Psychotherapy Research Report from

Introduction: SPR has been and is an important and encouraging organization for many Norwegian psychotherapy researchers. However, we do not have a national group. This report will be colored by the fact that there are, as you will see, numerous different research projects that are run across the country, and the report will not be inclusive. Rather, it will present some highlights of projects based on the information I have received from SPR members when trying to grasp the Norwegian research situation in 2016.

An attempted summary and research sites: Most psychotherapy research in Norway is carried out in regular clinical settings; run by researchers from the Universities. There are a few clinics that include researchers in their staff, as in research clinics. One topic Norwegians enjoy to study is the therapist; how to became and develop as a therapist, therapist effects, supervision of therapists, what therapist experience or feels, and how this is connected to treatment outcome. The focus on patients is indeed varied; e.g. different kinds of trauma, depression, anxiety, addictions, psychoses and personality disorders. There seems to be a common interest across the country in process and outcome, finding mediators and moderators of different techniques and therapies, rather than finding the best treatment per se. Most studies focus on adults, but there are also projects on adolescents, families and groups. There are both RCTs and naturalistic designs, and the methods used are quantitative, qualitative and mixed.

There seems to be 3 major sites for psychotherapy research in Norway at the moment; at the University in (UiO), the Universiety in (UiB) and at Modum Bad Research Institute. At the Universities of Trondheim and Tromsø, it seems like psychotherapy research is more in its beginning. In addition, there are research being done in clinics at Oslo University Hospital (OUS) where they have research groups, and both Vestfold (SiV) and Østfold Hospital Trust (SiØ) do some research as well do District General Hospital of Førde (Helse Førde), and probably other clinics as well that I do now know of. Hence, there are research groups spread throughout the country, with the largest groups close to the main cities. This report will give an impression of rather flourishing psychotherapy research, The projects are mentioned in alphabetical order except for Modum Bad Research Institute who presents a table with their ongoing projects at the end of this report.

Projects: The Art and Science of Conducting Psychotherapy study is led by Marit Råbu (UiO) and Christian Moltu (UiB). This study is examining how collaborative action between therapist and client generates and sustains life change. Ida Bernhardt (UiO) is working on this project in her PhD and is examining 20 Norwegian therapists and the significance of their personal history and qualities in their professional life, with the use of serial qualitative interviews.

Emotional arousal, deepening, and meaning making in affect oriented psychotherapies a mixed method study led by Gøril S. Kleiven

The FEST study is led by Per Høglend (UiO). One hundred patients were randomized to one year of dynamic psychotherapy with or without transference work. Follow-ups were 1 year and 3 years after treatment termination, all 100 patients met to 3 years follow up. The study has produced many articles on moderators, mediators, interaction effects, process and outcome. Mainly nomothetic studies, but also case studies.

The FEST-IT study is led by Randi Ulberg (UiO; SiV), Anne Grete Hersoug (UiO), Per Høglend (UiO), and Hanne-Sofie J Dahl (SiV; UiO). It is an ongoing RCT with a dismantling design inspired by the FEST-study for depressed adolescents. One hundred patients aged 16 to 18 years will be will be treated with general psychodynamic techniques over 28 weeks, with or without transference work. Follow-up is one year after treatment termination. Both process and outcome measures are used. The study collaborates with Nick Midgley and Ana Calderon at the Anna Freud center, among others.

The Five First Sessions Study, A Qualitative study led by Kristina Lavik Osland

The Short- and long-term groupanalytic therapy for outpatiens study: A randomized Clinical Trial led by Steinar Lorentzen (UiO). They have published several papers on outcome, therapeutic alliance, and group relationships. A doctoral thesis on differential outcome in IIP-C subscales in Short- and long-term group therapy is expected to be finalized shortly. The study also collaborate with professor Bernhard Strauss and PhD Uwe Altmann, University of Jena, on process-outcome papers, and have just translated Group Questionnaire (GQ; Krogel et al.,) for research use.

