Randi Ulberg

• Klungsøyr, Ole; Røssberg, Jan Ivar; Papageorgiou, Constantinos; Evensen, Julie Horgen; Løvgren, André & Malkomsen, Anders [Show all 10 contributors for this article] (2026). Personalized and optimal treatment estimated by a value search method in a randomized clinical trial with psychodynamic versus cognitive behavioral therapy for depression. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2026.2682995. Full text in Research Archive
• Lindqvist, Karin; Mechler, Jakob; Peristera, Paraskevi; Carlbring, Per; Falkenström, Fredrik & Lilliengren, Peter [Show all 17 contributors for this article] (2026). Twelve-month outcomes and comparative costs of internet-delivered psychodynamic therapy versus cognitive-behavioral therapy for adolescent depression: a randomized controlled trial. Frontiers in Psychiatry. 17. doi: 10.3389/fpsyt.2026.1794684. Full text in Research Archive
• Johansen, Rune; Dahl, Hanne-Sofie Johnsen; Lunde, Anna Grasdal; Sem, Rebekka Thorkildsen; Thorkildsen, Mathilde Sem & Fahs, Sarah Christine [Show all 7 contributors for this article] (2026). Transference interventions in psychodynamic psychotherapy for adolescent depression: a qualitative study. Frontiers in Child and Adolescent Psychiatry. 5. doi: 10.3389/frcha.2026.1789526. Full text in Research Archive Show summary

  Introduction Psychodynamic therapy is based on the understanding that past experiences, relationships, and unconscious conflicts can influence a person's current behavior and mental state. Transference is a central construct in psychodynamic psychotherapy, which refers to the emotions and attitudes that the patient attributes to the therapist. These emotions shape the patient's perception of both the therapist and the therapeutic process. Emphasizing and exploring how transferential phenomena manifest within the therapeutic relationship is assumed to have a beneficial therapeutic effect. The primary aim of the present qualitative study was to identify examples of such transference interventions in short-term psychoanalytic psychotherapy with adolescents diagnosed with depression. Method Examples of transference interventions were identified from randomly selected sessions, as well as from two therapies with good outcomes. Results Transference interventions were used to a moderate extent and were primarily aimed at encouraging patients to reveal and discuss their thoughts and feelings about the therapist and the therapy. Discussion Transference interventions in psychotherapy with adolescents with depression seemed mostly to be preparatory and directly relevant to the young person's present, everyday life. The interventions were often posed as open question.

• Torgersen, Kristin Stensland; Dammen, Toril; Klungsøyr, Ole; Wilberg, Theresa; Bringager, Christine Bull & Evensen, Julie Horgen [Show all 11 contributors for this article] (2026). Improvement and deterioration trajectories in psychotherapy for depression: results from an RCT with cognitive behavioural and psychodynamic therapy. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2026.2648291. Full text in Research Archive
• Kogstad, Norunn Helena Lauvland; Christiansen, Sunniva Elisabeth; Ulberg, Randi & Fiskum, Charlotte (2025). Therapists’ reasons for including horses into psychotherapy, a qualitative study. BMC Complementary Medicine and Therapies. 26(1), p. 1–21. doi: 10.1186/s12906-025-05185-2. Full text in Research Archive Show summary

  The integration of horses into psychotherapy has gained popularity over recent decades, offering unique therapeutic opportunities that may enhance emotional healing, empathy, and relational trust. This study investigates the perspectives of experienced psychotherapists on why they incorporate horses into their therapeutic practices. In-depth interviews were conducted with ten clinicians (eight female, two male) from diverse theoretical orientations. The data, which were analyzed using reflexive thematic analysis, revealed four key themes: “Supporting presence and getting to the heart of things quickly,” “The relationship to the horse as the primary factor,” “Going deeper, exploring further,” and “The horse as a partner providing support, direction and dynamics.” The findings highlight how the therapists described the presence of horses as fostering a strong therapeutic presence within a safe, authentic, and primarily nonverbal relationship. This frame was described as an “attachment laboratory” enhancing somatic awareness, and creating opportunities for exploration, experiential learning, and symbolic work. Importantly, therapists reported that working with horses not only benefited clients but also supported their own presence and abilities in therapy, as well as their professional satisfaction, offering a possible buffer against clinician burnout.

• Malkomsen, Anders; Ulberg, Randi; Dammen, Toril; Evensen, Julie Horgen; Hummelen, Benjamin & Løvgren, André [Show all 9 contributors for this article] (2025). Childhood trauma and treatment outcomes in short-term psychodynamic and cognitive behavioral therapy for adult depression. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1692277. Full text in Research Archive Show summary

  Childhood trauma (CT) is a known risk factor for major depressive disorder (MDD), yet its implications for treatment selection remain unclear. This exploratory randomized controlled trial (N = 100) compared short-term psychodynamic psychotherapy (STPP) and cognitive behavioral therapy (CBT) in adults with MDD treated in outpatient clinics. CT was assessed with the Childhood Trauma Questionnaire–Short Form (CTQ-SF), and depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II) and the Hamilton Depression Rating Scale (HDRS) at baseline and after 28 weeks of therapy. Linear mixed-model analyses showed that CT was associated with higher depression severity at the start of treatment. No significant predictive effects of CT were found for treatment outcome or for moderation of the comparative effectiveness of CBT and STPP. Emotional abuse was initially associated with greater improvement in STPP compared to CBT on the HDRS, but the effect did not remain significant after correction for multiple testing. These findings suggest that both CBT and STPP are suitable options for patients with MDD and a history of CT.

• Martins, Mariana Veloso; Marjanovi´c, Zorana Joli´c; Ferreira, Nuno; Hancheva, Camellia; Motrico, Emma & Mestre, Jose M. [Show all 15 contributors for this article] (2025). Evaluation of assessment instruments for working alliance in psychological interventions with adolescents: A systematic review. Clinical Psychology Review. ISSN 0272-7358. 119. doi: 10.1016/j.cpr.2025.102586. Full text in Research Archive Show summary

  The working alliance is one of the most robust predictors of outcomes in adult psychotherapy. Since the alliance is often challenging to establish and maintain in psychotherapy with adolescents, conducting high-quality assessments of the alliance using sound measures in this population is critical. Still, measurement instruments developed for adults cannot be directly transferred to adolescent samples. This systematic review aimed to identify and critically evaluate available assessment tools for working alliance in adolescent psychotherapy using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) framework. A comprehensive literature search across PsycINFO, PubMed, Web of Science, and PsycARTICLES, up to October 2024, yielded 47 research studies reporting on working alliance measurement properties. Findings indicate that self-report measures are most commonly studied, with the Working Alliance Inventory-Short Form (WAI-S) and Therapeutic Alliance Quality Scale (TAQS) showing the best psychometric properties. Nevertheless, even with these measures, there are notable shortcomings in cross-cultural validity, measurement error, and responsiveness, which are essential for applications in longitudinal studies and with diverse populations. Less commonly studied, often with very small samples, observer-rated tools displayed high reliability but limited predictive validity. Our review highlights the need for more stringent research on developmentally appropriate, reliable working alliance instruments for adolescents to support clinicians and researchers in studying and monitoring this aspect of patient-therapist relations. These findings, together with the COSMIN guidelines, inform recommendations for future research mainly in terms of improved content validity, measurement error, cross-cultural validity, and responsiveness.

• Malkomsen, Anders; Wilberg, Theresa; Bull-Hansen, Bente; Dammen, Toril; Evensen, Julie Horgen & Hummelen, Benjamin [Show all 10 contributors for this article] (2025). Comparative effectiveness of short-term psychodynamic psychotherapy and cognitive behavioral therapy for major depression in psychiatric outpatient clinics: a randomized controlled trial. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06544-6. Full text in Research Archive Show summary

  Background More studies with low risk of bias on the effectiveness of cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) for major depressive disorder (MDD) are needed. This study compares the outcome of CBT and STPP and examines the improvements in each treatment, focusing on effect sizes, reliable change, dropout rates, and remission rates, using broad inclusion criteria (e.g. participants using antidepressants or with strong suicidal ideation). Methods One hundred patients were randomly allocated to CBT or STPP. All patients were offered either 16 weekly sessions followed by 3 monthly booster sessions in CBT, or 28 weekly sessions in STPP. Primary outcome measures were Hamilton Depression Rating Scale (HDRS) and Beck’s Depression Inventory-II (BDI-II). Secondary outcome measures were Work and Social Adjustment Scale (WSAS), Generalized Anxiety Disorder-7 (GAD-7), Global Assessment of Functioning (GAF) and Short Form Health Survey-12 (SF-12). Results No significant differences in outcomes were found between the two treatment groups on any of the measures. The within-group effects were large (> 0.8) for the primary outcome measures and moderate to large for the secondary outcome measures. According to the reliable change index (RCI), 79% of patients reliably improved on HDRS and 76% improved on BDI-II, whereas respectively 6% and 10% reliably deteriorated. Conclusions These findings support the assumption that CBT and STPP are equally effective treatments for patients with depressive disorders in psychiatric outpatient clinics. Additionally, they strengthen the evidence for the effectiveness of both CBT and STPP in these settings, while also highlighting that not all depressed patients respond to short-term treatment.

• Ulberg, Randi & Dahl, Hanne-Sofie Johnsen (2024). Ulberg, R., & Dahl, H. S. J. Effekten av overføringsintervensjoner i psykodynamisk behandling av ungdom med depresjon. Mellanrummet: Tidsskrift om barn- og ungdomspsykoterapi. Full text in Research Archive
• Protić, Sonja; Wittmann, Lutz; Taubner, Svenja; Conejo-Cerón, Sonia; Ioannou, Yianna & Heinonen, Erkki [Show all 22 contributors for this article] (2024). Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review. Trauma, Violence, & Abuse. ISSN 1524-8380. doi: 10.1177/15248380231223264. Full text in Research Archive
• Malkomsen, Anders; Røssberg, Jan Ivar; Dammen, Toril; Wilberg, Theresa; Løvgren, André & Ulberg, Randi [Show all 7 contributors for this article] (2024). “It takes time to see the whole picture”: patients’ views on improvement in cognitive behavioral therapy and psychodynamic therapy after three years. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1342950. Full text in Research Archive Show summary

  Introduction: There is a lack of qualitative research that retrospectively explores how patients with major depressive disorder view their improvement in psychotherapy. Methods: Fifteen patients who received short-term cognitive behavioral therapy and psychodynamic therapy were individually interviewed approximately three years after completing therapy. Results: Some patients had altered their views on therapy, especially those who initially were uncertain of how helpful therapy had been. They said they did not realize the extent and importance of their improvement in therapy before some time had passed, which can be explained by the surprising cumulative effects of seemingly small changes. Discussion: This should make retrospective qualitative research an important part of future psychotherapy research.

