Helene Amundsen Nissen-Lie

• Bremer, Kjetil; Pedersen, Geir; Ekberg, Daniel Gustav Andreas; Morken, Katharina Teresa Enehaug; Nissen-Lie, Helene Amundsen & Oftedal, Eileen [Show all 8 contributors for this article] (2026). Improvement of personality functioning in patients with personality disorders: a comparative study of mentalization-based treatment versus non-manualized treatments. Frontiers in Psychiatry. 17, p. 1–17. doi: 10.3389/fpsyt.2026.1831782. Full text in Research Archive
• Stige, Signe Hjelen; Rønnestad, Michael Helge; Oddli, Hanne Berit Weie; Doorn, Katie Aafjes-van; Nissen-Lie, Helene, Amundsen & Visted, Endre (2026). The clinician's helpful and hindering uncertainty scale (CHUS). Development, factor structure, and initial validation. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2026.2689630. Full text in Research Archive Show summary

  Objective The ability to tolerate incomplete knowledge, or uncertainty, is a central clinical competence, yet it is an understudied topic. The few measures of therapist uncertainty tolerance that exist require clinical experience, limiting their usefulness for tracking development through training. We present the development and initial validation of the Clinician Helpful and Hindering Uncertainty Scale (CHUS), designed for use across all stages of clinical training. Method Based on comprehensive conceptual clarification, 68 items were constructed to reflect six facets denoting attitudes toward and dealing with uncertainty. Using confirmatory factor analysis (CFA), the measure’s conceptual fit and psychometric properties were examined in a combined sample of 376 English-speaking psychotherapists and students. Construct and concurrent validity were assessed through associations with self-efficacy, intolerance of uncertainty, professional self-doubt, and coping. Qualitative interviews with 15 participants explored the potential utility of CHUS in training. Results CFA supported a 30-item, six-factor structure. Factors showed good internal consistency (McDonald’s ω = .74-.91) and expected correlations with established measures. Qualitative analyses suggested that CHUS stimulated self-reflection and was viewed as helpful for professional development. Conclusion The CHUS shows promising initial psychometric properties and may represent a useful multidimensional measure of clinical uncertainty for research and training purposes.

• Severinsen, Linda; Stiegler, Jan Reidar; Nissen-Lie, Helene Amundsen; Shahar, Ben & Zahl-Olsen, Rune (2026). The Difficulties in Emotion Regulation Scale Short Form: A Confirmatory Factor Analysis Among Parents of Children With Mental Health Disorders in Norway. Scandinavian Journal of Psychology. ISSN 0036-5564. 67(4), p. 1157–1166. doi: 10.1111/sjop.70095. Full text in Research Archive
• Rzadkowska, Joanna; Tilden, Terje; Nissen-Lie, Helene, Amundsen; Whittaker, Kristoffer James & Vrabel, Kari-Anne (2025). Financial Stress, Shame, and Dyadic Coping Among Highly Distressed Couples in Therapy: An Interpretative Phenomenological Analysis. Family Process. ISSN 0014-7370. 64(4). doi: 10.1111/famp.70080. Full text in Research Archive Show summary

  Despite the detrimental impact financial stress has on mental health and relationships, couples experiencing it remain an under‐researched group, especially in a therapy setting. In this study, we conducted interviews with 10 participants from five couples who struggled financially during residential couple treatment in Norway. The empirical material was analyzed using interpretative phenomenological analysis (IPA) to examine couples' experiences and subjective meaning‐making. The findings revealed: (a) a sense of existential threat, (b) dyadic coping strategies with advantages and costs, (c) ways in which the community of helpers both supported and hindered the families. The core finding was a pervasive sense of shame that affected how the participants perceived themselves, their relationships, and their place in society. We discuss how shame and dyadic coping can influence both the couples' relationships and their finances, and how systemic and couple therapists can contribute by highlighting positive coping strategies and directly addressing financial shame.

• Høstmælingen, Andreas Teisner; Monsen, Jon Trygve; Nissen-Lie, Helene, Amundsen & Solbakken, Ole Andre (2025). Kan bruk av antidepressiver påvirke nytten av psykologisk behandling? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. doi: https:/www.psykologtidsskriftet.no/artikkel/2025as12ae-Kan-bruk-av-antidepressiver-p-virke-nytten-av-psykologisk-behandling-. Full text in Research Archive Show summary

  Pasienter med depresjon som brukte antidepressiver, trengte lengre tid i psykoterapi og hadde mindre symptomreduksjon

• Stänicke, Erik & Nissen-Lie, Helene, Amundsen (2025). Confronting modern zeitgeist: Visions of psychoanalysis in life and mental health care, Narcissism: Psychoanalytic Clinicians and Researchers in Dialogue. Routledge. ISSN 9781032932989. doi: https:/www.routledge.com/Narcissism-Psychoanalytic-Clinicians-and-Researchers-in-Dialogue/Leuzinger-Bohleber-Hau-Lerner-Stanicke-Gullestad/p/book/9781032932972. Full text in Research Archive Show summary

  For the modern zeitgeist, with its neoliberal values that prioritize efficiency, individualism, and evidence-based treatments, psychoanalysis provides a provoking and important worldview. Psychoanalysis implies a distinct tragic vision of the human condition that serves as a correction to a culture obsessed with quick fixes and superficial solutions. Contrary to Freud’s own argument that psychoanalysis is embedded within a scientific worldview and cannot be considered a “Weltanschauung,” the authors of this chapter state that understanding the human being with unconscious motivations and vulnerabilities indeed represents a worldview (or Weltanschauung) that is more important than ever before. Roy Schafer’s four visions of reality—the comic, romantic, tragic, and ironic—are used as lenses for understanding what psychoanalysis puts on the table. Cautioning against therapeutic hubris, the therapist’s role as pressured from different angles (e.g. healthcare policies and academia), into an omnipotent position, is discussed. In line with a psychoanalytic vision, the chapter proceeds to present recent findings suggesting that an attitude of professional humility in the psychotherapist is in fact beneficial. Psychoanalysis is argued to be an invaluable perspective that challenges prevailing cultural norms and reminds us of our intrinsic vulnerability and complexity.

• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve; Heinonen, Erkki; Wampold, Bruce E. & Czajkowski, Nikolai Olavi [Show all 9 contributors for this article] (2025). Use of antidepressant medication is associated with slower response to open-ended psychotherapy for depressed patients. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1503848. Full text in Research Archive Show summary

  Objective Depressed patients often experience both symptomatic distress and interpersonal problems. Comorbid personality disorder (PD) has been shown to attenuate the benefits of psychotherapy. Also, antidepressant medication (ADM) may affect the response to psychotherapy. The objective of this study was to investigate changes in depressive symptoms and interpersonal problems for ADM users and non-medicated depressed patients during psychotherapy and follow-up, controlling for comorbid PD. Method Depressive symptoms (SCL-90-R), and interpersonal problems (IIP-64) were assessed on 11 occasions for 166 depressed patients. ADM was used by 50.6% of the sample while 49.4% were unmedicated. Change during treatment and follow-up was assessed with multilevel modeling. We assessed whether ADM and PD predicted differences in symptom development. Results Depressive symptoms significantly reduced at a rate of.05 per month in treatment ( p <.001), corresponding to an effect size of 1.35. Interpersonal problems significantly reduced at a rate of.02 per month during treatment ( p <.001), corresponding to an effect size of.47. There was no significant difference between ADM users and nonmedicated patients at baseline. ADM users had nearly twice as long treatment duration than nonmedicated patients, and ADM users had lower rate of symptom reduction than nonmedicated patients for depressive symptoms and interpersonal problems. There were no differences in rates of change between patients with and without comorbid PD. Conclusion Medicated patients may experience less response to psychotherapy in terms of depressive symptoms and interpersonal problems compared to nonmedicated patients.