The Minnesota study of the development of psychotherapists and counselors. The study in done by Helge Rønnestad (UiO) in collaboration with prof. Thomas Skovholt at the U. Minnesota. The study applies a qualitative methodology and studies therapists across the life-span.

The MOP-study is led by Toril Dammen, Jan Ivar Røssberg, Randi Ulberg and Theresa Wilberg (all UiO). The overall aim is to examine putative moderators and mediators in CBT and PDT and develop more basic knowledge about their impact on outcomes of psychotherapy for patients with major depression. MOP is an ongoing randomized clinical trial. One hundred patients will be randomized to PDT (one weekly session in 28 weeks) or CBT (one weekly session over 16 weeks and 3 booster sessions (monthly) during the rest of the 28 week study period). The patients will be evaluated at baseline, during therapy, at the end of therapy, and at follow-up investigations at 1 and 3 years after treatment termination. The outcome measures comprise a large range of clinical and process variables, including assessment tools measuring specific preselected putative moderators and mediators.

The NORSE study - Personalized clinical feedback and routine outcome monitoring, led by Christian Moltu (UiB, Helse Førde) & Sam S. Nordberg, they use a mixed design.

The NORSE adolescent study - Personalized clinical feedback and routine outcome monitoring for adolescents in psychotherapy. A qualitative study led by Christian Moltu (UiB, Helse Førde) & Kristina Lavik Osland.

The NORTRAS Study is led by Hanne Strømme (UiO) and Hanne Oddli (UiO): Psychotherapy researchers from the three Nordic countries , Norway, and are involved in the Nordic Psychotherapy Training Study (NORTRAS). At the Departments of Psychology at the universities in Oslo, Trondheim, Copenhagen, Aalborg, Stockholm, and Örebro a large number of psychotherapies and supervisions will be investigated in parallel. A data-base with various quantitative and qualitative measures (including video) will be built up enabling empirical research to improve our understanding of processes and outcomes in psychotherapeutic education programmes generally and in the Nordic countries specifically. In addition, the NORTRAS study participates in the worldwide survey of psychotherapy educations (the SPRISTAD within the Society for Psychotherapy Research). The database will primarily be situated at the University in Oslo, and will generate a unique research tool for both psychotherapy and supervision research in the future

The Norwegian Multicenter study of Process an Outcome is led by Ole Andre Solbakken (UiO) and Jon Monsen (UiO). A mainly quantitative study.

The POET study (Processes and Outcomes of Experienced Therapists) earlier led by Helge Rønnestad now Margrethe Seeger Halvorsen (UiO). A mainly qualitative study. Thirteen staff and doctoral students/post docs at the department of psychology participate as researchers.

The ROM study (Routine outcome measurement in naturalistic settings): An in-depth study of the patients' perspective led by Stig Magne Solstad is a qualitative study.

SPR Collaborative Research Network, in which Helge Rønnestad, Helene Nissen-Lie (UiO) in cooperation with David Orlinsky, and others are studying the background, quality of life and their own experience from going to therapy of therapists from 20 different countries. The database now consists of data from more than 11.000 psychotherapists. We are working presently on analying data on ”the personal side” of being a therapist, plus coordinating the activities of members of the research network. There is a high level of activity in the network..

The SPRISTAD- study, a multisite study on the training and development of therapists. Helge Rønnestad (UiO) is the current chair and as such a member of the executive committee. They are about to launch a web-based data-collection.

Study on Borderline Personality Disorder. Diagnostic- and recovery processes, a qualitative study led by Britt Kverme.

Substance Use Disorder Treatments are being studied at OUS, with a specific focus on drop- outs from therapy.

The Therapist effect- study where Helene Nissen-Lie (UiO) has been cooperating with researchers from the University of -Madison (e.g. Wampold, Hoyt) and Brigham Young University (Nielsen).

The Tiller Feedback Project is a RCT where treatments with or without Feedback-Informed Treatment (FIT) is compared (University of Trondheim). Heidi Brattland is doing her phd within this project. They are examining both the main effect of the FIT intervention as well as studying process variables. A qualitative study on therapists’ response to negative feedback has also been undertaken.

