patient, in which both act out together ("stage") the unconscious conflict that is manifested. This phenomenon is expressed as an act that leads the other party to also act reciprocally, without any preponderance of reflection (fully developed thought). Objective - Describe how analysts understand, conceptualize, identify and elaborate the enactment phenomenon in their professional practice. Participants - Two analysts undergoing psychoanalytic training, four associate member psychoanalysts and two training analysts related to an institution of psychoanalytic training associated to the IPA (International Psychoanalytical Association) in Rio Grande do Sul/Brazil. It constitutes a non-probabilistic sample, intentional and for convenience sake, using the saturation method for its totalization. The anonymity of the participants is guaranteed through the Free and Clarified Term of Informed Consent. Method - A descriptive, qualitative study. The interpretation of the data is performed through the Analysis of Content, according to Bardin. Eight semi-structured interviews were performed, face-to-face, recorded and transcribed by the researcher, using as a guide a mixed questionnaire (closed questions and open ones), elaborated by the authors of the present work, with which the psychoanalysts expressed their ideas and experience. This research is approved by the Ethics Committee in Research with Human Beings (CEP/PROPESQ/UFRGS/Brazil) registered under number 443.358. Results and Conclusions - They are presented in three final answer categories: Theoretical Foundation, Technical Rationale and Level of Experience. Enactment is understood according to theoretical - technical psychoanalytic foundation. Psychoanalysts answered that it is an unconscious phenomenon, expressed through the ‘staging’ of psychic conflicts, of the patient and of the analyst, that intersect in the analytic field. Their manifestation enables identifying patterns of objects, updated in the transference/counter-transference relationship, through projective identification. If not identified and interpreted, they hinder the therapeutic evolution, developing collusions or impasses between the analytic pair. They identify the phenomenon as a current psychoanalytical concept, maturing, also considered as a useful technical/therapeutic standpoint, favoring the here-and-now interpretation of the analytical situation. Professional practicing time, associated with training and personal investment for the expansion of knowledge, favors the analyst, attitude in which the learnt technique becomes used with more security. It suggests that the experiences have value in building the notion of what constitutes human psychic. All of these responses suggest the existence, in psychoanalytic societies, of a solid and consistent professional training. The enactment phenomenon is characterized as one of the most current that reflect the contemporary emphasis of Psychoanalysis to the relationship of the therapeutic pair, justifying the continuity of studies that expand the notions of theoretical and technical psychoanalytic development.

The purpose of this research is to explore individual behaviour towards authority. The psychodynamic and phenomenological paradigms are used. Unstructured interviews, conducted on five female consultants, produced themes that provide possible insight into individual behaviour towards authority. These themes were; 'daddy and mommy's little girl', need for attention, approval, to not disappoint and sibling rivalry; anxiety and the use of defense mechanisms; conditions for acceptance and/or comfort; dependency for support; clear and/or rigid boundaries; split in experience towards authority; fear of authority; power struggle; and counterdependency. These themes suggest that individual's project and transfer feelings, fantasies, expectations and wishes of their experiences with their parents, their earliest authority figures, onto other authority figures, for example, their managers. The hypothesis generated was "past experiences with authority figures influences individual experiences and hence behaviour towards present authority figures". / Psychology / M.A. (Industrial Psychology)

Introdução - Pesquisas em relação à análise e à psicoterapia com orientação psicanalítica são fundamentais e tem demonstrado a eficácia destas práticas psicoterapêuticas. Estas são hoje entendidas, por algumas abordagens teóricas, como decorrentes da relação estabelecida entre o profissional e o paciente, estabelecendo assim um processo interrelacional. O funcionamento psicológico deste par é absolutamente presente e dominante no desenrolar deste processo, expresso através de inúmeros fenômenos, como transferência, contratransferência, identificação projetiva, campo analítico e, mais recentemente, enactment. Este último é definindo, no conteúdo psicanalítico, como um fenômeno inconsciente que ocorre entre a dupla terapêutica, analista e paciente, na qual ambos atuam conjuntamente (“encenam”) o conflito inconsciente que se manifesta. Evidencia-se como um ato que leva o outro a também agir reciprocamente, sem o predomínio da reflexão. Objetivo – Descrever como psicanalistas entendem, conceituam, identificam e elaboram o fenômeno encatment em sua prática profissional. Participantes - dois analistas em formação psicanalítica, quatro psicanalistas membros associados e dois analistas didatas vinculados a uma instituição de formação psicanalítica associada à IPA (International Psychoanalytical Association) no Rio Grande do Sul/Brasil. Constitui-se uma amostra não-probabilística, intencional e por conveniência, utilizando o método de saturação para a sua totalização. O anonimato dos participantes está garantido através do Termo de Consentimento Livre e Esclarecido-TCLE. Método - Estudo descritivo qualitativo. A interpretação dos dados é realizada pela Análise de Conteúdo, conforme Bardin. Foram realizadas oito entrevistas