• Thorpe, Christina; Steigen, Anne Mari; Nissen-Lie, Helene, Amundsen; Godtlund, Solveig Pettersen & Walderhaug, Espen (2025). Equine-Facilitated Psychotherapy as a Supplementary Treatment for Patients with Mental and/or Substance Use Disorders: An Observational Study on Treatment Outcome. Journal of Contemporary Psychotherapy. ISSN 0022-0116. doi: 10.1007/s10879-024-09660-8. Full text in Research Archive Show summary

  This study examines whether adult patients (n = 105) with mental and/or substance use disorders benefit from equinefacilitated psychotherapy (EFP)—therapy with horses—in addition to regular treatment. The study used an observational pre-post-study design with two measurement points. Treatment outcomes were measured using standardized self-report instruments reflecting psychological distress (Hopkins Symptom Checklist-10), self-efficacy (General Self-Efficacy Scale-5), quality of life (Quality of Life-5), and emotion regulation (sub-scale from the Severity Indices of Personality Problems-118). All outcome measurements found statistically significant pre-post improvements after the EFP treatment program. The f indings suggest that EFP could be a beneficial supplementary treatment for a broad range of patients with mental and/or substance use disorders. However, this observational study cannot establish causation or eliminate confounding variables.

• Nymoen, Katarina Duaas; Nissen-Lie, Helene, Amundsen; Lukasse, Mirjam & Røseth, Idun (2025). "It Resonates with Me!": How Personal Motivation Affects the Implementation of Complex Interventions. Global Implementation Research and Applications. p. 1–14. doi: 10.1007/s43477-025-00177-3. Full text in Research Archive Show summary

  Background The need for a family-based treatment for children with trauma led to the implementation of Dyadic Developmental Psychotherapy (DDP) at Child and Adolescent Mental Health Services (CAMHS) and Child Welfare Services (CWS) in Norway. This study aimed to explore clinicians’ experience with the implementation of DDP. Methodology Participants (N = 25) were followed over three years with serial focus group interviews analyzed with systematic text condensation. The data were analyzed both cross-sectionally and longitudinally, allowing for the identification of central themes both across and between groups over time. Results All the participants expressed similar initial challenges: lack of support, role clashes, the complexity of the intervention, strong feelings in the sessions, and challenges with finding the right patient. However, the implementation process unfolded into three distinct pathways, regardless of workplace (1) “It resonates with me” – where highly motivated participants reached proficiency and flexibility. (2) “Then I feel like a DDP’er after all!” – where participants with positive impressions of the intervention continued using it with the help of workplace support and leadership, and (3) “We can’t do this alone.” – where participants dropped out owing to lack of support or motivation. The personal significance that participants in pathway one attached to the intervention appeared to facilitate the implementation process. These participants expressed less need for external support and structure and were able to adapt the intervention to a variety of settings and clients. Conclusion Allowing clinicians to train in interventions that are meaningful to them may facilitate implementation and positively influence patient outcomes.

• Severinsen, Linda; Stiegler, Jan Reidar; Nissen-Lie, Helene, Amundsen; Shahar, Ben; Bertelsen, Thomas Bjerregaard & Zahl-Olsen, Rune (2025). Effectiveness of emotion-focused skills training (EFST) for parents: A randomized controlled trial investigating remission of mental health diagnosis and symptom reduction in children. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2025.2491477. Full text in Research Archive
• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve & Solbakken, Ole Andre (2025). Interrelationships of symptomatic and relational distress: Improvements in interpersonal problems predict subsequent improvement in depressive symptoms during open-ended psychotherapy for adults with depression. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. 93(6), p. 470–470. doi: 10.1037/ccp0000956. Full text in Research Archive Show summary

  Objective: Depressed patients often experience interpersonal distress. Understanding how interpersonal distress and depressive symptoms are associated may have implications for understanding the etiology and maintenance of depression, as well as for treatment. In this naturalistic psychotherapy study, we explored whether change in depressive symptoms predicted subsequent change in interpersonal distress or vice versa. Method: Depressive symptoms (depression scale of the Symptom Check List–90–Revised) and interpersonal problems (Inventory of Interpersonal Problems–64) were assessed on nine occasions, including before, during, and after treatment and at 1 and 2.5 years follow-up in a sample of 178 depressed patients receiving open-ended psychotherapy. We used latent curve modeling with structured residuals to assess possible reciprocal relations between interpersonal problems and depression, controlling for personality disorder. Results: The findings showed that interpersonal distress had a slower rate of change compared to depressive symptoms, but improvements in interpersonal distress predicted subsequent improvement in depressive symptoms during psychotherapy, and this effect was stable over time. Patients with comorbid personality disorder had higher initial levels of both depression and interpersonal distress, but there were no differences in rates of change for any of the outcomes. Conclusion: Our results indicate that improvements in interpersonal problems may play an important role in alleviating depressive symptoms during psychotherapy. We propose that reduction of interpersonal distress is associated with increased interpersonal flexibility, which may lead to more positive responses from others, thereby contributing to a reduction in depressive symptoms.

• Hoff, Cecilie Hillestad; Nissen-Lie, Helene, Amundsen & Strømme, Hanne (2024). Learning from embodied tension: A naturalistic multimodal single case study of nonverbal expressions and interactions in a psychotherapy training process. European Journal for Qualitative Research in Psychotherapy (EJQRP). 14, p. 44–61. doi: 10.24377/EJQRP.ARTICLE3102. Full text in Research Archive Show summary

  This multimodal single case study explored how nonverbal communication was handled in a psychodynamic training process. Using a multimodal qualitative method, video recordings of a 39 sessions psychodynamic therapy process (with a female therapist treating a male client with relational issues), parallel supervision sessions, and Interpersonal Process Recall interviews with the client and therapist, were analyzed within the framework of Reflexive Thematic Analysis (RTA). The analysis yielded three themes: a) The therapist’s insecurity seemed to have compromised her capacity to use her own bodily signals to facilitate the exploration of emotions together with the client; b) The therapist and the supervisor were sensitive to the nonverbal cues from the client, but supervision did not explicitly explore how the therapist could use this sensitivity to moderate her own bodily signals and inform her clinical interventions; and c) Supervision supported the therapist in tolerating embodied tension in the therapeutic relationship. This study illustrates the close relationship between therapists’ capacity for emotion regulation and their nonverbal relational skills. A more open exploration of the trainee’s emotion regulation capacities in supervision may have supported her to deal more effectively with her own and the client’s nonverbal expressions.

• Mcaleavey, Andrew Athan; Jong, Kim de; Nissen-Lie, Helene, Amundsen; Boswell, James F.; Moltu, Christian & Lutz, Wolfgang (2024). Routine Outcome Monitoring and Clinical Feedback in Psychotherapy: Recent Advances and Future Directions. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 51, p. 291–305. doi: 10.1007/s10488-024-01351-9. Full text in Research Archive Show summary

  In the past decade, there has been an increase in research related to the routine collection and active use of standardized patient data in psychotherapy. Research has increasingly focused on personalization of care to patients, clinical skills and interventions that modulate treatment outcomes, and implementation strategies, all of which appear to enhance the beneficial effects of ROM and feedback. In this article, we summarize trends and recent advances in the research on this topic and identify several essential directions for the field in the short to medium term. We anticipate a broadening of research from the focus on average effects to greater specificity around what kinds of feedback, provided at what time, to which individuals, in what settings, are most beneficial. We also propose that the field needs to focus on issues of health equity, ensuring that ROM can be a vehicle for increased wellbeing for those who need it most. The complexity of mental healthcare systems means that there may be multiple viable measurement solutions with varying costs and benefits to diverse stakeholders in different treatment contexts, and research is needed to identify the most influential components in each of these contexts.

• Bøe, Julianne Vike; Nissen-Lie, Helene, Amundsen & Wilberg, Theresa (2024). Finding a voice: A qualitative investigation of the therapeutic relationship with patients suffering from avoidant personality disorder. Counselling Psychology Quarterly. ISSN 0951-5070. doi: 10.1080/09515070.2024.2394766. Full text in Research Archive Show summary

  This study comprises in-depth qualitative analysis of transcribed audio recordings from therapy with Avoidant Personality Disorder (AvPD)-patients, with focus on the characteristics and challenges within the therapeutic relationship. The dataset comprises sixteen therapy sessions. The analysis employed Reflexive Thematic Analysisand yielded two themes: (1) Difficulties in conveying personal material and (2) How to get connected? The findings indicate that the patients struggled to share openly in sessions–often resulting in dialogues characterized by silence, lack of personal material, and a reduced sense of alliance. The silence seemed to represent a therapeutic challenge. Lack of observable ruptures made us hypothesize that the patients’ modus operandi was a detached mode. When the therapist made use of the “real relationship,” it seemed to affect the vitality and felt security of the patients. The findings indicate that these patients face difficulties expressing “a voice of their own,” posing a challenge in the relationship. To mitigate patients’ relational cautiousness and detachment, they may benefit from a therapist capable of scaffolding their efforts towards a strengthened agency and a sense of self. The risk of pseudo-alliance or subtle alliance ruptures, requires additional therapist attention and suggests that the relationship should be an explicit focus in therapy.