• Taubner, Svenja; Ioannou, Yianna; Saliba, Andrea; Sales, Célia M. D.; Volkert, Jana & Protić, Sonja [Show all 21 contributors for this article] (2023). Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-023-02186-9. Full text in Research Archive Show summary

  Abstract Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

• Gergov, Vera; Prevendar, Tamara; Vousoura, Eleni; Ulberg, Randi; Dahl, Hanne-Sofie Johnsen & Feller, Clémence [Show all 18 contributors for this article] (2023). Sociodemographic Predictors and Moderators of Treatment Outcomes of Psychotherapeutic Interventions for Young People with Mental Disorders: A Systematic Review. Adolescent Research Review. ISSN 2363-8346. doi: 10.1007/s40894-023-00228-6. Full text in Research Archive Show summary

  Abstract Despite the worrying prevalence of mental disorders among adolescents and young people, evidence on predictors of treatment outcome remains scarce. Systematic reviews have focused on specific disorders or treatment modalities and have not targeted this age group in particular. This systematic review presents an overview of the sociodemographic predictors and moderators on the outcome of psychotherapeutic interventions for adolescents and young people with mental disorders across treatment modalities. The search was conducted in PubMed and PsycINFO following the PICOS strategy. The included studies were clinical outcome studies on psychotherapeutic interventions, targeted for young people (aged 12–30 years) with specified mental disorders and published in peer-reviewed journals. During a four-step screening process, 17,359 articles were assessed, among which 114 met the inclusion criteria. Most included studies involved patients with mood, eating, or substance use disorders. Age, gender, and ethnicity were the most frequently reported predictors. For age and gender the findings were mixed, so it is not possible to state which age group or gender would benefit most from treatment across disorder groups. Ethnic minority status and history of traumatic events may predict poorer outcomes. However, the results mainly did not support the relevance of sociodemographic variables for predicting treatment outcome.

• Malkomsen, Anders; Røssberg, Jan Ivar; Dammen, Toril; Wilberg, Theresa; Løvgren, André & Ulberg, Randi [Show all 7 contributors for this article] (2022). How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-04083-y. Full text in Research Archive Show summary

  Background Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD). Methods Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach. Results Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth. Conclusions These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

• Schønning, Thea; Dahl, Hanne-Sofie Johnsen; Hummelen, Benjamin & Ulberg, Randi (2022). Do Sleep Disturbances Improve Following Psychoanalytic Psychotherapy for Adolescent Depression? International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19. doi: 10.3390/ijerph19031790. Full text in Research Archive Show summary

  Sleep disturbance is often a prominent symptom in adolescents diagnosed with major depressive disorder (MDD). Recent evidence indicates that short-term psychoanalytic psychotherapy (STPP) for depression may have an effect in reducing co-occurring sleep disturbance in youth. It is unknown if transference work (exploration of the patient–therapist relationship) has an additional effect in reducing sleep disturbance. Adolescents aged 16–18 years (n = 69, 84% female) who met diagnostic criteria for MDD based on the Mini International Neuropsychiatric Interview (M.I.N.I) were randomized to either STPP with transference work or without. Sleep problems were assessed at baseline, therapy session 20 (20 weeks), post-treatment (28 weeks), and one-year follow-up (80 weeks) with the Symptom Checklist-90-R. At baseline, 69% of the adolescents exhibited moderately to extreme sleep difficulties. Sleep disturbance was significantly correlated to depression depth at session 20 and at follow-up. Symptoms of insomnia significantly decreased from baseline to the end of treatment. Treatment gains were maintained until follow-up. No differences in recovery of sleep disturbance were found between the two treatment groups. The findings suggest that sleep disturbance improves following STPP for depression, with or without transference work. Future research should assess those with residual symptoms by different sleep measures.

• Fahs, Sarah Christine; Ulberg, Randi; Dahl, Hanne-Sofie Johnsen & Høglend, Per Andreas (2022). Parental Bonding and Relationships with Friends and Siblings in Adolescents with Depression. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(11). doi: 10.3390/ijerph19116530. Full text in Research Archive Show summary

  According to attachment theory, the quality of the early child-parent bond determines the child’s interpersonal relationships later in life. Utilising data from The First Experimental Study of Transference Work-In Teenagers (FEST-IT), the current paper investigated the connection between the self-reported quality of bonding with mother and father and the self-reported importance of relationships with friends and siblings in adolescents with depression. The scales employed were the Parental Bonding Instrument (PBI) and the Adolescent Relationship scale (ARS). A Pearson’s correlation tested the relationship between the reported levels of maternal and paternal care and control, and the reported importance of friendship and relationship with siblings. Results revealed a statistically significant negative correlation between high levels of maternal control and importance of friendship, and a statistically significant positive correlation between high levels of paternal care and importance of relationships with siblings. The results are in line with Bowlby’s theory of attachment.

• Korsgaard, Hans Ole; Ulberg, Randi; Hummelen, Benjamin; Midgley, Nick; Thorén, Agneta & Dahl, Hanne-Sofie Johnsen (2022). Personality Disorders as a Possible Moderator of the Effects of Relational Interventions in Short-Term Psychoanalytic Psychotherapy with Depressed Adolescents. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(17). doi: 10.3390/ijerph191710952. Full text in Research Archive Show summary

  A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

• Hoy, Angelika Van; Rzeszutek, Marcin; Pięta, Małgorzata; Mestre, Jose M.; Rodríguez-Mora, Álvaro & Midgley, Nick [Show all 22 contributors for this article] (2022). Subjective well-being among psychotherapists during the coronavirus disease pandemic: A cross-cultural survey from 12 european countries. Journal of Psychiatric Research. ISSN 0022-3956. 154, p. 315–323. doi: 10.1016/j.jpsychires.2022.07.065. Full text in Research Archive Show summary

  Objective The aim of this study is to examine the amount of the total variance of the subjective well-being (SWB) of psychotherapists from 12 European countries explained by between-country vs. between-person differences regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect [NA]). Second, we explored a link between the SWB and their personal (self-efficacy) and social resources (social support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress. Methods In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), the General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Results Cognitive well-being (CWB; satisfaction with life) was a more country-dependent component of SWB than affective well-being (AWB). Consequently, at the individual level, significant correlates were found only for AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower COVID-19-related distress. Self-efficacy and social support explained AWB only, including their main effects and the moderating effect of self-efficacy. Conclusions The results highlight more individual characteristics of AWB compared to CWB, with a more critical role of low self-efficacy for the link between social support and PA rather than NA. This finding suggests the need for greater self-care among psychotherapists regarding their AWB and the more complex conditions underlying their CWB.

• Hoy, Angelika Van; Rzeszutek, Marcin; Pięta, Małgorzata; Mestre, Jose M.; Rodríguez-Mora, Álvaro & Midgley, Nick [Show all 22 contributors for this article] (2022). Burnout among psychotherapists: a cross-cultural value survey among 12 European countries during the coronavirus disease pandemic. Scientific Reports. 12(1). doi: 10.1038/s41598-022-17669-z. Full text in Research Archive Show summary

  Abstract The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning.

• Mechler, Jakob; Lindqvist, Karin; Carlbring, Per; Topooco, Naira; Falkenström, Fredrik & Lilliengren, Peter [Show all 16 contributors for this article] (2022). Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial. The Lancet Digital Health. 4(8), p. e594–e603. doi: 10.1016/S2589-7500(22)00095-4. Full text in Research Archive Show summary

  Background Adolescent major depressive disorder (MDD) is highly prevalent and associated with lifelong adversity. Evidence-based treatments exist, but accessible treatment alternatives are needed. We aimed to compare internet-based psychodynamic therapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioural therapy [ICBT]) for the treatment of adolescents with depression. Methods In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. Eligible participants were 15–19 years old, presenting with a primary diagnosis of MDD according to DSM-5. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were randomly assigned to ICBT or IPDT. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Primary analyses were based on an intention-to-treat sample including all participants randomly assigned. A non-inferiority margin of Cohen's d=0·30 was predefined. The study is registered at ISRCTN, ISRCTN12552584. Findings Between Aug 19, 2019, and Oct 7, 2020, 996 young people completed screening; 516 (52%) were contacted for a diagnostic interview. 272 participants were eligible and randomly assigned to ICBT (n=136) or IPDT (n=136). In the ICBT group, 51 (38%) of 136 participants were classified as remitted, and 54 (40%) of 136 participants were classified as remitted in the IPDT group. Within-group effects were large (ICBT: within-group d=1·75, 95% CI 1·49 to 2·01; IPDT: within-group d=1·93, 1·67 to 2·20; both p<0·0001). No statistically significant treatment difference was found in the intention-to-treat analysis. Non-inferiority for IPDT was shown for the estimated change in depression during treatment (d=–0·18, 90% CI –0·49 to 0·13; p=0·34). All secondary outcomes showed non-significant between-group differences. Interpretation IPDT was non-inferior to ICBT in terms of change in depression for the treatment of adolescents with MDD. This finding increases the range of accessible and effective treatment alternatives for adolescents with depression.

• Brøsholen, Pernille; Ulberg, Randi; Dahl, Hanne-Sofie Johnsen & Thorén, Agneta (2022). Therapists’ Emotional Responses in Individual Therapy with Depressed Adolescents: An Evaluation of the Data Structure of the Feeling-Word Checklist—28. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(15). doi: 10.3390/ijerph19159496. Full text in Research Archive Show summary

  Countertransference (CT) responses during therapy sessions can be understood as the therapist’s emotional reactions towards the patient. Within adolescents’ psychotherapy, little is known about the effects of the therapists’ feelings on treatment outcome. The Feeling-Word Checklist—28 (FWC-28) is a self-report questionnaire designed to evaluate the therapist’s in-session feelings during therapy with younger patients. The aim of the study was to evaluate the psychometric properties of the clinician-rated FWC-28 and explore the associations between the CT-subscales and therapeutic alliance. Data were collected from a randomized controlled trial in which 11 therapists specialized in child and adolescent psychotherapy treated 16- to 18-year-old patients (n = 62) with major depressive disorder in outpatient clinics. The patients received psychodynamic psychotherapy treatment over 28 sessions. Therapists rated their emotional responses towards their patients on FWC-28 after sessions 3, 12, 20, and 28. Principal component analysis (PCA) with oblique rotation was performed to find clinically meaningful subscales of the FWC-28. PCA revealed four clinically meaningful components termed as follows: inadequate, confident, motherly, and disengaged. The psychometric properties of the FWC and the reliability of the CT subscales measured with Cronbach’s alpha were acceptable. The therapist-reported alliance showed significant and clinically meaningful correlations with all CT-subscales. Our findings indicate that the checklist is adequate for clinical practice and countertransference research in adolescents’ psychotherapy.

• Gergov, Vera; Milic, Branka; Löffler-Stastka, Henriette; Ulberg, Randi; Vousoura, Eleni & Poulsen, Stig (2022). Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.859042. Full text in Research Archive Show summary

  Background: Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12–30) with psychotic disorders. Methods: A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. Results: Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. Conclusion: There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment.