semi-estruturadas, face-a-face, gravadas e transcritas pelo pesquisador, utilizando como guia um questionário misto (questões fechadas e abertas), elaborado pelos autores do presente trabalho, com o qual os psicanalistas expressaram suas ideias e experiências. Esta pesquisa está aprovada pelo Comitê de Ética em Pesquisa com Seres Humanos (CEP/PROPESQ/UFRGS/Brasil) sob o número 443.358 em 01 de novembro de 2013 e está registrada na Plataforma Brasil. Resultados e Conclusões - São apresentados em três categorias finais de respostas: Fundamentação Teórica, Fundamentação Técnica e Nível de Experiência. Enactment é entendido conforme fundamentação psicanalítica teórico-técnica. Psicanalistas responderam que é um fenômeno inconsciente, expresso através da ‘encenação’ de conflitos psíquicos, do paciente e do analista, que se entrecruzam no campo analítico. Sua manifestação possibilita identificar padrão das relações objetais, atualizadas na relação transferencial/contratransferencial, através da identificação projetiva. Se não identificados e interpretados, impedem a evolução terapêutica, desenvolvendo conluios ou impasses entre o par analítico. Identificam o fenômeno como conceito psicanalítico atual, em amadurecimento, também considerado como útil do ponto de vista técnico/terapêutico, favorecendo a interpretação no aqui-agora da situação analítica. O tempo de exercício profissional, associado à formação e ao investimento pessoal para ampliação do conhecimento, favorece, ao analista, atitude na qual a técnica apreendida passa a ser utilizada com mais segurança. Sugere que as vivências têm valor na construção da noção do que constitui o psíquico humano. O conjunto destas respostas sugere a existência, nas sociedades psicanalíticas, de formação profissional sólida e congruente. O fenômeno enactment é caracterizado como um dos mais atuais que reflete a ênfase contemporânea da Psicanálise à relação da dupla terapêutica, justificando a continuidade de estudos que ampliem as noções de desenvolvimento teórico e técnico psicanalíticos. / Introduction - Research in relation to analysis and psychoanalytically oriented psychotherapy are fundamental and have demonstrated the effectiveness of these psychotherapeutic practices. These are nowadays understood, by some theoretical approaches, as deriving from the relationship established between the professional and the patient, creating in this way an inter-relational process. The psychological functioning of this pair is absolutely present and dominant in the unwinding of this process, expressed through innumerable phenomena, such as transference, counter-transference, projective identification, analytic field and, more recently, enactment. This latter is defined, in the psychoanalytic realm, as an unconscious phenomenon that occurs in the therapeutic relationship between the analyst and the patient, in which both act out together ("stage") the unconscious conflict that is manifested. This phenomenon is expressed as an act that leads the other party to also act reciprocally, without any preponderance of reflection (fully developed thought). Objective - Describe how analysts understand, conceptualize, identify and elaborate the enactment phenomenon in their professional practice. Participants - Two analysts undergoing psychoanalytic training, four associate member psychoanalysts and two training analysts related to an institution of psychoanalytic training associated to the IPA (International Psychoanalytical Association) in Rio Grande do Sul/Brazil. It constitutes a non-probabilistic sample, intentional and for convenience sake, using the saturation method for its totalization. The anonymity of the participants is guaranteed through the Free and Clarified Term of Informed Consent. Method - A descriptive, qualitative study. The interpretation of the data is performed through the Analysis of Content, according to Bardin. Eight semi-structured interviews were performed, face-to-face, recorded and transcribed by the researcher, using as a guide a mixed questionnaire (closed questions and open ones), elaborated by the authors of the present work, with which the psychoanalysts expressed their ideas and experience. This research is approved by the Ethics Committee in Research with Human Beings (CEP/PROPESQ/UFRGS/Brazil) registered under number 443.358. Results and Conclusions - They are presented in three final answer categories: Theoretical Foundation, Technical Rationale and Level of Experience. Enactment is understood according to theoretical - technical psychoanalytic foundation. Psychoanalysts answered that it is an unconscious phenomenon, expressed through the ‘staging’ of psychic conflicts, of the patient and of the analyst, that intersect in the analytic field. Their manifestation enables identifying patterns of objects, updated in the transference/counter-transference relationship, through projective identification. If not identified and interpreted, they hinder the therapeutic evolution, developing collusions or impasses between the analytic pair. They identify the phenomenon as a current psychoanalytical concept, maturing, also considered as a useful technical/therapeutic standpoint, favoring the here-and-now interpretation of the analytical situation. Professional practicing time, associated with training and personal investment for the expansion of knowledge, favors the analyst, attitude in which the learnt technique becomes used with more security. It suggests that the experiences have value in building the notion of what constitutes human psychic. All of these responses suggest the existence, in psychoanalytic societies, of a solid and consistent professional training. The enactment phenomenon is characterized as one of the most current that reflect the contemporary emphasis of Psychoanalysis to the relationship of the therapeutic pair, justifying the continuity of studies that expand the notions of theoretical and technical psychoanalytic development.