• Hoff, Cecilie Hillestad; Nissen-Lie, Helene, Amundsen & Strømme, Hanne (2024). Learning from embodied tension: A naturalistic multimodal single case study of nonverbal expressions and interactions in a psychotherapy training process. European Journal for Qualitative Research in Psychotherapy (EJQRP). 14. Full text in Research Archive Show summary

  This multimodal single case study explored how nonverbal communication was handled in a psychodynamic training process. Using a multimodal qualitative method, video recordings of a 39 sessions psychodynamic therapy process (with a female therapist treating a male client with relational issues), parallel supervision sessions, and Interpersonal Process Recall interviews with the client and therapist, were analyzed within the framework of Reflexive Thematic Analysis (RTA). The analysis yielded three themes: a) The therapist’s insecurity seemed to have compromised her capacity to use her own bodily signals to facilitate the exploration of emotions together with the client; b) The therapist and the supervisor were sensitive to the nonverbal cues from the client, but supervision did not explicitly explore how the therapist could use this sensitivity to moderate her own bodily signals and inform her clinical interventions; and c) Supervision supported the therapist in tolerating embodied tension in the therapeutic relationship. This study illustrates the close relationship between therapists’ capacity for emotion regulation and their nonverbal relational skills. A more open exploration of the trainee’s emotion regulation capacities in supervision may have supported her to deal more effectively with her own and the client’s nonverbal expressions.

• Bernhardt, Ida Stange; Nissen-Lie, Helene, Amundsen; Moltu, Christian & Råbu, Marit (2024). "Feeling at home" or not? A qualitative investigation into therapists' experienced congruence between their personal self and their professional role. European Journal for Qualitative Research in Psychotherapy (EJQRP). 14, p. 125–140. Full text in Research Archive Show summary

  Research suggests that conducting psychotherapy successfully involves an integration of professional and personal knowledge on the part of the psychotherapist. The concept of congruence has been used to convey an adaptive fit between the two, but less is known about how this integration is experienced by psychotherapists in their actual therapeutic work. Through in-depth interviews we aimed to explore how therapists experience their personal self as related to their professional role. Sixteen psychotherapists participated in the study, each interviewed twice. Interpretative Phenomenological Analysis yielded the superordinate theme: “Feeling at home” in one’s professional domain. Three constituent themes conveyed both congruence and dissonance between the personal and professional domains: 1) Experienced correspondence between the psychotherapist’s professional and personal selves; 2) How handling personal challenges is reflected in their work as psychotherapists; and 3) How personal issues are experienced as disruptive in relation to the psychotherapist’s professional role. The findings both consolidate and expand on the view of congruence as a predominantly useful state by adding experiential detail to recent models of therapist development. The main implication is suggested to be the need to develop and maintain an active awareness of the potential tension and/or fusion between one’s personal and professional self.

• Delgadillo, Jaime; Nissen-Lie, Helene, Amundsen; Jong, Kim De; Schröder, Thomas A. & Barkham, Michael (2024). An examination of therapists’ professional characteristics as moderators of the effect of feedback on psychological treatment outcomes. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2024.2310635. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen; Oddli, Hanne Berit Weie & Heinonen, Erkki (2024). Do therapists differ in their general effectiveness? Therapist effects and their determinants. In Leong, Frederick; Callahan, Jennifer L; Zimmerman, Jeffrey; Constantino, Michael J. & Eubanks, Catherine F. (Ed.), APA handbook of psychotherapy: Evidence-based practice, practice-based evidence, and contextual participant-driven practice, Vol. 2. American Psychological Association (APA). ISSN 9781433836749. p. 213–226. doi: 10.1037/0000354-014. Full text in Research Archive
• Tømmerås, Truls; Backer-Grøndahl, Agathe; Høstmælingen, Andreas Teisner; Laland, Hanne; Gomez, Maria & Apeland, Anett Kristin [Show all 16 contributors for this article] (2024). Study protocol for a randomized controlled trial of supportive parents – coping kids (SPARCK)—a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems. BMC Psychology. 12(1). doi: 10.1186/s40359-024-01765-y. Full text in Research Archive Show summary

  Abstract Background To meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents – coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent–child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group). Methods We describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up. Discussion The current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology. Trial registration ClinicalTrials.gov ID: NTCT05800522

• Ansar, Nadia; Nissen-Lie, Helene, Amundsen & Stiegler, Jan Reidar (2023). The effects of emotion-focused skills training on parental mental health, emotion regulation and self-efficacy: Mediating processes between parents and children. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2023.2218539. Full text in Research Archive
• Stormoen, Halvor Raddum; Nissen-Lie, Helene, Amundsen; Hoff, Cecilie Hillestad & Strømme, Hanne (2023). “Detoxification” of destructive clinical material in psychodynamic psychotherapy: A case study of how the therapists’ interpersonal skills are used in a challenging treatment case with a successful outcome. Counselling Psychology Quarterly. ISSN 0951-5070. doi: 10.1080/09515070.2023.2291199. Full text in Research Archive Show summary

  There is a need to gain more knowledge of how interpersonally skilled therapists handle demanding clinical situations to better understand therapist effects. The aim of this single-case study was to investigate how the therapist encountered challenging situations where her interpersonal skills were put to test and how her handling likely contributed to patient change. From a larger research project on learning processes, this case was selected since it was judged to be both challenging and with a good outcome. Interpretative phenomenological analysis of video-recordings of a 42 session long psychodynamic psychotherapy, was conducted. The analysis yielded one superordinate theme: The therapist “detoxifies” demanding clinical material, such as aggression and shame. Three constituent sub-themes expressed different ways in which this process took place (1: The therapist tolerates the patient’s skepticism and criticism in a non-defensive manner by focusing on the patient’s underlying feeling; 2: The therapist responds to the patient’s self-destructive behaviors in a non-judgmental and “containing” way that reduces shame; and 3: The therapist interprets the patient’s rejection as separation anxiety related to termination of the therapy). Our findings provide a more nuanced understanding on how the interpersonal skills of the therapist come into use in a specific, challenging therapy process.

• Nissen-Lie, Helene, Amundsen; Heinonen, Erkki & Delgadillo, Jaime (2023). Therapist factors. In Miller, Scott D.; Chow, Daryl; Malins, Sam & Hubble, Mark A. (Ed.), The Field Guide to Better Results: Evidence-Based Exercises to Improve Therapeutic Effectiveness. American Psychological Association (APA). ISSN 9781433837593. p. 79–107. doi: 10.1037/0000358-005. Full text in Research Archive
• Finsrud, Ingvild; Nissen-Lie, Helene, Amundsen; Ulvenes, Pål Gunnar; Vrabel, KariAnne; Melsom, Linne & Wampold, Bruce E. (2023). Emotional and Cognitive Processes in Psychotherapy Are Associated With Different Aspects of the Therapeutic Relationship. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. doi: 10.1037/ccp0000853. Full text in Research Archive Show summary

  Objective: In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors (“Confidence in the therapist” and “Confidence in the treatment”), which have been shown to impact outcomes in a clinical context. We also investigated whether these interrelationships varied across treatment orientations (i.e., cognitive or psychodynamic focused). Method: The sample consisted of 631 patients with a primary anxiety or depressive disorder who were admitted to an inpatient program and treated with psychotherapy. The data consisted of weekly measures of cognitive (i.e., “rumination”) and affective (i.e., “problems with emotional clarity”) change processes as well as scores on Confidence in the therapist and Confidence in the treatment and symptom distress. A multivariate version of the latent curve model with structured residuals was used to investigate the within-patient effects of week-to-week changes in all variables. Results: Initial analyses established that both problems with emotional clarity and rumination predicted symptom distress. Further, we found that higher Confidence in the therapist predicted higher emotional clarity (but not lower rumination) whereas higher Confidence in the treatment predicted lower rumination (but did not affect emotional clarity). Post hoc analyses found that these interrelationships varied across treatment orientation (i.e., cognitive vs. psychodynamic). Discussion: The results indicate that patients’ experience of the therapist is associated with emotional change processes, and that patients’ experience of the coherence and meaningfulness of treatment, on the other hand, is associated with cognitive change processes. Implications for clinical practice are discussed.

• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene Amundsen; Wampold, Bruce E. & Ulvenes, Pål Gunnar (2023). Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression. Psychotherapy and Psychosomatics. ISSN 0033-3190. 92(5), p. 345–345. doi: 10.1159/000533661. Full text in Research Archive Show summary

  Patients seeking psychotherapy often spend time on waitlist (WL), the effect of which is largely unknown. WL patients may forego alternative non-psychotherapeutic assistance and thus do more poorly than had they not been placed on a WL. The course of symptoms might also be influenced by use of antidepressant medication (ADM), an issue that remains unexplored in the literature. In a naturalistic setting, WL symptom change before inpatient psychotherapy (mean weeks of waiting = 22.6) was assessed in a sample (N = 313) of chronically depressed patients. The findings indicate that chronically depressed patients experience a decrease in symptoms during WL, quite likely due to treatment expectations. We discuss whether less symptom improvement for ADM users could be attributed to iatrogenic comorbidity and a higher degree of demoralization in this group.

• Finsrud, Ingvild; Nissen-Lie, Helene Amundsen; Ulvenes, Pål Gunnar; Melsom, Linne; Vrabel, KariAnne & Wampold, Bruce E. (2022). Confidence in the therapist and confidence in the treatment predict symptomatic improvement week by week in therapy: A latent curve modeling approach. Journal of Counseling Psychology. ISSN 0022-0167. doi: 10.1037/cou0000640. Full text in Research Archive Show summary

  Previous research suggests that common relationship factors are composed of two overarching factors, “Confidence in the therapist” and “Confidence in the treatment.” The aim of this naturalistic process–outcome study was to investigate the reciprocal relationships between these two constructs and patients’ symptom level across treatment. The sample consisted of 587 patients who were admitted to an inpatient program and treated with psychotherapy for a range of mental health disorders, such as chronic depression, anxiety disorders, and eating disorders. Our data consisted of weekly measures of symptomatic distress (Patient Health Questionnaire) and the common relationship factors were measured weekly using a newly developed scale. Latent curve modeling with structured residuals was used to investigate the between- and within effects of week-to-week changes in the two components as predictors of subsequent symptom level. An increase in both relationship factors predicted a decrease in subsequent levels of symptoms at the within-patient level, and the other way around, but the two relationship factors did not systematically relate to one another at the within-patient level over the course of treatment. Our findings indicate that patients’ perceptions of the therapist as a person and their appraisal of the treatment, are important, different predictors of therapeutic change. Furthermore, they support prior research demonstrating a reciprocal relationship between common relationship factors and symptomatic distress and add to existing common factor theory by exploring the role of two central relationship dimensions and using a method which examines reciprocal relationships and within-patient effects simultaneously

• Ansar, Nadia; Nissen-Lie, Helene, Amundsen; Zahl-Olsen, Rune; Bertelsen, Thomas Bjerregaard; Elliott, Robert & Stiegler, Jan-Reidar (2022). Efficacy of Emotion-Focused Parenting Programs for Children’s Internalizing and Externalizing Symptoms: A Randomized Clinical Study. Journal of Clinical Child & Adolescent Psychology. ISSN 1537-4416. 51(6), p. 923–939. doi: 10.1080/15374416.2022.2079130. Full text in Research Archive Show summary

  Objective Emotion-Focused Skills Training (EFST) is a 12-week parental program based on Emotion-Focused Therapy, developed to improve children and adolescents’ mental health problems. Methods In a randomized clinical dismantling study, including parents of 236 children and adolescents (ages 6–13, Mage 8.9, 60.6% boys, 95.8% Caucasian) with externalizing and/or internalizing problems within clinical range, we examined the efficacy of two versions of EFST: one experiential condition (n = 120) involving emotionally evocative techniques and two-chair interventions, and one psychoeducational only condition (n = 116) involving didactic teaching of emotion skills. Both groups received a 2-day group training and 6 hours of individual supervision. Outcomes were parent- and teacher-reported symptoms at baseline, posttreatment, and 4-, 8-, and 12-month follow-up. Analyses were conducted using multilevel growth curve modeling and Bayesian post hoc analysis. Results EFST showed efficacy in reducing parent-reported externalizing (b = −1.72, p < .001, d = 1.0) and internalizing (b = −1.71, p < .001, d = 0.9) symptoms, and teacher-reported externalizing (b = −.96, p < .001, d = 0.4), but not internalizing (b = −.13, p > .05, d = 0.2) symptoms. Multilevel analyses showed nonsignificant differences between conditions (all p’s > .05), although a Bayesian longitudinal sensitivity analysis indicated a better outcome for the experiential condition. Conclusion EFST showed efficacy in symptom reduction for children and adolescents with internalizing and externalizing symptoms. Outcomes were maintained over 12 months for both conditions, supporting EFST as a transdiagnostic parental approach for early intervention.

• Severinsen, Linda; Stiegler, Jan-Reidar; Nissen-Lie, Helene, Amundsen; Ben, Shahar & Zahl-Olsen, Rune (2022). Effectiveness of emotion focused skills training for parents: study protocol for a randomized controlled trial in specialist mental health care. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-04084-x. Full text in Research Archive Show summary

  Background Emotion-Focused Skills Training (EFST) is a newly developed manualized skill training program for parents to strengthen emotional bonds between parents and children and improve mental health outcomes in children. Results from several preliminary trials indicate that EFST can be quite effective, but more rigorous methods are needed to affirm the evidence of the program. The primary objective of this study is to compare the effectiveness of EFST to treatment as usual (TAU) in a Norwegian outpatient clinic for child and adolescent mental health. Additionally, the study will examine the basic theoretical assumption underlying EFST that increased parental emotional functioning predicts a decline in children’s mental health symptoms.  Method  120 patients will be randomly assigned to either EFST or TAU. The main outcome measure is the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL) scored by trained assessors administered at pretreatment and repeated after 3 months. The secondary outcome measure is the DSM-IV version of the Strength and Difficulties Questionnaire (SDQ) administered at pretreatment as well as 3, 6, and 12 months after the intervention. To examine the efficacy question, effect sizes and reliable change for each of the treatment arms will be assessed as well as symptom differences between the conditions. To examine the second aim of the study, we will examine (1) how parents relate to emotions in their children assessed by the Emotion-Related Parenting Styles (ERPS), (2) the parents’ emotion regulation capacity assessed by the Difficulties in Emotion Regulation Scale, short-form (DERS-SF), and (3) parents’ sense of self-efficacy and the strength of their relationship with the child will be assessed by the relationship with child scale (RWC) of the systemic inventory of change. Discussion This study will provide insights into the effectiveness of EFST in improving children’s mental health and the mechanisms of change responsible for the program’s effectiveness. Impotently, this study may provide information regarding whether children’s mental health issues can be alleviated through therapeutic work provided to the parents alone. Trial registration Clinical trials.gov Identifier: NCT04885036. First Posted on May 13, 2021. Trial status: In recruitment.

• Orlinsky, D. E.; Rønnestad, Michael Helge & Nissen-Lie, Helene, Amundsen (2022). Quality of life. In Orlinsky, David E. (Eds.), How Psychotherapists Live. The Personal Self and Private Life of Professional Healers. Routledge. ISSN 9781032108797. p. 82–99. Full text in Research Archive
• 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.