• Svela, Eirik Wixøe; Korsgaard, Hans Ole; Stänicke, Line Indrevoll & Ulberg, Randi (2022). Inter-rater reliability of the structured interview of DSM-IV personality (SIDP-IV) in an adolescent outpatient population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19:12283(19), p. 1–10. doi: 10.3390/ijerph191912283. Full text in Research Archive Show summary

  Personality disorders (PDs) are a class of mental disorders which are associated with subjective distress, decreased quality of life and broad functional impairment. The presence of one or several PDs may also complicate the course and treatment of symptom disorders such as anxiety and depression. Accurate and reliable means of diagnosing personality disorders are thus crucial to ensuring efficient treatment planning and resource allocation, a fact which is widely acknowledged within the adult mental health field. In adolescents, on the other hand, the consensus view has been that the rapid and discontinuous processes of normal personality development render the construct of PD in adolescents clinically unhelpful and conceptually dubious. However, recent research has established the reliability and validity of the construct, heralding an increased interest in the field, with important conceptual and clinical implications. The present article presents reliability data for the Structured Interview of DSM-IV Personality (SIDP-IV) in an adolescent outpatient population. For this study, 25 interviews conducted by experienced clinicians were blindly re-scored based on sound recordings, which allowed for the calculation of intra-class correlation metrics. The intra-class correlation coefficient for categorical diagnosis of specific personality disorders was found to be 0.876 (95% CI 0.718–0.945); Cohen’s kappa for presence/absence of personality diagnosis was found to be 0.896. The present study found excellent intra-rater reliability for the sample, which suggests that the SIDP-IV is a suitable instrument for assessing personality pathology in adolescent populations.

• Calderon, Ana; Elvejord, Cecilie; Storeide, Knut Arne Hooper; Nissen-Lie, Helene, Amundsen; Ulberg, Randi & Dahl, Hanne-Sofie Johnsen (2022). Examining Psychotherapeutic Processes with Depressed Adolescents: A Comparative Study of Two Psychodynamic Therapies. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(24). doi: 10.3390/ijerph192416939. Full text in Research Archive Show summary

  To understand processes associated with better or poorer psychotherapy outcomes is vital. This study examined and contrasted interaction patterns between one therapist and two depressed 17-year-old girls, Johanna (good outcome) and Sonja (poor outcome), in short-term psychoanalytic therapies selected from an RCT. Outcome data were collected regarding level of inter- and intra-personal functioning and symptoms of depression. Process data were obtained using the Adolescent Psychotherapy Q-Set on all available sessions. Analyses yielded five relational patterns or “interaction structures” in the two therapy processes; Three explained most of the variance in sessions with Johanna (i.e., ‘positive working alliance’, ‘therapist’s active use of psychodynamic techniques’, and ‘a receptive patient’) and two explained more of the variance in sessions with Sonja (i.e., ‘therapist using a more problem-solving and symptom-oriented approach’ and ‘patient displaying limited capacity for mentalization’). The processes in the two cases presented differences related to mentalization, psychological mindedness, and attachment style of the patients. The therapist used different therapeutic approaches, favouring more psychodynamic interventions in the good outcome case and a more problem-solving and symptom-oriented approach with the poor outcome case. In the latter case, the relationship seemed to be more of a struggle.

• Mestre, Jose M.; Taubner, Svenja; Mota, Catarina Pinheiro; Henriques, Margarida Rangel; Saliba, Andrea & Heinonen, Erkki [Show all 21 contributors for this article] (2021). Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.730921. Full text in Research Archive Show summary

  Background Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old). Methods A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis. Results Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent–adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively. Conclusions Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified. Ethics and Dissemination Ethical approval was not required. PROSPERO registration number: CRD42021231835.

• Vousoura, Eleni; Gergov, Vera; Tulbure, Bogdan Tudor; Camilleri, Nigel; Saliba, Andrea & Garcia-Lopez, LuisJoaquin [Show all 16 contributors for this article] (2021). Predictors and moderators of outcome of psychotherapeutic interventions for mental disorders in adolescents and young adults: protocol for systematic reviews. Systematic Reviews. 10(1), p. 1–14. doi: 10.1186/s13643-021-01788-1. Full text in Research Archive Show summary

  Background Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. Methods The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. Discussion This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people. Systematic review registration PROSPERO CRD42020166756 .

• Volkert, Jana; Taubner, Svenja; Barkauskiene, Rasa; Mestre, Jose M.; Sales, Célia M. D. & Thiele, Vanessa [Show all 22 contributors for this article] (2021). Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol. Frontiers in Psychology. 12, p. 1–7. doi: 10.3389/fpsyg.2021.703095. Full text in Research Archive Show summary

  Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear. Aim: As part of the “European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders” (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects). Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case–control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems. Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959). Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders.

• Sales, Célia M. D.; Martins, Filipa; Alves, Marisa M.; Carletto, Sara; Conejo-Cerón, Sonia & Silva, Luis Costa da [Show all 22 contributors for this article] (2021). Patient and Public Involvement in Youth Mental Health Research: Protocol for a Systematic Review of Practices and Impact. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.703624. Full text in Research Archive Show summary

  Various health settings have advocated for involving patients and members of the public (PPI) in research as a means to increase quality and relevance of the produced knowledge. However, youth PPI has been an understudied area. This protocol paper describes a new project that aims to summarize what is known about PPI with young people in mental health research. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement guidelines we will identify and appraise suitable articles and extract and synthesize relevant information including at least two reviewers at each stage of the process. Results will be presented in two systematic reviews that will describe (a) how youth PPI has been conducted (Review1) and (b) what impact youth PPI had on the subsequent research and on stakeholders (Review2). To our knowledge, this is the first set of reviews that uses a critical appraisal tool, which is co-developed with children and young people. Findings from this project will provide valuable insights and set out the key steps to adopting adequate PPI methods when involving children and young people in mental health research.

• Taubner, Svenja; Saliba, Andrea; Heinonen, Erkki; Protić, Sonja; Volkert, Jana & Adler, Asta [Show all 21 contributors for this article] (2021). Mediators and theories of change in psychotherapy with adolescents: a systematic review protocol. BMJ Open. 11(3). doi: 10.1136/bmjopen-2020-042411. Full text in Research Archive Show summary

  Introduction Approximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The ‘European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders’, funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents. Method A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer from a mental disorder or psychological difficulties and receive an intervention that aims at preventing, ameliorating and/or treating psychological problems. Ethics and dissemination Ethical approval is not required for this systematic review as no primary data will be collected. The results will be published in a peer-reviewed journals and at conference presentations and will be shared with stakeholder groups. The whole data set will be offered to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. PROSPERO registration number CRD42020177535.

• Edbrooke-Childs, Julian; Silva, Luís Costa da; Čuš, Anja; Liverpool, Shaun; Mota, Catarina Pinheiro & Pietrabissa, Giada [Show all 11 contributors for this article] (2021). Young People Who Meaningfully Improve Are More Likely to Mutually Agree to End Treatment. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.641770. Full text in Research Archive Show summary

  Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment. Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; mean Age = 13.66 (SD = 2.87) years] using anonymised administrative data from young people's mental health services. Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement (Odds Ratio or OR = 0.58, 95% Confidence Interval or CI = 0.50–0.61). Similarly, they were less likely to transfer (OR = 0.61, 95% CI = 0.49–0.74) or end treatment for other reasons (OR = 0.59, 95% CI = 0.50–0.70) than by case closure due to mutual agreement. Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services.

• Fredum, Hanne Gotaas; Rost, Felicitas; Ulberg, Randi; Midgley, Nick; Thorén, Agneta & Aker, Julie Frederikke Dalen [Show all 10 contributors for this article] (2021). Psychotherapy dropout: Using the Adolescent Psychotherapy Q-Set to explore the early in-session Process of short-term psychodynamic psychotherapy. Frontiers in Psychology. 12, p. 1–18. doi: 10.3389/fpsyg.2021.708401. Full text in Research Archive Show summary

  esearch suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16–18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.

• Cielo, Federica; Ulberg, Randi & Giacomo, Dina Di (2021). Psychological impact of the covid-19 outbreak on mental health outcomes among youth: A rapid narrative review. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(11), p. 1–15. doi: 10.3390/ijerph18116067. Full text in Research Archive Show summary

  The coronavirus disease (COVID-19) outbreak has affected not only physical health but also mental health and psychological wellbeing. This narrative review aimed to map the literature on the psychological impact on the young generation of the COVID-19 pandemic, social restrictions, and extraordinary measures to curb the spread of coronavirus. We performed a systematic search of MEDLINE through PubMed and Web of Science [Science Citation Index Expanded, SCI-EXPANDED), Social Sciences Citation Index (SSCI), and Emerging Sources Citation Index (ESCI)] of all scientific literature published from May 2020 until 15 March 2021. Based on inclusion and exclusion criteria, a total of 15 articles were included. We conducted a narrative review. The reviewed articles suggested the impact of the pandemic and lockdown measures on young persons for several mental symptoms as well as anxiety, stress, depression, event-specific distress, decrease in psychological wellbeing, and changes in sleep habits. Psychological symptoms were related to the experience of several stressors, such as risk for reduction of academic perspectives, massive e-learning adoption, economic issues, social restrictions, and implications for daily life related to the COVID-19 outbreak. This narrative review points out the negative psychological impact of the pandemic outbreak and the high vulnerability of the young in the development of psychological distress, highlighting the relevant focus on the mental health of young people during the pandemic and the need for structured and tailored psychological support and interventions focused to the improvement of Quality of Life of university students after the pandemic experience.

• Ulberg, Randi; Hummelen, Benjamin; Hersoug, Anne Grete; Midgley, Nick; Høglend, Per Andreas & Dahl, Hanne-Sofie Johnsen (2021). The first experimental study of transference work-in teenagers (FEST-IT): a multicentre, observer- and patient-blind, randomised controlled component study. BMC Psychiatry. 21(1). doi: 10.1186/s12888-021-03055-y. Full text in Research Archive Show summary

  Background: Little is known about the influence on outcome of exploration of the patient-therapist relationship (that is, transference work) in psychoanalytic psychotherapy. We hypothesized that depressed adolescents would have better long-term effects from psychoanalytic psychotherapy with than without transference work. Methods: Depressed adolescent (16 to 18 years) were recruited in health authority funded out-patient clinics in Oslo and Vestfold County, Norway. They were randomized to 28 weeks of treatment with psychoanalytic psychotherapy with or without transference work. Change was assessed using linear-mixed models. The primary outcome measure was the Psychodynamic Functioning Scale (pre- post-, and 1-year post-treatment). Level of depression was measured at the same time points and during therapy (week 12, and 20). Results: 69 adolescents were treated with (N = 39) or without (N = 31) transference work. The mean number of sessions was 18.6 (SD = 8,6) in the transference work group and 18.0 (SD = 10.9) in the non-transference work group. Both groups showed large and significant improvement on Psychodynamic Functioning Scale during the whole study period. The difference between the two groups was not significant during the treatment period (95% CI -.79 to 1.2, p = .674, F = .18), or from post-treatment to one-year follow-up (95% CI -.13 to .96; p = .134; F = 2.3). For the secondary outcome measures the transference work group had significantly better outcomes from 12 weeks in treatment to one-year follow-up (Beck Depression Inventory, 95% CI - 1.7 to -.14, p = .022; Montgomery and Åsberg Depression Rating Scale, 95% CI - 1.6 to -.23, p = .009). Conclusion: The findings suggest that exploration of the adolescents' relations to the therapist amplify the effects of short-term psychoanalytic psychotherapy on their depressive symptoms for adolescents with a Major Depressive Disorder.