Introdução - Pesquisas em relação à análise e à psicoterapia com orientação psicanalítica são fundamentais e tem demonstrado a eficácia destas práticas psicoterapêuticas. Estas são hoje entendidas, por algumas abordagens teóricas, como decorrentes da relação estabelecida entre o profissional e o paciente, estabelecendo assim um processo interrelacional. O funcionamento psicológico deste par é absolutamente presente e dominante no desenrolar deste processo, expresso através de inúmeros fenômenos, como transferência, contratransferência, identificação projetiva, campo analítico e, mais recentemente, enactment. Este último é definindo, no conteúdo psicanalítico, como um fenômeno inconsciente que ocorre entre a dupla terapêutica, analista e paciente, na qual ambos atuam conjuntamente (“encenam”) o conflito inconsciente que se manifesta. Evidencia-se como um ato que leva o outro a também agir reciprocamente, sem o predomínio da reflexão. Objetivo – Descrever como psicanalistas entendem, conceituam, identificam e elaboram o fenômeno encatment em sua prática profissional. Participantes - dois analistas em formação psicanalítica, quatro psicanalistas membros associados e dois analistas didatas vinculados a uma instituição de formação psicanalítica associada à IPA (International Psychoanalytical Association) no Rio Grande do Sul/Brasil. Constitui-se uma amostra não-probabilística, intencional e por conveniência, utilizando o método de saturação para a sua totalização. O anonimato dos participantes está garantido através do Termo de Consentimento Livre e Esclarecido-TCLE. Método - Estudo descritivo qualitativo. A interpretação dos dados é realizada pela Análise de Conteúdo, conforme Bardin. Foram realizadas oito entrevistas semi-estruturadas, face-a-face, gravadas e transcritas pelo pesquisador, utilizando como guia um questionário misto (questões fechadas e abertas), elaborado pelos autores do presente trabalho, com o qual os psicanalistas expressaram suas ideias e experiências. Esta pesquisa está aprovada pelo Comitê de Ética em Pesquisa com Seres Humanos (CEP/PROPESQ/UFRGS/Brasil) sob o número 443.358 em 01 de novembro de 2013 e está registrada na Plataforma Brasil. Resultados e Conclusões - São apresentados em três categorias finais de respostas: Fundamentação Teórica, Fundamentação Técnica e Nível de Experiência. Enactment é entendido conforme fundamentação psicanalítica teórico-técnica. Psicanalistas responderam que é um fenômeno inconsciente, expresso através da ‘encenação’ de conflitos psíquicos, do paciente e do analista, que se entrecruzam no campo analítico. Sua manifestação possibilita identificar padrão das relações objetais, atualizadas na relação transferencial/contratransferencial, através da identificação projetiva. Se não identificados e interpretados, impedem a evolução terapêutica, desenvolvendo conluios ou impasses entre o par analítico. Identificam o fenômeno como conceito psicanalítico atual, em amadurecimento, também considerado como útil do ponto de vista técnico/terapêutico, favorecendo a interpretação no aqui-agora da situação analítica. O tempo de exercício profissional, associado à formação e ao investimento pessoal para ampliação do conhecimento, favorece, ao analista, atitude na qual a técnica apreendida passa a ser utilizada com mais segurança. Sugere que as vivências têm valor na construção da noção do que constitui o psíquico humano. O conjunto destas respostas sugere a existência, nas sociedades psicanalíticas, de formação profissional sólida e congruente. O fenômeno enactment é caracterizado como um dos mais atuais que reflete a ênfase contemporânea da Psicanálise à relação da dupla terapêutica, justificando a continuidade de estudos que ampliem as noções de desenvolvimento teórico e técnico psicanalíticos. / Introduction - Research in relation to analysis and psychoanalytically oriented psychotherapy are fundamental and have demonstrated the effectiveness of these psychotherapeutic practices. These are nowadays understood, by some theoretical approaches, as deriving from the relationship established between the professional and the patient, creating in this way an inter-relational process. The psychological functioning of this pair is absolutely present and dominant in the unwinding of this process, expressed through innumerable phenomena, such as transference, counter-transference, projective identification, analytic field and, more recently, enactment. This latter is defined, in the psychoanalytic realm, as an unconscious phenomenon that occurs in the therapeutic relationship between the analyst and the patient, in which both act out together ("stage") the unconscious conflict that is manifested. This phenomenon is expressed as an act that leads the other party to also act reciprocally, without any preponderance of reflection (fully developed thought). Objective - Describe how analysts understand, conceptualize, identify and elaborate the enactment phenomenon in their professional practice. Participants - Two analysts undergoing psychoanalytic training, four associate member psychoanalysts and two training analysts related to