The Treatment experiences and life of traumatized refugees study. From NKVTS (UiO) Marianne Oppaas together with Sverre Varvin, and others are doing a naturalistic, longitudinal study of traumatized refugees from treatment start in specialist mental health services, through therapy, and in the years after. The study uses both qualitative and quantitative measures, and includes repeated checklists of mental health symptoms and quality of life, the Rorschach personality assessment method, and interviews with the refugee participants and with their therapists.

The Ullevål Personality Project is led by Elfrida H Kvarstein (OUS). The research group study the treatment of personality disorders with a focus on mentalization bazed treatments, both individual and group. They also work on other aspects concerning personality disorders, like attachment, mentalization and emotions.

Østfold Hospital Trust is doing research oriented towards how clients and therapists understand successful outpatient treatment in dyads. In another study Arne Kristian Henriksen and his colleges used mixed methods to know more about how referrals to specialist health care were evaluated in outpatient clinics. The data set in both studies serve as a background for more focused studies.

From Modum Bad Research Institute the following table shows the activity in 2016, with a total of 20 projects. All projects are for adults if nothing else is specified. Title of project Project leader Researcher(s) Type of project Collaborating units Longterm follow-up Asle Hoffart Process – outcome, on anxiety treatment combining quantitative and qualitative methods The use of the OQ-45 Ingunn Amble RCT multicenter Outpatient clinics at feedback system Modum Bad, and Bærum Posttraumatic stress Asle Hoffart Tomas Formo RCT Psychological disorder treated in Lankaas, Tuva Institute, University the Anxiety Unit Øktedalen of Oslo Prevention of burn- Karin Rø Tuva Hertzberg Process – outcome, out with physicians quantitative and qualitative Meta-cognitive vs. Asle Hoffart Sverre Urnes RCT Psychological cognitive therapy for Johnsen Institute, University anxiety disorders of Oslo Existential items in Kari Halstensen Process – outcome, psychotherapy quantitative and qualitative The use of STIC Terje Tilden RCT multicenter. This Family unit, Modum feedback system in project also includes Bad, adolescence couple and family data from young and child psychiatry, therapy people > 12 years of Sørlandet Hospital, age. Parents also Drammen – answer about their family children’s problems, counseling office and their relationship with their children (> 5 years of age) The context’s role in Terje Tilden Halvard Vike Etnographic/social- psychotherapy Heidi Haukelien antropological field study Outpatient vs. Pål Ulvenes RCT inpatient treatment of dysthymia Posttraumatic stress Harald Bækkelund RCT disorder in outpatient treatment After the terror Pål Ulvenes Quantitative attacks 22/7: How prepared were the outpatient clinics? Validation of Asle Hoffart Pål Ulvenes, Quantitative Norwegian Institute questionnaires Sverre Urnes for Public Health Johnson, Tuva Øktedalen Why cohabitation Helle Myrvik Qualitative Self-compassion vs. KariAnne Vrabel RCT cognitive treatment of eating disorders Patient’s reflections KariAnne Vrabel Malin Olofsson Quantitative – Psychological on two treatment qualitative Institute, University approaches to eating of Oslo disorders 15 years follow-up KariAnne Vrabel Hanne Punsvik Quantitative after eating disorder Eielsen treatment The role of cytokines Terje Tilden Helge Toft Quantitative Sykehuset Innlandet in relation to alcohol abuse and depression The image and Einar Eidsaa Qualitative Menighetsfakultetet narratives of God Edland Evaluation of «Rask Asle Hoffart Quantitative Kildehuset, Modum Psykisk Helsehjelp» Bad, (receiving therapy Helsedirektoratet fast) LIST-project Asle Hoffart Quantitative University of Bergen comparing to psychoeducatve approaches for young people Testing out an Bruce Wampold Pål Ulvenes, Quantitative instrument for Sverre Urnes frequent Johnsen, Asle measurements Hoffart, targeting change KariAnne mechanisms Vrabel, Terje Tilden

Sincerely,

A Country coordinator, Hanne-Sofie J Dahl ([email protected])