• Henriksen, Arne K; Ulberg, Randi; Tallberg, Björn Peter Urban; Løvgren, André & Dahl, Hanne-Sofie Johnsen (2021). Conflicted anger as a central dynamic in depression in adolescents—a double case study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(12), p. 1–20. doi: 10.3390/ijerph18126466. Full text in Research Archive Show summary

  The incidence of depression in teenagers has increased for many years and is one of the most common diagnosis in adolescent psychiatry. Effective and accessible psychotherapy methods need sustained attention since psychopharmaceutic treatment might be less effective in younger people than in adults. The First Experimental Study of Transference–In Teenagers (FEST-IT) is a Randomized Controlled Study (RCT) with a dismantling design. The main intention in this study was to illustrate a way to address parts of a case formulation by focusing a psychodynamic feature in two different therapies with a good outcome suffering from depression. We present two representative patients from the FEST-IT with case formulations revealing conflicted anger. The patients were different in many aspects, as were the therapeutic methods. Therapies with and without transference interpretations may help to understand what is helpful in therapy in general. It may also show how a more individualized approach can guide the therapy beyond diagnosis and to make it more effective for the specific patient. Looking into individual cases with good outcomes can help us address dynamic features in therapy and give some ideas about what works for whom. The use of nested qualitative double case studies may together add more knowledge about working aspects in successful therapies.

• Malkomsen, Anders; Røssberg, J.I.; Dammen, T.; Wilberg, T.; Løvgren, A. & Ulberg, R. [Show all 7 contributors for this article] (2021). Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy. BMC Psychiatry. 21(1), p. 1–12. doi: 10.1186/s12888-021-03551-1. Full text in Research Archive Show summary

  Background In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. Methods Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. Conclusions Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

• Røssberg, Jan Ivar; Evensen, Julie Horgen; Dammen, Toril; Wilberg, Theresa; Klungsøyr, Ole & Jones, Maria-Helene [Show all 11 contributors for this article] (2021). Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial. BMC Psychology. 9, p. 1–14. doi: 10.1186/s40359-021-00517-6. Full text in Research Archive Show summary

  Background Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. Methods One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. Discussion The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. Trial registration ClinicalTrials.gov Identifier: NCT03022071.

• Løvgren, André; Røssberg, Jan Ivar; Engebretsen, Eivind & Ulberg, Randi (2020). Improvement in Psychodynamic Psychotherapy for Depression: A Qualitative Study of the Patients’ Perspective. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(18). doi: 10.3390/ijerph17186843. Full text in Research Archive
• Jones, Maria-Helene; Råbu, Marit; Røssberg, Jan Ivar & Ulberg, Randi (2020). Therapists’ experiences of psychodynamic therapy with and without transference interventions for adolescents with depression. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(13), p. 1–18. doi: 10.3390/ijerph17134628. Full text in Research Archive Show summary

  Psychodynamic therapy is an effective treatment for depression. However, a large number of adolescent patients with depression do not respond and/or drop out of therapy and little is known about what therapists actually do in therapy with adolescents. Thus, more research is needed to explore the various actions that therapists do in therapy, so that therapists can tailor their therapy more specifically to each individual adolescent. The present study aimed to investigate how the experience of psychotherapists differs between two treatment modes for adolescents with depression: psychodynamic psychotherapy with and without transference interventions. In-depth interviews were conducted with six therapists. The data, which were analyzed using thematic analysis, generated three key themes: (1) The therapists experienced that transference interventions are often useful in therapies with adolescents with depression, (2) therapies without transference interventions can be challenging for therapists, but still helpful for patients, and (3) the experience contributed to the deepening recognition of therapists that they always need to adapt their techniques to the particular patient. The results enhance our knowledge of the significance of therapists’ actions in therapy with adolescents. The therapists highlighted issues that are important for identifying barriers to incorporating new knowledge into clinical practice.

• Løvgren, André; Røssberg, Jan Ivar; Engebretsen, Eivind & Ulberg, Randi (2020). Multiple Mutuality. Positions and Storylines in Adolescent Psychodynamic Psychotherapy. Journal of Infant, Child, and Adolescent Psychotherapy (JICAP). ISSN 1528-9168. doi: 10.1080/15289168.2020.1771530. Full text in Research Archive Show summary

  In the psychodynamic psychotherapy of adolescents, a mutual relationship is a central and often reoccurring theme. However, what this mutuality consists of and how adolescents experience this seems to have been the subject of scant investigation or conceptualization. Thus, the aim of the present study was to obtain a more comprehensive insight into mutuality by innovatively applying interdisciplinary positioning theory to the analysis of adolescents’ experiences of psychotherapy. Qualitative, post-treatment interviews with nine female adolescents receiving psychodynamic psychotherapy for depression in the Norwegian First Experimental Study of Transference Work – In Teenagers were conducted. Drawing on positioning theory, unique characteristics of mutuality with a focus on storylines and positions were identified within the patients’ descriptions of their therapy. Adolescents in psychodynamic psychotherapy experience multifarious forms of mutuality and partake in the co-creation of shifting positions. They also constantly evaluate and negotiate what to say and disclose in therapy. These negotiations offer both desired and unattractive positions, dependent on each individual adolescent’s norms and moral perceptions. From the study, it was found that adolescents pass through different forms of mutuality. These are discussed, illuminating how the power of positions and storylines may be used by therapists to promote therapeutic, mutual relationships.

• Tallberg, Björn Peter Urban; Ulberg, Randi; Dahl, Hanne-Sofie Johnsen & Høglend, Per Andreas (2020). Core conflictual relationship theme: the reliability of a simplified scoring procedure. BMC Psychiatry. 20. doi: 10.1186/s12888-020-02558-4. Full text in Research Archive Show summary

  Background Creating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient’s interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns. The CCRT method is based on the assumption that humans display a central relationship theme, which is shown in most relationships as well as in the patient-therapist relation. The CCRT scoring is based on how the patient describes interactions with others, in therapy sessions or in a specific interview. These descriptions are transcribed. Raters then score the identified relational episodes by choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. The method has shown high validity and reliability. Inter rater reliability is generally good: Cohen’s kappa ranging from 0.55 to 0.70. To decide CCRT pattern from transcribed material is time consuming and labour intensive This study investigates a labour- and timesaving version of the method. Methods This study aimed to investigate rater agreement in a simplified method of scoring the CCRT, based directly on live semi-structured dynamic interviews without transcribing the material. Fifty-two patients referred for psychotherapy in a clinical trial, were scored for CCRT pattern. Based on information that came forth during the two-hour interview, raters scored the patients choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. More than one category in each component could be chosen without ranking. Five raters compared two by two were investigated. Inter rater reliability was measured by Cohen’s kappa. Results Mean kappa for Wishes, Response from Others and Response from Self was .33, .41 and .45 respectively. Mean kappa for CCRT in total was .41 among 5 raters. Conclusion In this simplified method to score the CCRT based on oral dynamic interviews, fair to moderate IRR was obtained. Trial registration First Experimental Study of Transference-interpretations (FEST307/95). Registration number: ClinicalTrials.gov Identifier: NCT00423462.

• Siegel, Marte Langenes; Binder, Eva Mathilde Gullestad; Dahl, Hanne-Sofie Johnsen; Czajkowski, Nikolai Olavi; Critchfield, Kenneth L. & Høglend, Per Andreas [Show all 7 contributors for this article] (2020). Therapeutic Atmosphere in Psychotherapy Sessions. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(11). doi: 10.3390/ijerph17114105. Full text in Research Archive Show summary

  There is uncertainty concerning what the active ingredients in psychotherapy are. The First Experimental Study of Transference interpretations (FEST) was a randomized controlled trial of the effects of transference work (TW) in psychodynamic psychotherapy. Women with low quality of object relations (QOR) showed a large positive effect of transference work, while men with high QOR showed a slight negative effect. The present study aimed to expand the knowledge from the FEST by investigating the therapeutic atmosphere with Structural Analysis of Social Behavior (SASB). Two-way ANOVAs were conducted to investigate differences between SASB cluster scores between subgroups. The therapeutic atmosphere was characterized by Protect-Trust, Affirm-Disclose and Control-Submit. Multilevel modeling was used to assess the relationship between a therapist variable and outcomes for men and women. Contrary to expectations, no significant differences in therapeutic atmosphere between subgroups (with or without TW in women with low QOR and men with high QOR) were observed using the process measure SASB.

• Liverpool, Shaun; Mota, Catarina Pinheiro; Sales, Célia M D; Čuš, Anja; Carletto, Sara & Hancheva, Camellia [Show all 14 contributors for this article] (2020). Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 22(6), p. 1–17. doi: 10.2196/16317. Full text in Research Archive Show summary

  Background There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. Objective This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. Methods A literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts “child and adolescent mental health,” “digital intervention,” and “engagement.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively. Results This study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs. Conclusions The development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs.

• Lindqvist, Karin; Mechler, Jakob; Carlbring, Per; Lilliengren, Peter; Falkenström, Fredrik & Andersson, Gerhard [Show all 16 contributors for this article] (2020). Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 22(3), p. 1–15. doi: 10.2196/18047. Full text in Research Archive Show summary

  Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments. This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents. The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment. IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P&lt;.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P&lt;.001) and increasing emotion regulation (d=0.97, P&lt;.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules. IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254

• Løvgren, André; Røssberg, Jan Ivar; Nilsen, Liv; Engebretsen, Eivind & Ulberg, Randi (2019). How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study. BMC Psychiatry. 19. doi: 10.1186/s12888-019-2080-0. Full text in Research Archive Show summary

  Background There is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents’ experiences of factors promoting improvement in psychodynamic therapy. Methods Eight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work – In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation. Results The analysis revealed four main themes. ‘Exploring oneself’ comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. ‘Therapist relation and characteristics’ includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. ‘Focusing on everyday life’ includes learning and practical orientation. ‘Time factors’ refers to duration and frequency. Conclusions Together with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one’s place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life.

• Sørbye, Øystein; Dahl, Hanne-Sofie Johnsen; Eells, Tracy D.; Amlo, Svein; Hersoug, Anne Grete & Haukvik, Unn Kristin H. [Show all 9 contributors for this article] (2019). Psychodynamic case formulations without technical language: a reliability study. BMC Psychology. 7. doi: 10.1186/s40359-019-0337-5. Full text in Research Archive Show summary

  Background To bridge the gap between symptoms and treatment, constructing case formulations is essential for clinicians. Limited scientific value has been attributed to case formulations because of problems with quality, reliability, and validity. For understanding, communication, and treatment planning beyond each specific clinician-patient dyad, a case formulation must convey valid information concerning the patient, as well as being a reliable source of information regardless of the clinician’s theoretical orientation. The first aim of the present study is to explore the completeness of unstructured psychodynamic formulations, according to four components outlined in the Case Formulation Content Coding Method (CFCCM). The second aim is to estimate the reliability of independent formulations and their components, using similarity ratings of matched versus mismatched cases. Methods This study explores psychodynamic case formulations as made by two or more experienced clinicians after listening to an evaluation interview. The clinicians structured the formulations freely, with the sole constraint that technical, theory-laden terminology should be avoided. The formulations were decomposed into components after all formulations had been written. Results The results indicated that most formulations were adequately comprehensive, and that overall reliability of the formulations was high (> 0.70) for both experienced and inexperienced clinician raters, although the lower bound reliability estimate of the formulation component deemed most difficult to rate - inferred mechanisms - was marginal, 0.61. Conclusions These results were achieved on case formulations made by experienced clinicians using simple experience-near language and minimizing technical concepts, which indicate a communicative quality in the formulations that make them clinically sound. Trial registration ClinicalTrials.gov Identifier: NCT00423462. https://doi.org/10.1007/s00432-018-2781-7 ., January 18, 2007.