an institution of psychoanalytic training associated to the IPA (International Psychoanalytical Association) in Rio Grande do Sul/Brazil. It constitutes a non-probabilistic sample, intentional and for convenience sake, using the saturation method for its totalization. The anonymity of the participants is guaranteed through the Free and Clarified Term of Informed Consent. Method - A descriptive, qualitative study. The interpretation of the data is performed through the Analysis of Content, according to Bardin. Eight semi-structured interviews were performed, face-to-face, recorded and transcribed by the researcher, using as a guide a mixed questionnaire (closed questions and open ones), elaborated by the authors of the present work, with which the psychoanalysts expressed their ideas and experience. This research is approved by the Ethics Committee in Research with Human Beings (CEP/PROPESQ/UFRGS/Brazil) registered under number 443.358. Results and Conclusions - They are presented in three final answer categories: Theoretical Foundation, Technical Rationale and Level of Experience. Enactment is understood according to theoretical - technical psychoanalytic foundation. Psychoanalysts answered that it is an unconscious phenomenon, expressed through the ‘staging’ of psychic conflicts, of the patient and of the analyst, that intersect in the analytic field. Their manifestation enables identifying patterns of objects, updated in the transference/counter-transference relationship, through projective identification. If not identified and interpreted, they hinder the therapeutic evolution, developing collusions or impasses between the analytic pair. They identify the phenomenon as a current psychoanalytical concept, maturing, also considered as a useful technical/therapeutic standpoint, favoring the here-and-now interpretation of the analytical situation. Professional practicing time, associated with training and personal investment for the expansion of knowledge, favors the analyst, attitude in which the learnt technique becomes used with more security. It suggests that the experiences have value in building the notion of what constitutes human psychic. All of these responses suggest the existence, in psychoanalytic societies, of a solid and consistent professional training. The enactment phenomenon is characterized as one of the most current that reflect the contemporary emphasis of Psychoanalysis to the relationship of the therapeutic pair, justifying the continuity of studies that expand the notions of theoretical and technical psychoanalytic development.

Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options. The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia. In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design. In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking. Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition. / Substansberoende är en allvarlig störning och samsjuklighet ofta förekommande Den stora variationen av svårigheter kräver olika behandlingsalternativ. Syftet med avhandlingen var att undersöka affekters roll i psykoterapi för populationen. Ytterligare syften var att undersöka betydelsen av gemensamma faktorer i psykoterapi samt normera ett självskattningsformulär för affektfobi. I studie I undersöktes skillnaden mellan patienters förväntningar, erfarenheter av terapi och allians. I studie II utvärderades de psykometriska egenskaperna hos affektfobitestet. I studie III och IV undersöktes genomförbarheten av affektfobiterapi individuellt och i grupp. Resultaten av studierna visade att större skillnad mellan rollförväntningar inför- och erfarenheter av terapi var signifikant korrelerade med lägre allians i gruppterapi. Affektfobitestets psykometriska egenskaper var tillfredsställande avseende skalan som helhet. Affektfobiterapi visade sig öka adaptiv affektiv förmåga och självmedkänsla, men behandlingen gav inget säkert stöd för påverkan på substansbruket. Slutsatserna är att fokus på affekter i terapi för substansberoende har betydelse och att affektfobiterapi är en genomförbar behandling för populationen. Genom att undersöka förväntningar och rädslor inför terapi kan avhopp förhindras. / <p>Information om opponent saknas Information about opponent is missing</p>

Inledning: Tystnad finns alltid närvarande i den terapeutiska processen och blir ett utrymme föromedveten kommunikation där latenta budskap kan förmedlas bortom orden. I samtidaforskning har det visat att tystnaden som uppstår hos psykoterapeuten och den unga vuxna kanupplevas som hindrande av den unga vuxna och skulle kunna påverka behandlingsresultatet. Syfte: Syftet med studien var att undersöka legitimerade och verksamma psykoterapeuters erfarenheter av sin egen och den unga vuxnas tystnad som uppkommer i den terapeutiska processen i psykodynamisk psykoterapi med patienter som är 18 - 25 år. Metod: Kvalitativ metod användes där fem psykoterapeuter intervjuades. Resultat: Tystnad upplevdes som en betydelsefull del i den terapeutiska processen och dess betydelse måste förstås. Tystnadens betydelse kunde handla om att vara ett utrymme för