• Nissen-Lie, Helene, Amundsen; Orlinsky, David E. & Rønnestad, Michael Helge (2021). The Emotionally Burdened Psychotherapist: Personal and Situational Risk Factors. Professional Psychology: Research and Practice. ISSN 0735-7028. 52(5), p. 429–438. doi: 10.1037/pro0000387. Full text in Research Archive Show summary

  Objective: Psychotherapists’ experiences of emotional burdens and distress in their personal lives can compromise their professional functioning, as well as undermine their own wellbeing. To identify preventative measures, we need more knowledge about the personal and situational risk factors that contribute to therapists’ emotional burdens. Method: From a large-scale international study of psychotherapists (N = 12,036), we analyzed a scale of Personal Burdens (PB) as a criterion variable with different sets of predictors: (a) age and gender; (b) childhood family functioning (e.g., trauma/abuse; early care quality); (c) dimensions of self (as experienced in close personal relationships); (d) current work satisfaction; and (e) current life stressors (financial and health worries), examining the relative importance of these predictors. Scores on attachment avoidance and anxiety were also included (as Step 6) for a subsample (N = 1,243) which had responded to a standard measure of those dimensions. Finally, we investigated whether the association of personal self (in the full sample) and attachment dimensions (in the subsample) depended on therapist gender and age cohort (Steps 7 & 8). Results: The most salient predictors of therapists’ PB were current worries; early trauma; experiences of self in close relationships (e.g., being demanding and/or reclusive); low work satisfaction; an anxious attachment style (especially for male therapists) and younger age. The model with all predictors explained almost 30% of the variance in PB. Conclusions: Both personality-related and past and current life circumstances contributed to therapists’ emotional burdens. Implications for prevention and selfcare are suggested. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

• Ditlefsen, Ingrid Tande; Nissen-Lie, Helene Amundsen; Andenæs, Agnes; Normann-Eide, Eivind; Johansen, Merete Selsbak & Kvarstein, Elfrida Hartveit (2021). “Yes, There Is Actually Hope!”—A Qualitative Investigation of How Patients Experience Mentalization-Based Psychoeducation Tailored for Borderline Personality Disorder. Journal of psychotherapy integration. ISSN 1053-0479. 31(3), p. 257–276. doi: 10.1037/int0000243. Full text in Research Archive Show summary

  Common factors, such as the working alliance, positive expectations, and psychoeducation have been robustly related to outcome in studies of psychotherapy. As a multicomponent treatment for borderline personality disorder (BPD), Mentalization-based treatment (MBT) includes introductory group-based psychoeducation on core features of personality functioning, BPD, the treatment program and disorder-related personal management. Generally, few studies have investigated patients’ views on how psychoeducation works. This study aimed to explore their experience of the group-based psychoeducation. Twelve patients who had attended the introductory group-based psychoeducation in MBT participated. Qualitative interviews were analyzed using Interpretative Phenomenological Analysis. MBT psychoeducation was found helpful in itself and in the further treatment process. Identified experiences related to the group (feeling less ashamed, learning from others, feeling different from others), acquisition of “tools” for better personal management (the psychoeducational content; putting new knowledge into practice), preparation for longer term therapy (therapy became more trustworthy, easier to understand, felt more effective), and demanding aspects (problems with attendance or concentration). This qualitative study is the first to present patients’ own experiences of psychoeducation as part of MBT and suggests that psychoeducation is a powerful and facilitating intervention. Careful patient selection may further optimize its potential. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

• Finsrud, Ingvild; Nissen-Lie, Helene, Amundsen; Vrabel, KariAnne; Høstmælingen, Andreas; Wampold, Bruce E. & Ulvenes, Pål Gunnar (2021). It's the therapist and the treatment: The structure of common therapeutic relationship factors. Psychotherapy Research. ISSN 1050-3307. 32, p. 139–150. doi: 10.1080/10503307.2021.1916640. Full text in Research Archive
• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene Amundsen; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2021). Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 28, p. 1111–1127. doi: 10.1002/cpp.2561. Full text in Research Archive Show summary

  Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi-experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12-week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow-up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory-II (BDI-II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1-year follow-up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy.

• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene Amundsen; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2021). Do self-criticism and somatic symptoms play a key role in chronic depression? Exploring the factor structure of Beck depression inventory-II in a sample of chronically depressed inpatients. Journal of Affective Disorders. ISSN 0165-0327. 283, p. 317–324. doi: 10.1016/j.jad.2021.01.066. Full text in Research Archive Show summary

  Background: The factor structure of depression differs for different sub-samples. The purpose of this study was to explore the factor structure of Beck Depression Inventory-II in patients with chronic depression presenting for inpatient treatment. Methods: Using exploratory structural equation modeling (ESEM), we explored whether a two-factor solution or a bifactor solution provided best model fit for a sample of 377 patients. For the best fitting model stability was assessed with tests for invariance across primary diagnosis (persistent depressive disorder v. recurrent major depressive disorder), and presence of comorbidity. Results: A bifactor solution with one general factor and two specific factors provided best model fit. Invariance analyses provided support for measurement invariance and stability of the factor solution. Limitations: The naturalistic study design implies some uncertainty regarding possible systematic differences between the patients on demographic and clinical characteristics. Conclusion: The factor structure in our sample was best explained by a general depression factor, one specific factor pertaining to self-criticism, and one consisting of the somatic items fatigue, disturbance of sleep, and appetite. Clinicians could benefit from paying special attention to the subfactors identified, as these findings may have implications for treatment choice for patients with chronic depression.

• Oddli, Hanne; Mcleod, John; Nissen-Lie, Helene Amundsen; Rønnestad, Michael Helge & Halvorsen, Margrethe S. (2021). Future orientation in successful therapies: Expanding the concept of goal in the working alliance. Journal of Clinical Psychology. ISSN 0021-9762. doi: 10.1002/jclp.23108. Full text in Research Archive
• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene, Amundsen; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2021). Trajectories of change in chronic depression: Differences in self-criticism and somatic symptoms between users of antidepressants and nonmedicated patients. Journal of Counseling Psychology. ISSN 0022-0167. 69, p. 85–99. doi: 10.1037/cou0000572. Full text in Research Archive
• Nissen-Lie, Helene Amundsen; Dahl, Hanne-Sofie Johnsen & Høglend, Per Andreas (2020). Patient factors predict therapists' emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy. Psychotherapy Research. ISSN 1050-3307. 32(1), p. 3–15. doi: 10.1080/10503307.2020.1762947. Full text in Research Archive Show summary

  Objective: Recently, studies have reported systematic relationships between the therapists’ emotional response/countertransference (CT) during therapy and a variety of patient characteristics, speaking to the communicative potential of CT. Within an RCT assessing the role of transference work (TW) in psychodynamic therapy, we investigated whether therapist CT was related to patients’ pre-treatment interpersonal problems, degree of personality pathology and motivation for psychodynamic therapy. Secondly, we explored if these relationships depended on whether the therapists used TW or not in sessions. Method: One hundred outpatients were treated with psychodynamic psychotherapy (with or without TW) for one year. Their therapists’ emotional reactions after sessions (CT) were assessed with the Feeling Word Checklist-58 (FWC-58). Results: Four subscales of the FWC-58; Inadequate, Confident, Disengaged and Parental feelings were differentially predicted by patient characteristics. Some of the associations depended on treatment condition such that degree of PD pathology was associated with therapists feeling more inadequate in the non-TW-group. Patients’ motivation for treatment was associated with less disturbing CT feelings, such as Inadequate and Disengaged CT (the latter especially in the TW group), and feeling more Confident CT. Conclusion: Patient factors predict therapists’ emotional countertransference differently depending on whether therapists use transference work in psychodynamic therapy

• Bernhardt, Ida S.; Nissen-Lie, Helene Amundsen & Råbu, Marit (2020). The embodied listener: a dyadic case study of how therapist and patient reflect on the significance of therapist`s personal presence for the therapeutic change process. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2020.1808728. Full text in Research Archive Show summary

  Objective: There is a need to understand more of the dyadic processes in therapy and how the therapist’s ways of being are experienced and reflected upon by both patient and therapist. The aim of this dyadic case study was to investigate how the therapist’s personal presence was perceived by the patient and the therapist as contributing to change. Method: From a larger project on collaborative actions between patient and therapist, a dyadic case involving in-depth interviews of the therapist and patient was selected to examine the research question. Interpretative phenomenological analysis of four interviews with the therapist and one interview with the patient was conducted. Results: The analyses indicated that the therapist’s way of being, as perceived by both therapist and patient, was expressed at a superordinate level through the concept of embodied listening, which was of particular help for the patient, and influenced by the therapist’s theoretical orientation, as well as being rooted in his own personal history. Three sub-themes emerged from the analysis, each illustrating how embodied listening contributed to the therapeutic relationship and process. Our findings flesh out how the underlying phenomena of emotional attunement, presence, and genuineness are observable in therapeutic encounters.