• Marble, Alice Ruth; Høglend, Per Andreas & Ulberg, Randi (2018). Recovery and Nonrecovery After Psychotherapy With Transference Interpretation: Two Case Studies. American Journal of Psychotherapy. ISSN 0002-9564. doi: 10.1176/appi.psychotherapy.20180014. Full text in Research Archive Show summary

  The First Experimental Study of Transference Interpretation (FEST), conducted in Norway, is a dismantling, randomized clinical trial of the long-term effects of transference interpretation (TI). This article examines two case studies of women with poor quality of object relations (QOR), one who was rated as recovered after psychotherapy and one who was rated as not recovered. Both received TI. In general, women with poor QOR needed TI to recover, but some members of this group did not recover, even with TI. The therapist’s negative countertransference and tendency to use controlling interventions was more pronounced with the poor-outcome patient. In addition, the poor-outcome patient had three subthreshold personality disorders in addition to obsessive-compulsive personality disorder. In childhood she had experienced substantial emotional abuse and some physical abuse. She was less motivated before therapy and more evasive during therapy than the good-outcome patient. The good-outcome patient also had obsessive-compulsive personality disorder but no subthreshold personality disorders, and her childhood home environment was more secure, although her parents were distant. She was more open to the therapist than the poor-outcome patient was. This article illustrates that different people require different techniques even though they belong to the same group (low QOR) that, in the FEST study, did well with TI.

• Ness, Elisabeth; Dahl, Hanne-Sofie Johnsen; Critchfield, Kenneth L. & Ulberg, Randi (2018). Exploring In-Session Process with Qualitative and Quantitative Methods in Psychotherapy with an Adolescent. Journal of Infant, Child, and Adolescent Psychotherapy (JICAP). ISSN 1528-9168. 17(4), p. 310–327. doi: 10.1080/15289168.2018.1526021. Full text in Research Archive
• Ulberg, Randi; Dahl, Hanne-Sofie Johnsen; Amlo, Svein; Blayvas, Phelix & Høglend, Per Andreas (2018). Psykodynamisk kartlegging av ungdom og voksne ved hjelp av semistrukturert intervju og funksjonsskalaer. Mellanrummet: Nordisk tidskrift för barn- och ungdomspsykoterapi. Full text in Research Archive Show summary

  Få redskaper finnes for å kartlegge og evaluere dynamisk endring i forbindelse med psykodynamisk terapi. Psykodynamiske funksjonsskalaer (PFS) er revidert og oversatt til norsk. Basert på et psykodynamisk intervju er skalaene egnet for kartlegging av dynamisk fingering hos ungdom og voksne. I denne artikkelen presenteres en revidert versjon av PFS som er oversatt fra engelsk til norsk. En guide for det semistrukturerte intervjuet er også inkludert.

• Ness, Elisabeth; Dahl, Hanne-Sofie Johnsen; Tallberg, Björn Peter Urban; Amlo, Svein; Høglend, Per Andreas & Thorén, Agnetha [Show all 8 contributors for this article] (2018). Assessment of dynamic change in psychotherapy with asdolescents. Child and Adolescent Psychiatry and Mental Health (CAPMH). 12:39, p. 1–11. doi: 10.1186/s13034-018-0246-z. Full text in Research Archive Show summary

  Background Diagnostic interviews and questionnaires are commonly used in the assessment of adolescents referred to child and adolescent mental health services. Many of these rating scales are constructed for adults and focus on symptoms related to diagnosis. Psychodynamic Functioning Scales (PFS) focus on relational aspects and how the patients handle affects and solve problems, rather than manifest symptoms. As these aspects are considered important for mental health, the PFS were developed to assess change in adults, consistent with the relational and intrapsychic concepts of dynamic psychotherapy. The scales describe internal predispositions and psychological resources that can be mobilized to achieve adaptive functioning and life satisfaction. PFS consist of six subscales; the relational subscales Family, Friends and Romantic/Sexual relationships and the dynamic subscales Tolerance for Affects, Insight and Problem-solving Capacity. PFS has been used for the first time as a measure of change in adolescent psychotherapy. This study examines the reliability of PFS when used to assess adolescents’ level of relational functioning, affective tolerance, insight, and problem-solving capacities. Methods Outpatient adolescents 16–18 years old with a major depressive disorder were included in the First Experimental Study of Transference work in Teenagers (FEST-IT). They were evaluated before and after time-limited psychodynamic psychotherapy with an audio-recorded semi-structured psychodynamic interview. Based on the audio-tapes, raters with different clinical background rated all the available interviews at pre-treatment (n = 66) and post-treatment (n = 30) using PFS. Interrater reliability, the reliability of change ratings and the discriminability from general symptoms were calculated in SPSS. Results The interrater reliability was on average good on the relational subscales and fair to good on the dynamic subscales. All pre-post changes were significant, and the analyses indicated discriminability from general symptoms. The interrater reliability on PFS (mean) and Global Assessment of Functioning were good to excellent. Conclusion Based on the interrater reliability in our study, PFS could be recommended in psychotherapy with adolescents by experienced clinicians without extensive training. From the post-treatment evaluations available, the scales seem to capture statistically and clinically significant changes. However, the interrater reliability on dynamic subscales indicates that subscales of PFS might be considered revised or adjusted for adolescents. Trial registration First Experimental Study of Transference-Work-In Teenagers (2011/1424 FEST-IT). ClinicalTrials.gov Identifier: NCT01531101

• Ulberg, Randi; Amlo, Svein; Dahl, Hanne-Sofie Johnsen & Høglend, Per Andreas (2017). Does Insight Mediate Treatment and Enhance Outcome? Psychoanalytic inquiry. ISSN 0735-1690. 37(3), p. 140–152. doi: 10.1080/07351690.2017.1285184. Full text in Research Archive Show summary

  According to psychoanalytic and psychodynamic theory, insight is an important mechanism which may lead to better interpersonal functioning. In the present paper we have summarized empirical studies attempting to shed some light on insight as a putative mediator of treatment effects. Two case examples illustrate how improved insight might lead to clinical change.

• Dahl, Hanne-Sofie Johnsen; Ulberg, Randi; Marble, Alice Ruth; Gabbard, Glen O.; Røssberg, Jan Ivar & Høglend, Per Andreas (2017). Beyond the Statistics: A Case Comparison Study of Victor and Tim. Psychoanalytic psychology. ISSN 0736-9735. 34(4), p. 461–477. doi: 10.1037/pap0000085. Full text in Research Archive
• Dahl, Hanne Sofie Johnsen; Høglend, Per Andreas; Ulberg, Randi; Amlo, Svein; Gabbard, Glen O. & Perry, John Christopher [Show all 7 contributors for this article] (2017). Does Therapists' Disengaged Feelings Influence the Effect of Transference Work? A Study on Countertransference. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 24(2), p. 462–474. doi: 10.1002/cpp.2015. Full text in Research Archive
• Korsgaard, Hans Ole; Torgersen, Svenn; Wentzel-Larsen, Tore & Ulberg, Randi (2016). Substance abuse and personality disorder comorbidity in adolescent outpatients: are girls more severely ill than boys? Child and Adolescent Psychiatry and Mental Health (CAPMH). 10:8(8), p. 1–9. doi: 10.1186/s13034-016-0096-5. Full text in Research Archive Show summary

  Background Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender. Methods The sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality. Results 18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD. Conclusions We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.

• Ulberg, Randi; Ness, Elisabeth; Dahl, Hanne-Sofie Johnsen; Høglend, Per Andreas; Critchfield, Kenneth L. & Blayvas, Phelix [Show all 7 contributors for this article] (2016). Relational interventions in psychotherapy: development of a therapy process rating scale. BMC Psychiatry. 16(310). doi: 10.1186/s12888-016-1021-4. Full text in Research Archive Show summary

  Background In psychodynamic psychotherapy, one of the therapists’ techniques is to intervene on and encourage exploration of the patients’ relationships with other people. The impact of these interventions and the response from the patient are probably dependent on certain characteristics of the context in which the interventions are given and the interventions themselves. To identify and analyze in-session effects of therapists’ techniques, process scales are used. The aim of the present study was to develop a simple, not resource consuming rating tool for in-session process to be used when therapists’ interventions focus on the patients’ relationships outside therapy. Methods The present study describes the development and use of a therapy process rating scale, the Relational Work Scale (RWS). The scale was constructed to identify, categorize and explore therapist interventions that focus on the patient’s relationships to family, friends, and colleges Relational Interventions and explore the impact on the in-session process. RWS was developed with sub scales rating timing, content, and valence of the relational interventions, as well as response from the patient. For the inter-rater reliability analyzes, transcribed segments (10 min) from 20 different patients were scored with RWS by two independent raters. Two clinical vignettes of relational work are included in the paper as examples of how to rate transcripts from therapy sessions with RWS. Results The inter-rater agreement on the RWS items was good to excellent. Conclusion Relational Work Scale might be a potentially useful tool to identify relational interventions as well as explore the interaction of timing, category, and valence of relational work in psychotherapies. The therapist’s interventions on the patient’s relationships with people outside therapy and the following patient-therapist interaction might be explored. Trial registration First Experimental Study of Transference-interpretations (FEST307/95) Registration number: ClinicalTrials.gov Identifier: NCT00423462 .

• Korsgaard, Hans Ole; Torgersen, Svenn; Wentzel-Larsen, Tore & Ulberg, Randi (2016). Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD. BMC Psychiatry. 16:175, p. 1–10. doi: 10.1186/s12888-016-0871-0. Full text in Research Archive Show summary

  Background Attention deficit hyperactivity disorder (ADHD) is a lifelong condition which carries great cost to society and has an extensive comorbidity. It has been assumed that ADHD is 2 to 5 times more frequent in boys than in girls. Several studies have suggested developmental trajectories that link ADHD and certain personality disorders. The present study investigated the prevalence of ADHD, common Axis I disorders, and their gender differences in a sample of adolescent outpatients. We also wanted to investigate the relationship between ADHD and personality disorders (PDs), as well as how this relationship was influenced by adjustment for Axis I disorders, age and gender. Methods We used a sample consisting of 153 adolescents, aged 14 to 17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. ADHD, conduct disorder (CD) and other Axis I conditions were assessed using the Mini International Neuropsychiatric Interview (MINI). PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV). Results 13.7 % of the adolescents met diagnostic criteria for ADHD, with no significant gender difference. 21.6 % had at least one PD, 17.6 % had CD, and 4.6 % had both ADHD and a PD. There was a significantly elevated number of PD symptoms in adolescents with an ADHD diagnosis (p = 0.001), and this relationship was not significantly weakened when adjusted for age, gender and other Axis I disorders (p = 0.026). Antisocial (χ 2 = 21.18, p = 0.002) and borderline (χ 2 = 6.15, p = 0.042) PDs were significantly more frequent in girls than in boys with ADHD. Conclusions We found no significant gender difference in the prevalence of ADHD in a sample of adolescents referred to a general mental health outpatient clinic. Adolescent girls with ADHD had more PDs than boys, with antisocial and borderline PDs significantly different. The present study suggests that ADHD in girls in a general outpatient population may be more prevalent than previously assumed. It especially highlights the importance of assessing antisocial and borderline personality pathology in adolescent girls presenting with ADHD symptoms.