självreflektion, där den unga vuxna kunde upptäcka sig själv och öva på ensamhet, men också vara en icke verbal kommunikation. Ett aktivt och närvarande förhållningssätt eftersträvades där psykoterapeuten behövde ta ansvar så tystnaden inte skapade för hög ångest. Metakommunikation kring relationen och att sätta ord på tystnaden sågs som viktigt. Den unga vuxna kunde öka sin förmåga till mentalisering genom att psykoterapeuten satte ord på tystnaden och sina egna tankar samt skapade ett reflekterande förhållningssätt tillsammans med den unga vuxna. Diskussion: Tystnad kunde både vara verksam och inte med en ung vuxen. Tystnaden förutsatte en god relation och när tystnaden var gynnsam kunde den vara en del i att växa som vuxen. Ett anpassat förhållningssätt till tystnad krävdes annars fanns det en risk att det påverkade psykoterapin negativt. / Introduction: Silence is always present in the therapeutic process and becomes a space forunconscious communication where latent messages can be conveyed beyond words. In contemporary research, it has been shown that the silence that arises in the psychotherapist and the young adult can be perceived as an obstacle by the young adult and could affect thetreatment result. Purpose: The purpose of the study was to investigate legitimate and active psychotherapists experiences of their own and the young adult´s silence that arises in the therapeutic process of psychodynamic psychotherapy with patients aged 18-25. Method: Qualitative method was used where five psychotherapists were interviewed. Results: Silence was perceived as an important part of the therapeutic process and itssignificance must be understood. The meaning of silence could be about being a space for selfreflection,where the young adult could discover himself and practice loneliness, but also be a non-verbal communication. An active and competitive attitude was sought where the psychotherapist needed to take responsibility so that the silence did not create too much anxiety. Metacommunication around the relationship and putting words to the silence was important. By the psychotherapist putting words to the silence and creating his own thoughts, a reflective approach is required, increasing the young adult's ability to mentalize. Discussion: Silence could both be effective and not with a young adult. Silence presupposed a good relationship and when silence was favorable, it could be a part of growing as an adult. An adapted approach to silence was required compared otherwise there was a risk that it had a negative effect on psychotherapy.

To date, the vast literature on theories of psychology, and psychology as a practice, still remains a reflection of Western experiences and conceptions of reality. This is so despite "psychology" and "psychotherapy" being studied and implemented by Africans, dealing with Africa's existential issues, in Africa. In this context, a distorted impression that positions psychology and psychotherapy as irreplaceable and irrefutable Western discoveries is created. This perception creates a tendency in which psychotherapists adopt and use universalised, foreign and imposed theories to explain and deal with African cultural experiences. In recent years, African scholars' quest to advance "African-brewed" conceptions, definitions and practices of "psychology" and "psychotherapy" is gaining momentum. Psychologists dealing with African clients are increasingly confronted with the difficulty, and in some instances the impossibility, of communicating with, and treating local clients using Western conceptions and theories. Adopting the dominant Western epistemological and scientific paradigms constitutes epistemological oppression and alienation. Instead, African conceptions, definitions and practices of "psychology" and "psychotherapy" based on African cultural experiences, epistemology and ontology are argued for. The thesis defended in this study is that the dominant Western paradigm of scientific knowledge in general and, psychology in particular, is anchored in a defective claim to neutrality, objectivity and universality. To demonstrate this, indigenous ways of knowing and doing in the African experience are counterpoised against the Western understanding and construction of scientific knowledge in the fields of psychology and psychotherapy. The conclusion arising from our demonstration is the imperative to rethink psychology and psychotherapy in order to (i) affirm the validity of indigenous African ways of knowing and doing; (ii) show that the exclusion of the indigenous African ways of knowing and doing from the Western paradigm illustrates the tenuous and questionable character of its epistemological and methodological claims to neutrality, objectivity and universality. Indeed the Western claim to scientific knowledge, as described, speaks to its universality at the expense of the ineradicable as well as irreducible v ontological pluriversality of the human experience. This study's aim is to advance the argument for the sensitivity to pluriversality of be-ing and the imperative for wholistic thinking. / Psychology / D. Phil. (Psychology)