• Bakali, Jan-Vegard; Vestbø, Hanne Sofie & Nissen-Lie, Helene Amundsen (2020). The role of attachment anxiety and avoidance for reduced interpersonal problems in training group analytic therapy. Group Dynamics. ISSN 1089-2699. doi: 10.1037/gdn0000112. Full text in Research Archive
• Nissen-Lie, Helene Amundsen; Solbakken, Ole Andre; Falkenström, Fredrik; Wampold, Bruce E.; Homqvist, Rolf & Ekeblad, Annika [Show all 7 contributors for this article] (2020). Does it make a difference to be more "on the same page"? Investigating the role of alliance convergence for outcomes in two different samples. Psychotherapy Research. ISSN 1050-3307. p. 1–17. doi: 10.1080/10503307.2020.1823030. Full text in Research Archive Show summary

  Objective: To better understand the complexity of dyadic processes, such as the mechanisms of the working alliance, researchers recommend taking advantage of innovations in data analytic procedures when studying the interactions between therapists and patients that are associated with favorable therapeutic outcomes. Inspired by a recent line of alliance research using dyadic multilevel modeling, the present study investigated the hypothesis that convergence in the patient-therapist working alliance (i.e., increased similarity in ratings of the alliance across treatment) would be associated with better outcomes. Method: Data were retrieved from two samples: 1. A randomized controlled trial for treatment resistant depression (N= 96 dyads), and 2. An archival dataset of naturalistic psychotherapies from public health care (N = 139 dyads). Multilevel growth curve analysis was employed to investigate the degree of change in session-to-session agreement of global WAI ratings between therapists and patients (i.e., alliance convergence) as a predictor of symptom reduction in the BDI-II and the SCL-90R. Results: Contrary to our expectations, alliance convergence did not predict outcome in either sample, but was negatively associated with symptom severity in Study 2. Implications for understanding the complexity of dyadic processes and alliance work in psychotherapy are discussed.

• Råbu, Marit; Mcleod, John; Haavind, Hanne; Bernhardt, Ida S.; Nissen-Lie, Helene A & Moltu, Christian (2019). How psychotherapists make use of their experiences from being a client: Lessons from a collective autoethnography. Counselling Psychology Quarterly. ISSN 0951-5070. 34(1), p. 109–128. doi: 10.1080/09515070.2019.1671319. Full text in Research Archive Show summary

  First-hand experience of being a client is regarded by many psychotherapists as making an essential contribution to professional development. Although research has not established any direct influence on client outcome, arising from therapist participation in personal therapy, qualitative studies have explored how therapists transfer learning from one context to the other. A group of six therapists-researchers engaged in a collective autoethnography in which we shared narrative accounts of our own experiences as clients. Together we covered a wide set of therapies, sought for varied purposes, and from different stages in the life-course. Different areas of learning were identified: negative experiences could strengthen own convictions for acting differently; positive experiences worked as inspiration and support; being in therapy early in life represented a significant formative experience; working through complex personal issues in therapy gave the courage to identify similar conflicts in phantasies and realities of clients. The link between having been a client and working as a therapist is a subjective, reflective process of reworking figure and ground in the search for professional sensitivity.

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• Nymoen, Katarina Duaas; Nissen-Lie, Helene, Amundsen; Lukasse, Mirjam & Røseth, Idun (2026). «Here I can share things that never should have happened”: Experiences of attachment-based family-treatment for complex trauma. Full text in Research Archive
• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve; Heinonen, Erkki; Wampold, Bruce E. & Czajkowski, Nikolai Olavi [Show all 8 contributors for this article] (2026). The Potential Impact of Antidepressant Medication on Psychotherapy Outcome for Depressed Patients. Full text in Research Archive Show summary

  Aim: Many depressed patients are already being treated with antidepressant medication (ADM) when presenting for psychotherapy. However, the potential impact of ADM on psychotherapy processes and outcome remains an unresolved issue. A large body of research indicates a combination of ADM and psychotherapy is superior to either monotherapy, but there are also indications that especially long-term use of ADM may be associated with negative consequences such as tolerance, negative side effects and iatrogenic comorbidity. The aim of this study was to investigate changes in depressive symptoms and interpersonal problems for ADM users and non-medicated depressed patients during psychotherapy and follow-up. Methods: Depressive symptoms (SCL-90-R) were assessed on 11 occasions for 166 depressed patients. ADM was used by 50.6% of the sample while 49.4% were unmedicated. Change during treatment and follow-up was assessed with multilevel modeling. We assessed whether ADM predicted differences in symptom development. Results: Depressive symptoms significantly reduced at a rate of .05 per month in treatment (p <.001), corresponding to an effect size of 1.35. There was no significant difference between ADM users and nonmedicated patients at baseline. ADM users had nearly twice as long treatment duration than nonmedicated patients, and ADM users had lower rate of symptom reduction than nonmedicated patients for depressive symptoms. Conclusions: Our results indicate medicated patients experience less response to psychotherapy than non medicated. Patients on ADM may believe that depression is primarily a biochemical condition and thus have less confidence in the potential for psychotherapy to treat depression. Also, it is possible that patients not using ADM have better access to emotions that need to be accessed and processed in psychotherapy. Iatrogenic comorbidity may thus have contributed to slower improvement for ADM users.

• Nymoen, Katarina Duaas; Lukasse, Mirjam; Nissen-Lie, Helene, Amundsen & Røseth, Idun (2025). «Det gir gjenklang!». Full text in Research Archive
• Bernhardt, Ida Stange; Nissen-Lie, Helene, Amundsen & Råbu, Marit (2025). Vi forsket ikke på karakteranalyse. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 10, p. 627–627. doi: https:/www.psykologtidsskriftet.no/artikkel/2025as10ae-Vi-forsket-ikke-pa-karakteranalyse. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen & Stänicke, Erik (2025). En samtale om terapeutisk hybris, press fra akademia, helsemyndigheter, psykologstanden, pasienten og vår egen narsissistiske sårbarhet. doi: https:/psykologforening.fra1.digitaloceanspaces.com/Aktuelt/Psykologikongressen-2025-Program.pdf. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2025). Deliberate Practice in Psychotherapy Supervision: A Promising Paradigm for Enhancing Clinical Effectiveness Even if We Still Have Puzzles to Solve. Journal of Clinical Psychology. ISSN 0021-9762. doi: https:/onlinelibrary.wiley.com/doi/10.1002/jclp.70043. Full text in Research Archive Show summary

  The current paper is a commentary of the four papers (Brand et al.; Husby, Sacks, and Rosén) on deliberate practice (DP) as applied to psychotherapy supervision across therapeutic methods and contexts, published in this virtual issue of the Journal of Clinical Psychology: In Session. The commentary starts by situating the efforts of DP into the broader context of psychotherapy research and therapist effects (TEs), before providing a brief summary of each paper. All the papers point to the fact that traditional supervision often misses opportunities to practice specific clinical skills and the promotion of translation of reflection into action. They each give hands on and engaging cases of supervisory practices. Still, there are some critical questions that warrant attention which concern some of the assumptions that DP supervision is based on, which are discussed here. These are: (1) Are client outcomes enhanced as a result of DP supervision?; (2) Is it true that declarative knowledge does not translate into procedural knowledge?; (3) Does DP supervision put too much emphasis on the supervisor's ability to know what needs to be changed? and (4) Is it possible to apply the principles of DP to a dyadic enterprise such as psychotherapy? While clinical supervision based on DP principles is promising, there are issues to be solved, and we should proceed with sobriety with regard to how much DP may enhance the training of psychotherapists and clinical practice.