• Lorentzen, Steinar; Fjeldstad, Anette; Ruud, Torleif; Marble, Alice Ruth; Klungsøyr, Ole & ULBERG, RANDI [Show all 7 contributors for this article] (2015). The Effectiveness of Short- and Long-Term Psychodynamic Group Psychotherapy on Self-Concept: Three Years Follow-Up of a Randomized Clinical Trial. International journal of group psychotherapy. ISSN 0020-7284. 65(3), p. 362–85. doi: 10.1521/ijgp.2015.65.3.362. Full text in Research Archive
• Korsgaard, Hans Ole; Torgersen, Svenn; Wentzel-Larsen, Tore & ULBERG, RANDI (2015). The Relationship between Personality Disorders and Quality of Life in Adolescent Outpatients. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. 3(3), p. 180–189. doi: 10.21307/sjcapp-2015-018. Full text in Research Archive Show summary

  Background: During recent years, there has been an increasing focus on the benefits of the early detection and treatment of personality disorders in adolescents. Previous studies of adults have shown that the number of personality disorder criteria met is negatively correlated with a patient’s quality of life and general functioning. Objective: The aim of the present study was to investigate the prevalence of personality disorders, particularly with regard to the correlation between the number of personality disorder criteria fulfilled and self-perceived quality of life. Distribution according to gender and age in a clinical sample of adolescent outpatients were also considered. Method: This study included 153 adolescents between the ages of 14 and 17 years who were referred to a mental health outpatient clinic. Personality disorders were assessed using the Structured Interview for DSM-IV Personality. Quality of life was assessed using the Youth Quality of Life Instrument - Research Version, which is a 41-item questionnaire that covers broad aspects of quality of life. Axis I disorders were assessed using the Mini International Neuropsychiatric Interview. Results: Results demonstrated that 21.6% of the adolescents met the diagnostic criteria for at least one personality disorder. A relationship between the number of personality disorder criteria met and reduced quality of life was found. No significant gender differences with regard to the prevalence of each of the personality disorders were revealed. Adjustment for the presence of Axis I disorders did not appreciably affect these findings Conclusion: The present study indicates that reduced quality of life as a result of the number of personality disorder criteria met affects adolescents in much the same way that it does adults. This further emphasizes the clinical importance of including quality of life assessment as part of the general diagnostic procedures used with adolescents.

• Hersoug, Anne Grete; ULBERG, RANDI & Høglend, Per Andreas (2014). When Is Transference Work Useful in Psychodynamic Psychotherapy? Main Results of the First Experimental Study of Transference Work (FEST). Contemporary psychoanalysis. ISSN 0010-7530. 50(1-2), p. 156–174. doi: 10.1080/00107530.2014.880314. Full text in Research Archive
• Dahl, Hanne Sofie; Røssberg, Jan Ivar; Crits-Christoph, Paul; Gabbard, Glen O.; Hersoug, Anne Grete & Perry, John Christopher [Show all 8 contributors for this article] (2014). Long-term effects of analysis of the patient-therapist relationship in the context of patients' personality pathology and therapists' parental feelings. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. 82(3), p. 460–471. doi: 10.1037/a0036410. Full text in Research Archive
• ULBERG, RANDI; Buran, Taran Nærdal; Eide, Trine Klokseth; Hersoug, Anne Grete; Johannessen, Heidi & Klavenes, Kari Hasaas [Show all 10 contributors for this article] (2014). Følelser i møte med ungdommer. Mellanrummet: Nordisk tidskrift för barn- och ungdomspsykoterapi. p. 48–53. Full text in Research Archive
• ULBERG, RANDI (2014). Konferanserapport:Fokus på psykoterapi med barn og ungdom på årets internasjonale konferanse i Society of Psychotherapy Research (SPR). Mellanrummet: Nordisk tidskrift för barn- och ungdomspsykoterapi. p. 92–93. Full text in Research Archive
• ULBERG, RANDI; Amlo, Svein & Høglend, Per Andreas (2014). Manual for transference work scale; a micro-analytical tool for therapy process analyses. BMC Psychiatry. 14(1). doi: 10.1186/s12888-014-0291-y. Full text in Research Archive Show summary

  Background The present paper is a manual for the Transference Work Scale (TWS). The inter-rater agreement on the 26 TWS items was good to excellent and previously published. TWS is a therapy process rating scale focusing on Transference Work (TW) (i.e. analysis of the patient-therapist relationship). TW is considered a core active ingredient in dynamic psychotherapy. Adequate process scales are needed to identify and analyze in-session effects of therapist techniques in psychodynamic psychotherapy and empirically establish their links to outcome. TWS was constructed to identify and categorize relational (transference) interventions, and explore the in-session impact of analysis of the patient-therapist relationship (transference work). TWS has sub scales that rate timing, content, and valence of the transference interventions, as well as response from the patient. Methods Descriptions and elaborations of the items in TWS are provided. Clinical examples of transference work from the First Experimental Study of Transference Interpretations (FEST) are included and followed by examples of how to rate transcripts from therapy sessions with TWS. Results The present manual describes in detail the rating procedure when using Transference Work Scale. Ratings are illustrated with clinical examples from FEST. Conclusion TWS might be a potentially useful tool to explore the interaction of timing, category, and valence of transference work in predicting in-session patient response as well as treatment outcome. TWS might prove especially suitable for intensive case studies combining quantitative and narrative data. Trial registry name First Experimental Study of Transference-interpretations (FEST307/95). Registration number: ClinicalTrials.gov Identifier: NCT00423462 . URL: http://clinicaltrials.gov/ct2/show/NCT00423462?term=FEST&rank=2 .

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• Pietrabissa, Giada; Scmidt, Stefanie Julia; Loefler-Statska, Henriette & Ulberg, Randi (2022). Individualized Psychotherapy Treatment of Young People with Mental Disorders. Frontiers in Psychology. ISBN 9782889743483. 155 p. doi: 10.3389/978-2-88974-348-3. Full text in Research Archive Show summary

  Fifty percent of lifetime mental health disorders start by the age of 14, and the number increases to 75% by the age of 24. Mental disorders in youth are associated with direct and indirect costs including personal distress, costs to family and friends, high healthcare costs, barriers to employment and job performance, poverty, economic deprivation, and social exclusion. However, only a minority of young people suffering from mental health problems seek help and receive adequate treatment. Further, the average patient treatment adherence rate is below 50%. Young people with chronic conditions are especially at risk of developing multi-morbidities, which include psychiatric conditions and dysfunctional beliefs overlapping with the illness. Over the course of the disease, more significant parts of their lives are perceived as being dominated by the disease, diminishing young people' sense of agency and control. To minimize these effects, continuous contact and interactions with healthcare professionals would be necessary. Further, training efforts undertaken by professionals must be focused. This is not feasible in current healthcare systems due to limited financial and personnel resources. The SARS-CoV-2 pandemic has further aggravated these problems, and patient-centered care has become even more challenging. Alternative approaches to maintaining contact with patients has become essential. There is a need for coordinated and multidisciplinary efforts to improve knowledge of individualized psychological treatment for young people. While different psychotherapy modalities are effective for the most frequently occurring mental disorders in young people (e.g., anxiety and depression), little is known about how and for whom the different treatment modalities work. This requires studying both the mechanisms of change (mediators) and the specific patient, therapist, and intervention variables (moderators). The Research Topic is therefore aimed at reviewing and identifying the state of the art in individualized psychotherapy treatment for young people with mental disorders. Further, we aim to identify putative markers and mechanisms of change in different psychotherapy modalities, as well as suitable psychotherapy processes, treatment measures, and study designs. Overall, we invite researchers to offer a basis for personalized psychotherapy that provides holding, reflecting, and containment of painful affects over the long term. Further, it is our hope that this basis would enhance unconscious learning and lead to enduring change. Conceptual analyses, Systematic Reviews, Case Reports and cohort studies are welcome. Additional themes of interest include (but are not limited to): - Building up the essential parameters or technical devices that should be considered before starting a process of care; - Projects with patient/public involvement (PPI); - Projects utilizing deep learning approaches; - The effects and applications of strategies and approaches with a fusion of psychotherapeutic and neuroscientific concepts; - Technology to improve adherence to transformation processes; - Suitable psychotherapy process and treatment measures; - Study designs as a tool for better individualization.

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• Ulberg, Randi; Wilberg, Theresa; Dammen, Toril; Evensen, Julie Horgen; Osnes, Kåre & Røssberg, Jan Ivar (2026). Psykoterapi må ha en sentral plass i psykiatrien. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. Full text in Research Archive Show summary

  For at pasientene skal få persontilpasset behandling, er det viktig at psykiatere er oppdaterte innen nevrobiologi og medisinering, men også har psykoterapeutisk kompetanse. Derfor må spesialisthelsetjenesten ha organisatoriske rammer for å legge til rette for videreutdannelse, i de evidensbaserte og velutviklede psykoterapeutiske metodene som inngår i spesialistutdanningene i BUP og VOP.

• Ulberg, Randi (2022). Eksamen som læringsarena. 142(11). doi: 10.4045/tidsskr.22.0489. Full text in Research Archive
• Pietrabissa, Giada; Schmidt, Stefanie Julia; Loeffler-Stastka, Henriette & Ulberg, Randi (2022). Editorial: Individualized Psychotherapy Treatment of Young People With Mental Disorders. Frontiers in Psychology. 13. doi: 10.3389/fpsyg.2022.838296. Full text in Research Archive
• Conejo-Cerón, Sonia; Taubner, Svenja; Heinonen, Erkki; Adler, Asta; Barkauskiene, Rasa & Giacomo, Dina Di [Show all 21 contributors for this article] (2021). Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review. Frontiers in Psychology. 12, p. 1–7. doi: 10.3389/fpsyg.2021.708436. Full text in Research Archive Show summary

  Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with depression and/or anxiety and that have examined mediators of psychological treatments. A group of 20 reviewers from the COST-Action TREATme (CA16102) divided into 10 pairs independently screen studies for inclusion, extract information from the included studies, and assess the methodological quality of the included studies and the requirements for mediators. The methodological quality will be assessed by The Mixed Methods Appraisal Tool. Extracted data from the included studies will be collected and presented using a narrative approach. Discussion This systematic review will summarize and provide a comprehensive overview of the current evidence on mediators of psychological treatments for anxiety and depression for adolescents and young adults. Results will allow the identification of strategies to optimize intervention to enhance clinical outcomes. Ethics and dissemination Ethics approval is not required. Findings from this systematic review will be published in a peer-reviewed journal and disseminated at conferences and meetings. PROSPERO registration number: CRD42021234641.

• Camilleri, Nigel; Saliba, Andrea; Vosousoura, Eleni; Prevendar, Tamara; Löffler-Statska, Henriette & Fondcar, D Vella [Show all 14 contributors for this article] (2020). Evidence- based psychotherapeutic interventions for young people with mental disorders: a systematic review. Full text in Research Archive Show summary

  Introduction: Young People (YP) with mental disorders have the highest rates of long-term morbidity and mortality. Mental disorders increase markably in young adulthood: 75% of mental disorders emerge before the age of 25 years but less than half of YP receive appropriate treatment. Recognizing this public health concern, the European Cooperation in Science and Technology (COST) funded the “European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders” (TREATme). Objectives: To conduct systematic literature reviews elucidating the efficacy of psychotherapeutic interventions for YP diagnosed with mental disorders Methods: Systematic reviews on treatment outcomes for psychotherapeutic interventions targeting specific disorders were performed as part of a larger study. Search strings were created for each disorder group and used in Pubmed and PsychInfo databases followingPRISMAguidelines.Inclusionandexclusioncriteriawere createdfollowingthePICOSmodel.Identifiedpaperswereratedby two independent raters per disorder and the final selection made after consensus was reached. Results: Searches identified 14,021 studies on 9 different mental disorders, duplicates removed n=9980. A total of 332 ASD studies identified,15 clinical trials chosen from full text selection criteria, ADHD 497 studies, selected n=14, Substance misuse of 2136 studies, 185 were selected, CD 1381, 27 selected, Table 1. The preliminary results from 4 systematic reviews will be presented and discussed. Conclusions: The findings inform which psychotherapeutic interventionshavestrongestevidenceonbeingeffectiveforthesemental disorders in YP. Conflict of interest: No Keywords young people; mental disorders; psychotherapy; Systematic Review

• Camilleri, Nigel; Saliba, Andrea; Vosousoura, Eleni; Prevendar, Tamara; Löffler-Statska, Henriette & Fondcar, D Vella [Show all 14 contributors for this article] (2020). Evidence- based psychotherapeutic interventions for youngpeople with mental disorders:asystematicreview. European psychiatry. ISSN 0924-9338. doi: 10.1192/j.eurpsy.2020.5. Full text in Research Archive Show summary

  EPP0960 Evidence- based psychotherapeutic interventions for youngpeoplewithmentaldisorders:asystematicreview N. Camilleri1*, A. Saliba1, E. Vousoura2, T. Prevender3, H. LöfflerStastka4, E. Saliba1, D. Vella Fondcaro1, R. Sacco5, S. MarkovskaSimoska6,4, Hochgerner4, B. Tudor Tulbure7, L.-J. Garcia-Lopez8, R. Ulberg9, S. Poulsen10 and V. Gergov11 1MentalHealthMalta,ChildandAdolescentPsychiatry,Attard,Malta; 2University of Athens, Psychology, Athens, Greece; 3Sigmund Freud University, Psychology, Vienna, Austria; 4Medical University, Psychiatry, Vienna, Austria; 5Mental Health Services, Psychiatry, Attard, Malta; 6Academy of Sciences and Arts of North Macedonia, Psychology, Skopje, Serbia and Montenegro; 7western university of Timsauri, Psychology, Timisauri, Romania; 8UNIVERSITY OF JAEN, DEPARTAMENT OF PSYCHOLOGY, Psychology, Madrid, Spain; 9InstituteofClinicalMedicine,UniversityofOslo,Norway,Psychiatry, Oslo, Norway; 10Department of Psychology, University of Copenhagen, Denmark, Psychology, Copenhagen, Denmark and 11University of Helsinki, Finland, Psychology, Helsinki, Finland *Corresponding author. Introduction: Young People (YP) with mental disorders have the highest rates of long-term morbidity and mortality. Mental disorders increase markably in young adulthood: 75% of mental disorders emerge before the age of 25 years but less than half of YP receive appropriate treatment. Recognizing this public health concern, the European Cooperation in Science and Technology (COST) funded the “European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders” (TREATme). Objectives: To conduct systematic literature reviews elucidating the efficacy of psychotherapeutic interventions for YP diagnosed with mental disorders Methods: Systematic reviews on treatment outcomes for psychotherapeutic interventions targeting specific disorders were performed as part of a larger study. Search strings were created for each disorder group and used in Pubmed and PsychInfo databases followingPRISMAguidelines.Inclusionandexclusioncriteriawere createdfollowingthePICOSmodel.Identifiedpaperswereratedby two independent raters per disorder and the final selection made after consensus was reached. Results: Searches identified 14,021 studies on 9 different mental disorders, duplicates removed n=9980. A total of 332 ASD studies identified,15 clinical trials chosen from full text selection criteria, ADHD 497 studies, selected n=14, Substance misuse of 2136 studies, 185 were selected, CD 1381, 27 selected, Table 1. The preliminary results from 4 systematic reviews will be presented and discussed. Conclusions: The findings inform which psychotherapeutic interventionshavestrongestevidenceonbeingeffectiveforthesemental disorders in YP. Conflict of interest: No Keywords young people; mental disorders; psychotherapy; Systematic Review

• Sacco, R; Camilleri, Nigel; Saliba, E; Vousoura, Eleni; Saliba, Andrea & Fondcaro, D Vella [Show all 18 contributors for this article] (2020). Evidence-based psychotherapeutic interventions for young people with substance use disorders: a systematic literature review. Full text in Research Archive Show summary

  Introduction: Substance use disorders (SUD) are a global problem with many health and economic consequences, impacting the user, the mental health system and society at large. Over half of SUD problems begin during adolescence. Treatment approaches and effective management frequently involve psychotherapeutic interventions, which prevents long term morbidity and mortality. Recognizing this public health concern and the need for more empirical based knowledge, the European Cooperation in Science and Technology (COST) funded the ‘European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders’ (TREATme). Objectives: As part of the aims of TREATme, in this particular study a systematic review of the published literature was conducted to determine the effectiveness of specific psychotherapeutic interventions (PI) in young people (YP) with SUDs. Methods: A systematic review on psychotherapeutic treatment outcomes for specific SUDs in YP was performed. Systematic literature searches were conducted in PubMed and PsycINFO following the PRISMA guidelines, and inclusion and exclusion criteria were created following PICOS model. Two independent raters carried out the ratings of the papers and final selection was made based on the inclusion criteria after reading the full texts and reaching consensus between two autonomous raters. Results: The systemic search generated 2135 papers, of which 577 were included for full-text review following exclusion by title and abstract. A consensus was reached that 212 papers met the inclusion criteria. Conclusions: The findings from this systematic literature review advise which PI may be most effective for each SUD in YP based on research evidence. Conflict of interest: No Keywords

• Sacco, R; Camilleri, Nigel; Saliba, E; Vousoura, Eleni; Saliba, Andrea & Fondcaro, D Vella [Show all 18 contributors for this article] (2020). Evidence-based psychotherapeutic interventions for young people with substance use disorders: a systematic literature review. European psychiatry. ISSN 0924-9338. Full text in Research Archive Show summary

  Introduction: Substance use disorders (SUD) are a global problem with many health and economic consequences, impacting the user, the mental health system and society at large. Over half of SUD problems begin during adolescence. Treatment approaches and effective management frequently involve psychotherapeutic interventions, which prevents long term morbidity and mortality. Recognizing this public health concern and the need for more empirical based knowledge, the European Cooperation in Science and Technology (COST) funded the ‘European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders’ (TREATme). Objectives: As part of the aims of TREATme, in this particular study a systematic review of the published literature was conducted to determine the effectiveness of specific psychotherapeutic interventions (PI) in young people (YP) with SUDs. Methods: A systematic review on psychotherapeutic treatment outcomes for specific SUDs in YP was performed. Systematic literature searches were conducted in PubMed and PsycINFO following the PRISMA guidelines, and inclusion and exclusion criteria were created following PICOS model. Two independent raters carried out the ratings of the papers and final selection was made based on the inclusion criteria after reading the full texts and reaching consensus between two autonomous raters. Results: The systemic search generated 2135 papers, of which 577 were included for full-text review following exclusion by title and abstract. A consensus was reached that 212 papers met the inclusion criteria. Conclusions: The findings from this systematic literature review advise which PI may be most effective for each SUD in YP based on research evidence. Conflict of interest: No Keywords

• Mechler, Jakob; Lindqvist, Karin; Carlbring, Per; Lilliengren, Peter; Falkenström, Fredrik & Andersson, Gerhard [Show all 16 contributors for this article] (2020). Internet-based psychodynamic versus cognitive behaviour therapy for adolescents with depression: Study protocol for a non-inferiority randomized controlled trial (the ERiCA study). Trials. 21(1). doi: 10.1186/s13063-020-04491-z. Full text in Research Archive Show summary

  Background Adolescent depression is a common mental health problem and there is an urgent need for effective and accessible treatments. Internet-based interventions solve many obstacles for seeking and receiving treatment, thus increasing access to effective treatments. Internet-based cognitive behavioural therapy (ICBT) for adolescent depression has demonstrated efficacy in previous trials. In order to broaden the range of evidence-based treatments for young people, we evaluated a newly developed affect-focused Internet-based psychodynamic treatment (IPDT) in a previous study with promising results. The purpose of the planned study is to evaluate the efficacy of IPDT for adolescent depression in a non-inferiority trial, comparing it to ICBT. Methods The study will employ a parallel randomized non-inferiority design (ratio 1:1; n = 270). Eligible participants are adolescents 15–19 years suffering from depression. The primary hypothesis is that IPDT will be non-inferior to ICBT in reducing depressive symptoms from pre-treatment to end of treatment. Secondary research questions include comparing outcomes of IPDT and ICBT regarding anxiety symptoms, emotion regulation and self-compassion. Additional data will be collected to evaluate cost-effectiveness as well as investigating predictors, moderators and mediators of outcome. In addition, we will examine long-term outcome up to 1 year after end of treatment. Diagnostic interviews with MINI 7.0 will be used to establish primary diagnosis of depression as well as ruling out any exclusion criteria. Both treatments consist of eight modules over 10 weeks, complemented with therapist support through text messages and weekly chat sessions. Primary outcome measure is the Quick Inventory of Depressive Symptomatology in Adolescents Self-Rated (QIDS-A17-SR). Primary outcome will be analysed using data from all participants entering the study using a multilevel growth curve strategy based on the weekly measurements of QIDS-A17-SR. The non-inferiority margin is defined as d = 0.30. Discussion This trial will demonstrate whether IPDT is non-inferior to ICBT in the treatment of adolescent depression. The study might therefore broaden the range of evidence-based treatment alternatives for young people struggling with depression. Further analyses of data from this trial may increase our knowledge about “what works for whom” and the pathways of change for two distinct types of interventions. Trial registration ISRCTN12552584 , Registered on 13 August 2019.