• Bernhardt, Ida Stange; Nissen-Lie, Helene, Amundsen & Råbu, Marit (2025). Vi forsket ikke på karakteranalyse. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 10, p. 627–627. doi: https:/www.psykologtidsskriftet.no/artikkel/2025as10ae-Vi-forsket-ikke-pa-karakteranalyse. Full text in Research Archive
• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve & Solbakken, Ole Andre (2025). Practice oriented research in Norway: Improvements in interpersonal problems predict subsequent improvement in depressive symptoms during open-ended psychotherapy for adults with depression. doi: https:/cdn.ymaws.com/www.psychotherapyresearch.org/resource/resmgr/spr2025/spr_meeting_program_2025.pdf. Full text in Research Archive Show summary

  Objective: Depressed patients often experience interpersonal distress. Understanding how interpersonal distress and depressive symptoms are associated may have implications for understanding the aetiology and maintenance of depression, as well as for treatment. In this practice-oriented research program, we explored whether change in depressive symptoms predicted subsequent change in interpersonal distress or vice versa. Method: Depressive symptoms (depression scale of the SCL-90-R), and interpersonal problems (IIP-64) were assessed on 9 occasions including before, during, and after treatment, and at 1 and 2.5-years’ follow-up in a sample of 178 depressed patients receiving open-ended psychotherapy. We used latent curve modelling with structured residuals (LCM-SR) to assess possible reciprocal relations between interpersonal problems and depression, controlling for personality disorder (PD). Results: The findings showed that interpersonal distress had a slower rate of change compared to depressive symptoms, but improvements in interpersonal distress predicted subsequent improvement in depressive symptoms during psychotherapy and this effect was stable over time. Patients with comorbid PD had higher initial levels of both depression and interpersonal distress, but there were no differences in rates of change for any of the outcomes. Conclusion: Our results indicate that improvements in interpersonal problems may play an important role in alleviating depressive symptoms during psychotherapy. We propose that reduction of interpersonal distress is associated with increased interpersonal flexibility, which may lead to more positive responses from others, thereby contributing to a reduction in depressive symptom

• Nissen-Lie, Helene, Amundsen (2025). Fremtidens psykoterapi: Hvilken rolle bør KI spille? Full text in Research Archive
• Schlüter, Christian & Nissen-Lie, Helene, Amundsen (2025). Bokbad NM i psykiatri- intervju med forfatteren. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2025). Om terapiens ureduserbare kompleksitet og evidensspørsmålet. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2025). EASIER (Emotions; Attachment; Systems; Identity in Extended Residential Care) - Om tilblivelsen av et forskningsprosjekt. Foredrag på festseminar til Terje Tilden, Modum Bad. Full text in Research Archive
• Vaz, Alexandre; McLeod, Julia & Nissen-Lie, Helene, Amundsen (2025). Rethinking Psychotherapy Training and Supervision: The Case for Deliberate Practice. Journal of Clinical Psychology. ISSN 0021-9762. doi: 10.1002/jclp.23777. Full text in Research Archive
• Bremer, Kjetil & Nissen-Lie, Helene, Amundsen (2024). Betydningen av terapeutens egenskaper i behandling. Nasjonal kompetansetjeneste for personlighetspsykiatri, NAPP. Podcast, intervjuer: Kjetil Bremer, Ous. [Radio]. Nasjonal kompetansetjeneste for personlighetspsykiatri, NAPP. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2024). Dagsseminar om psykoterapi. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2024). Foredrag på lansering av Stein Bråtens bok: "Fange øyeblikk med gjensidig kommunikasjon mellom barn og voksne". Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2024). “Hvordan bidrar feedback til bedre utfall?” Foredrag i forbindelse med OPTIMO prosjektet - Lovisenberg sykehus. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2024). The Power of Professional Humility- Bruce Wampold with friends. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen; Stiegler, Jan Reidar Reidar & Hagen, Anne Hilde Vassbø (2024). Boklansering av Terapeutens håndbok i emosjonsfokusert terapi. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2024). Si hva Modum Bad har gitt verden! En refleksjon over forskningsbidragene fra Modum Bad gjennom årene. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). Discussant for the panel: "Searching for, finding, and revealing exceptional therapists: Complex empirical, professional, and interpersonal issues". Moderated by Stevan Lars Nielsen. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). But how does it actually work? Transdiagnostic change mechanisms and mediators of outcome in psychotherapy across patient diagnoses, age groups, settings and treatment models. Moderator for panel. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). Discussant on the panel "Development of Psychotherapist Trainees: New Qualitative and Quantitative Findings from the SPRISTAD Longitudinal Study". Moderated by Armin Hartmann. Full text in Research Archive
• Stänicke, Erik; Nissen-Lie, Helene, Amundsen & Blüml, Victor (2023). Visions of psychoanalysis. Confronting modern Zeitgeist. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). How to improve the effectiveness of psychotherapy? The role of therapists' skills and appropriate responsiveness. Full text in Research Archive
• Jernberg, Maria & Nissen-Lie, Helene, Amundsen (2023). Terapeutfaktorn. [Journal]. Psykologtidningen. Full text in Research Archive Show summary

  Terapeutfaktorn är på väg fram ur skuggan. Forskarna vet alltmer om vad som utmärker terapeuter som lyckas med sina behandlingar. Nya studier vill ge svar på om och hur det går att lära sig

• Wampold, Bruce E. & Nissen-Lie, Helene, Amundsen (2023). "The Power of Professional Humilty"- Podcast episode in "Making Therapy Better" led by Prof. Bruce Wampold. [Radio]. Making Therapy Better /www.makingtherapybetter.com. Full text in Research Archive Show summary

  Helene Nissen-Lie is a professor of clinical psychology at the University of Oslo and a practicing psychologist. She participates in a number of research projects in Norway as well as internationally, including collaborations with the University of Sheffield and the University of Chicago. She has published over 50 papers and articles, and her research interests include therapist effects, the therapeutic alliance, mechanisms of change in psychotherapy, and outcomes research, among many others. In this episode, Bruce talks to Helene about her research and her surprising finding that therapists who expressed more professional self-doubt, which they both agree may be better thought of as "professional humility" end up with better outcomes for their clients. They also talk about some of the applications of measurement-based care and the differences between the Norwegian and American systems of mental-health care. The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major" www.makingtherapybetter.com

• Nissen-Lie, Helene, Amundsen; Wampold, Bruce E. & Muran, John Christopher (2023). The Great Psychotherapy Debate 2.0. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). Transference and countertransference dynamics working in psychoanalysis with a patient gradually emerging from a psychic retreat. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen; Vøllestad, Jon & Halvorsen, Joar Øveraas (2023). Virker egentlig psykoterapi? [Radio]. Litt Pod; Litteraturhuset i Bergen sin podkast. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen; Vøllestad, Jon & Halvorsen, Joar Øveraas (2023). Virker egentlig psykoterapi? Full text in Research Archive
• Ekroll, Vidar Blokhus & Nissen-Lie, Helene, Amundsen (2023). Folkeforvirring om effekten av psykologisk behandling. Full text in Research Archive
• Ansar, Nadia & Nissen-Lie, Helene, Amundsen (2023). Boksamtale om "Min Skam" av Nadia Ansar. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). DEN STORE #PSYKOTERAPI DEBAT 2.0: HVAD VIRKER OG HVAD HAR DET MED MIG AT GØRE? Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). "Nadine" og de de ulike terapiretningene: Er de likere enn vi tror eller representerer de radikalt forskjellige menneskesyn? En kommentar. Full text in Research Archive
• Ekroll, Vidar Blokhus & Nissen-Lie, Helene, Amundsen (2023). Pasienter fortjener god kommunikasjon rundt psykologisk behandling. Full text in Research Archive
• Oddli, Hanne Berit Weie; Nissen-Lie, Helene, Amundsen; Røssberg, Jan Ivar; Schanche, Elisabeth & Karlsson, Bengt Eirik (2023). Runderbordssamtale om endring. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2023). Når psykoterapi ikke virker. Full text in Research Archive
• Oddli, Hanne Berit Weie; Nissen-Lie, Helene, Amundsen; Hagen, Roger; Halvorsen, Margrethe S.; Råbu, Marit & Solbakken, Ole Andre [Show all 8 contributors for this article] (2022). Psykoterapi har god effekt – selv om NRK sår tvil. Morgenbladet. ISSN 0805-3847. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen & Stänicke, Erik (2022). Den omnipotente terapeut og ISTDP-debatten: Hva lærte vi? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. Full text in Research Archive Show summary

  I denne artikkelen oppsummerer vi debatten som kom i kjølvannet av Flaatens bekymringsmelding. Vi er fullt klar over at vi ikke vet hva som faktisk skjedde i terapien, og at det er hennes erfaring som beskrives. Vi tar likevel utgangspunkt i Flaatens beskrivelse fordi den er en viktig påminnelse om å ta klientens opplevelse på alvor. Vi ønsker dessuten å kommentere Flaatens innlegg fordi det skriver seg inn i helt sentrale debatter i terapiforskningsfeltet (se Fors, 2021; Heinonen & Nissen-Lie, 2020; Nissen-Lie & Rønnestad, 2015). Hun peker indirekte på hvor vanskelig det er å skille metoden fra terapeuten. Vi vet at metodisk tilhørighet har stor betydning for terapeutenes identitet, men samtidig er det også kjent at terapeuteffekten er mange ganger større enn metodeeffekten (Wampold & Owen, 2021). Derfor er det relevant å trekke frem den empiriske forskningen på gunstige og ugunstige terapeutegenskaper for å sette Flaatens innlegg og debatten som fulgte, inn i denne sammenhengen. Vi følger Ole Magnus Vik (Vik, 2022a og b), Henrik Berg (Berg, 2020) og sist Kaja Betin (Betin, 2022); ISTDP-debatten reiser en større diskusjon om terapiens grunnlagsproblemer og vitenskapssyn – og til syvende og siste berører de store spørsmål i vårt fag, for eksempel hvordan vi lar oss informere av teori og empiri, hvordan vi ser på vår rolle i klientens endringsarbeid – og spørsmålet om menneskesyn.

• Nissen-Lie, Helene Amundsen (2022). Responsiveness as common factor? Discussion in plenary on responsiveness in psychotherapy. Full text in Research Archive
• Nissen-Lie, Helene Amundsen (2022). Lost in Transition: Patient and Therapist Experiences of Forced Shift to Remote Psychotherapy during the COVID-19 Pandemic. Discussion by Helene A. Nissen-Lie. Full text in Research Archive
• Steimoen, Teodor Melker Nytrøen; Høstmælingen, Andreas Teisner; Nissen-Lie, Helene Amundsen; Monsen, Jon Trygve & Solbakken, Ole Andre (2022). Toward a more nuanced understanding of the role of the working alliance in producing therapeutic benefits. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2022). Den terapeutiske relasjon og hjelperens egenskaper. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen & Rubin, Fredrik (2022). Så är en bra terapeut – och så är en dålig: ”Kan handla om en mängd orsaker”. [Journal]. Socionomen . Full text in Research Archive Show summary

  Finns det bra och dåliga terapeuter? Ja, menar inte bara patienter utan även forskare som tittat på frågan. Faktum är att den terapeutiska metoden till viss del ges en undanskymd roll. Åtminstone jämfört med terapeutens personliga egenskaper.

• Solbakken, Ole Andre; Nissen-Lie, Helene, Amundsen; Oddli, Hanne Berit Weie; Råbu, Marit; Stänicke, Erik & Hagen, Roger [Show all 8 contributors for this article] (2022). Folkeopplysningens konklusjon er misvisende. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. p. 1051–1052. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2021). Faglig foredrag om driftsbegrepet i psykoanalysen under lanseringen av Siri E. Gullestads bok "Å begjære den du elsker". Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2021). "Terapeutens hemmelige liv". Key note foredrag. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen; Norcross, John C.; Wampold, Bruce E. & Castonguay, Louis Georges (2021). Roundtable: The developing therapist. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen & Friestad, Marit (2021). Om terapeuten og temaet på Schizofrenidagene i Stavanger, NRK Rogaland, Lokalen (Distriktsprogram). [Radio]. NRK Rogaland . Full text in Research Archive
• Ansar, Nadia; Nissen-Lie, Helene, Amundsen; Elliott, Robert & Stiegler, Jan Reidar (2021). Emotion Focused Skills Training: A randomized controlled trial for parents of children with mental health symptoms. Paper-in-Panel on "Emotion Focused Therapy (EFT) in various forms", chaired by Franz Caspar. Full text in Research Archive Show summary

  Objective: There is a need to find effective and easy-to-implement interventions to alleviate emotional problems in children. Research indicates that how parents deal with their own emotional issues play a crucial role in the development, maintenance and deterioration of emotional issues in their children. There are currently few programs targeting these mechanisms. The purpose of the present study was to investigate a parent-based intervention and its effect on the internalizing or externalizing symptoms in children were within a clinical range. Method: Emotion Focused Skills Training (EFST) (Dolhanthy and Greenberg, 2007) is a manualized parental program based on principles from Emotion Focused Therapy (Greenberg, 2010) and humanistic client-centered therapy (Elliott, 2013). Parents of 236 children aged 6-13 with externalizing/internalizing symptoms were randomly allocated to one of two conditions; one with an experiential component/chair work and one without, which makes this study a dismantling, randomized controlled trial. Parents received 2 days’ group training and 6 hours of parental supervision. Feedback regarding symptoms was obtained from parents and teachers at baseline, treatment completion and at 3, 6 and 9 months follow-up. Results: Preliminary results of multilevel modeling indicate that the children’s symptoms changed significantly over time after receiving EFST in both conditions. Internalizing symptoms changed more if the parents had participated in the condition with the active experiential component (chair work). There was no significant difference in externalizing symptoms caused by different conditions. Conclusion: Children’s symptoms can be reduced with a short term accessible parental training program based on emotion focused principles.

• Nissen-Lie, Helene, Amundsen (2021). Therapist effects and development of psychotherapists: How can we best develop our personal and professional qualities to maximize client outcomes? Key note lecture. Full text in Research Archive
• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene, Amundsen; Eielsen, Mikkel & Wampold, Bruce E. (2021). Trajectories of change in psychotherapy for chronically depressed patients: Differences in self-criticism and somatic symptoms between users and non-users of antidepressant medication. Paper-in-Panel on the treatment of depression for vulnerable groups, chaired by Helene A. Nissen-Lie. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2021). What are the therapist characteristics that are associated with positive client outcomes? Paper-in-Panel on What works for whom? Patient, therapist, technique, and relationship determinants of success and failure in psychotherapy, chaired by Erkki Heinonen. Full text in Research Archive
• Rønnestad, Michael Helge; Orlinsky, David E.; Willutzki, Ulrike; Loeffler-Stastka, Henriette; Messina, Irene & Nissen-Lie, Helene, Amundsen (2021). Psychotherapy Trainees' Quality of Life: Demographic and Personal Factors and Implications, panel chaired by Ulrike Willutzki. Discussant. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen; Orlinsky, David E. & Rønnestad, Michael Helge (2021). The emotionally burdened psychotherapist: Personal and situational factors. Paper in panel: The impact of therapist effects: Improving patient outcomes and therapists’ wellbeing, chaired by Michael Barkham. Full text in Research Archive
• Barkham, Michael; Castonguay, Louis Georges; Jong, Kim De; Douglas, Susan; Penedo, Juan Martin Gomez & Kilcullen, Ryan [Show all 9 contributors for this article] (2021). Generating practice-oriented research: Guidelines from patient focus, practice evidence, and practice oriented research. Structured discussion. Full text in Research Archive
• Nissen-Lie, Helene, Amundsen (2021). "Mellom person og profesjon: Hvordan kan vi utvikle gunstige terapeutegenskaper?" Faglig foredrag ved 50 års-jubileet for internklinikkene ved Det Psykologiske Fakultet, UiB. Full text in Research Archive
• Nissen-Lie, Helene Amundsen (2020). Humility and self-doubt are hallmarks of a good therapist. Aeon. Full text in Research Archive

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