• Fondcaro, D Vella; Vousoura, Eleni; Poulsen, Stig Bernt; Camilleri, Nigel; Saliba, Andrea & Ulberg, Randi [Show all 13 contributors for this article] (2020). Evidence-based psychotherapeutic interventions for young people with mood disorders: a systematic review. Full text in Research Archive
• Fondcaro, D Vella; Vousoura, Eleni; Poulsen, Stig Bernt; Camilleri, Nigel; Saliba, Andrea & Ulberg, Randi [Show all 13 contributors for this article] (2020). Evidence-based psychotherapeutic interventions for young people with mood disorders: a systematic review. European psychiatry. ISSN 0924-9338. Full text in Research Archive Show summary

  Introduction: Mood disorders are amongst the most common groups of mental disorders in young people (YP). Depression may affect 8-20% of all YP and may result in a cascade of negative developmentaloutcomespredictinglong-termmorbidityandpoor functioning.Inviewofthis,theCOSTaction‘EuropeanNetworkof Individualized Psychotherapy Treatment of Young People with Mental Disorders’ (TREATme) was set up to help improve mental health services in YP. Objectives: One of the overarching aims of TREATme is to carry out a systematic review to assess for the effectiveness of psychotherapeutic interventions in YP. In this study, we present results from the systematic review of treatment effectiveness of youth interventions for mood disorders. Methods: Following PRISMA guidelines, we systematically searched for clinical trials targeting mood symptoms in YP in PubMed and PsycINFO. The PICOS model was used to define inclusion and exclusion criteria. Included studies were selected by reaching consensus between six independent raters. Results: The systematic search yielded 4181 papers. The title and abstract were reviewed and a consensus was reached to accept 608papersforfull-textreview.Asperinclusioncriteria,aconsensus wasreachedtoinclude91papersintothereviewforeffectivenessof psychotherapeutic interventions in mood disorders. Conclusions: The results of this systematic review provides an overview of the current evidence base of youth psychotherapeutic interventions for mood disorders. Discussion of findings will emphasize the importance of personalizing psychotherapy treatment to target effectively mood disorders in YP. Conflict of interest: No Keywords: young people; Systematic Review; psychotherapy; Mood disorders

• Siegel, Marte Langenes; Binder, Eva Mathilde Gullestad; Dahl, Hanne-Sofie Johnsen; Czajkowski, Nikolai Olavi; Critchfield, Kenneth L. & Høglend, Per Andreas [Show all 7 contributors for this article] (2020). Erratum: Therapeutic atmosphere in psychotherapy sessions. int. j. environ. res. public health 2020, 17, 4105. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(14), p. 1–2. doi: 10.3390/ijerph17145241. Full text in Research Archive
• Marble, Alice Ruth; Høglend, Per Andreas & Ulberg, Randi (2018). Patients’ Representation of the Therapeutic Dialogue and the Outcome of Therapy. Psychotherapy and Psychosomatics. ISSN 0033-3190. p. 1–2. doi: 10.1159/000492618. Full text in Research Archive
• Ulberg, Randi & Dahl, Hanne-Sofie Johnsen (2018). Empirical support for the psychoanalytic concepts. The Lancet Psychiatry. ISSN 2215-0374. 5(7), p. 543–544. doi: 10.1016/S2215-0366(18)30208-6. Full text in Research Archive
• Dahl, Hanne-Sofie Johnsen; Calderon, Ana & Ulberg, Randi (2017). A close-up study of psychodynamic therapy process using the Adolescent Psychotherapy Q-sort and the Working Alliance Inventory. Full text in Research Archive
• Ulberg, Randi (2017). Youth psychotherapy. Full text in Research Archive
• Ulberg, Randi; Poulsen, Stig Bernt; Taubner, Svenja; Schmidt, Stefanie; Volkert, Jana & Falkenström, Fredrik (2017). How to Develop Research on Individualized Psychotherapy Treatment of Young People with Mental Disorders? Full text in Research Archive Show summary

  Aim: The structured discussion aims at encourage a dialogue among members of TREATME and SPR in Europe on the future direction in youth psychotherapy research. Method: The COST Action TREATME is aimed at establishing a sustainable European multidisciplinary researcher network focusing on individualized psychotherapy for young people with mental disorders. 50% of lifetime mental health disorders start by the age of 14, and the number increases to 75% by the age of 24. Mental disorders in youth are associated with direct and indirect costs including personal distress, costs to family and friends, high healthcare costs, barriers to employment and job performance, poverty and economic deprivation and social exclusion. The “Roadmap for Mental Health Research in Europe” concludes on the need for coordinated and multidisciplinary efforts to improve knowledge on individualized psychological treatment for young people. Psychotherapy works for the most frequent mental disorders such as anxiety and depression. Different psychotherapy modalities work on average equally well. However, little is known about how different treatment modalities work (the mechanisms of change/mediators) and for whom (moderators). Thus, empirically informed individualized treatment cannot be delivered. The panel members presents the focus of the five Working Groups in TREATME: The need for more knowledge on putative moderators and mediators (WGs 1&2), age customized measures and research designs (WGs 3&4), communication with stakeholders on what works for whom and how in youth psychotherapy. Discussion: How can psychotherapy researchers meet the European challenge on improving knowledge on individualized psychotherapy for young people? Keywords: youth psychotherapy, moderators, mediators, age customized process and treatment measures age customized study designs,

• Ulberg, Randi (2017). Dynamic mechanism, dynamic change, and the depressed adolescents’ experience of change in psychodynamic therapy. Full text in Research Archive Show summary

  Panel Title: Dynamic mechanism, dynamic change, and the depressed adolescents’ experience of change in psychodynamic therapy. Presenters: Randi Ulberg (Moderator), Elisabeth Ness, Peter Tallberg and André Løvgren, University of Oslo Discussant: eleni.vousoura, Greece. The First Experimental Study of Transference Work–In Teenagers (FEST–IT) is a randomized clinical trial with a dismantling design. The study is aimed to explore the effects of transference work in psychodynamic psychotherapy for adolescents with depression. 70 patients aged 16 to 18 years are randomized to one of two treatment groups with or without focus on transference work. Three papers from FEST-IT will be presented. The first paper focuses on case formulations exploring the dynamic mechanisms using a structured guideline for case formulations. The second presentation investigates whether it is possible to measure dynamic change during therapy using an assessment tool, the Psychodynamic Functioning Scales (PFS), originally developed for adults. The third presentation is a qualitative study on how the young patients experienced psychodynamic psychotherapy.

• Tallberg, Björn Peter Urban; Ulberg, Randi & Ness, Elisabeth (2017). Structured case formulations in a study on adolescent psychotherapy. Full text in Research Archive
• Løvgren, André; Nilsen, Liv; Engebretsen, Eivind; Røssberg, Jan Ivar & Ulberg, Randi (2017). Adolescents’ experience of change in psychodynamic therapy; a qualitative study. Full text in Research Archive Show summary

  Aim: There is an emerging empirical support for the effect of psychodynamic psychotherapy in adolescents. However, there is lack of knowledge in how psychodynamic therapy works for depressed adolescents, how they experience the therapy process and the factors contributing to positive change. Little is known when it comes to adolescent patients’ own experiences of what they found helpful and leading to less symptoms and better interpersonal relationships. The aim of this study was to explore what adolescents themselves recognised as helpful during therapy. Method: An interview guide was developed, focusing on the experiences of the therapy process from the adolescents’ point of view, and what they after treatment identified as helpful factors. Main topics were on how therapy was experienced, what within therapy was helpful – or not so helpful, and how therapy affected important relations and areas in the adolescents’ everyday life. Explorative, semi-structured interviews were conducted with nine, female adolescents. The interviews lasted for approximately one hour, was audio recorded and transcribed verbatim. The transcripts were analysed with thematic content analysis, looking for similarities and differences among the adolescents’ utterances. Results: During the analysis of the transcribed interviews, thematic areas emerged. They were categorised in three main groups with several sub themes. The main areas were Exploring of self, Relational work, and Time. Discussion: Categories and themes will be presented and discussed. Keywords: Psychotherapy change, adolescent depression, patients’ perspective.

• Ulberg, Randi (2016). Psykoterapiveiledningspedagogikk, BUP. Full text in Research Archive
• Ulberg, Randi (2016). Psykodynamisk terapi for ungdom grunnbegreper og kasus-illustrasjoner. Full text in Research Archive
• Ulberg, Randi (2016). Hva nytter:Empirisk grunnlag for Psykodynamisk psykoterapi. Full text in Research Archive
• Dahl, Hanne-Sofie Johnsen & Ulberg, Randi (2016). A portrait of a therapy of a young girl - A pilot study. Full text in Research Archive
• Dahl, Hanne-Sofie Johnsen; Ulberg, Randi & Høglend, Per Andreas (2016). Therapists’ Self-reported Countertransference and Patients’ Characteristics. Full text in Research Archive
• Dahl, Hanne-Sofie Johnsen & Ulberg, Randi (2016). Hvor står FEST-IT studien og prosessmålet APQ. Full text in Research Archive
• Dahl, Hanne-Sofie Johnsen; Ulberg, Randi; Friis, Svein; Perry, John Christopher & Høglend, Per Andreas (2016). Therapists' inadequate feelings and long-term effect of transference work. Psychotherapy and Psychosomatics. ISSN 0033-3190. 85(5), p. 309–310. doi: 10.1159/000444647. Full text in Research Archive
• ULBERG, RANDI (2015). Psykoterapiveiledningspedagogikk, BUP. Full text in Research Archive
• ULBERG, RANDI (2015). Forskning på psykoterapi.Hva nytter:Empirisk grunnlag for Psykodynamisk psykoterapi. Full text in Research Archive
• Ulberg, Randi (2015). ULBERG, RANDI. Psykoterapiveiledningspedagogikk, BUP. Full text in Research Archive
• Ulberg, Randi (2015). Relasjoner i arbeid med ungdom. Full text in Research Archive
• Ulberg, Randi (2015). Forskning på psykoterapi.Hva nytter:Empirisk grunnlag for Psykodynamisk psykoterapi. Full text in Research Archive
• ULBERG, RANDI (2014). Bokanmeldelse av boken "The Developmental Science of Adolescence:History Through Autobiography" Redaktør:Richard M. Lerner. Mellanrummet: Nordisk tidskrift för barn- och ungdomspsykoterapi. p. 98–99. Full text in Research Archive
• ULBERG, RANDI (2014). Forskning på psykoterapi.Hva nytter:Empirisk grunnlag for Psykodynamisk psykoterapi. Full text in Research Archive
• ULBERG, RANDI (2014). Psykoterapi med ungdom. (Forelesning hele dagen). Full text in Research Archive
• ULBERG, RANDI (2014). Forskning på psykoterapi.Hva nytter:Empirisk grunnlag for Psykodynamisk psykoterapi. Full text in Research Archive
• Amlo, Svein; Blayvas, Phelix; Høglend, Per Andreas & ULBERG, RANDI (2015). Relasjons-Intervensjoner (Extra-Transference Interventions): Kliniske eksempler fra First Experimental Study of Transference-interpretations (FEST). Universitetet i Oslo. Full text in Research Archive

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