Margrethe Seeger Halvorsen

• Stänicke, Line Indrevoll; Rymoen, Liselotte Carlsen; Omdal, Tora Sandra Ausland & Halvorsen, Margrethe Seeger (2026). Pro-Ana—Balancing a Digital Safe Space and Indirect Self-Harming. Findings From a Meta-Synthesis. International Journal of Eating Disorders. ISSN 0276-3478. doi: 10.1002/eat.70067. Fulltekst i vitenarkiv Vis sammendrag

  Objective Harmful consequences of having an eating disorder can be exacerbated by engagement in digital groups that promote eating disorder-related content, particularly related to anorexia nervosa, and are often called pro-Ana. This study aims to synthesize qualitative research regarding individuals' experiences of participating in these digital groups to elucidate the underlying personal drivers of the engagement and how it can affect eating problems. Methods A systematic database search for first-person experiences yielded 27 relevant studies. We used an ethnographic approach and a thematic analysis for the meta-synthesis. Results We identified three meta-themes across the studies: (1) “Pro-Ana feels like a safe space where I can be myself”, (2) “Pro-Ana is a dangerous path”, and (3) “Pro-Ana becomes a joint project for living with an eating disorder”. Discussion Participants' experiences in pro-Ana communities relate to concepts on offline stigmatization, fundamental needs for belonging, and the inherent ambivalence toward the online community—balancing the pursuit of emotional support with the risks of indirect digital self-harming. Helpers and clinicians are recommended to directly engage with clients regarding their digital activities and associated risks, including engagement in pro-Ana, with openness and respect to mitigate feelings of shame and guilt.

• Holbæk, Ingunn; Vrabel, KariAnne & Halvorsen, Margrethe S. (2025). “I know that all this is me” Pathways of change in complex dissociative disorder. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2025.2457402. Fulltekst i vitenarkiv
• Lorentzen, Kari Evelin Arellano; Nordanger, Dag; Weimand, Bente Margrethe; Hammersbøen, Åse Marit; Telles, Shirley & Halvorsen, Margrethe S. (2025). How adult patients with complex trauma experiences (CTE) experience yoga as treatment: A qualitative evidence synthesis (Review). European Journal of Trauma & Dissociation. 9(2). doi: 10.1016/j.ejtd.2025.100529. Fulltekst i vitenarkiv Vis sammendrag

  Background The therapeutic potential of practising yoga for trauma-related mental health problems is being increasingly investigated. However, there is little research on yoga as treatment for patients with Complex Trauma Experiences (CTE) specifically, and how adult patients with CTE experience yoga as treatment. Purpose The aim of this Qualitative Evidence Synthesis (QES) was to explore and synthesize qualitative research on how adult patients with CTE experience yoga as treatment for trauma-related mental health problems. Methods We searched seven databases until July 25, 2024, and screened 1973 studies. We included studies written in Norwegian, Swedish, Danish, English, or Spanish, with qualitative design, that were peer-reviewed, published, and available during the search period. Five studies were included after quality appraisal. Thematic Synthesis was used to synthesize the findings. Results An overarching analytical theme “yoga as a multifaceted, transformative treatment process that extends beyond the yoga mat into daily life and self-reformation” was developed with three main themes: 1) “Yoga as new encounters with oneself on the yoga mat”, 2) “Yoga as possibilities for daily life coping”, and 3) “Yoga as opportunities for personal growth”. The confidence in the findings were assessed to be of moderate to high confidence. Conclusion This review indicates that adult patients with CTE experience yoga as treatment as a comprehensive therapeutic journey. Based on these findings, implications regarding the integration, recognition and exploration of yoga as a multifaceted, transformative treatment process for adult patients with CTE are presented to support future practice, policy and research.

• Riise, Julie; Gulliksen, Kjersti Solhaug; Vrabel, KariAnne & Halvorsen, Margrethe S. (2025). “Binge eating disorder is the slum of eating disorders”: a qualitative study of Norwegian women with binge eating disorder in the encounter with the healthcare system. Journal of Eating Disorders. 13(1). doi: 10.1186/s40337-025-01223-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Binge Eating Disorder (BED) is the most prevalent eating disorder, yet it remains under-recognized and insufficiently understood in both healthcare and society. This leads to a lack of appropriate treatment options and challenges of identification within somatic healthcare. Our study aims to elucidate effective treatment approaches for BED by exploring patients’ personal understandings of their treatment needs. Methods We interviewed 6 individuals diagnosed with BED regarding their healthcare experiences and analyzed the data using a modified qualitative method combining thematic and interpretive phenomenological analysis. Results The analysis resulted in three main themes: Lack of understanding, Trapped in body shame and Hope and movement, each with belonging subcategories. These themes narrate a journey from being unrecognized with a psychological issue, feeling immobilized by body shame towards embarking on recovery. Particularly Trapped in body shame links the other main themes representing a barrier and a pivotal point in the recovery process. Conclusions Our study highlights that shame related to binge eating and body image is pervasive in participants, exacerbated by a healthcare system that often prioritizes weight and lifestyle. Such shame can block treatment access and prolong the disorder. We argue for a paradigm shift in clinical practice towards patient-centered care that prioritizes empathy and holistic support over weight-focused models. Group therapy can be beneficial in reducing shame, if the group composition is carefully considered. Effective BED treatment should involve creating a safe environment for discussing body shame, emphasizing the need to address this issue to improve treatment effectiveness and patient satisfaction.

• Halvorsen, Margrethe S.; Stige, Signe Hjelen; Halvorsen, Jorunn; Binder, Per-Einar; Måkestad, Elida & Albæk, Ane Ugland [Vis alle 7 forfattere av denne artikkelen] (2024). Detecting child sexual abuse in child and adolescent psychiatry: a survey study of healthcare professionals’ assessment practice. International Journal of Mental Health Systems. 18, s. 1–12. doi: 10.1186/s13033-024-00632-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: Research shows that only around half of all survivors of child sexual abuse (CSA) disclose the abuse during childhood and adolescence. This is worrying, as CSA is related to substantial suffering later in life. The proportion of children and adolescents who have been exposed to CSA is significantly higher in Child and Adolescent Psychiatry (CAP) than in the general population. Healthcare professionals report that uncovering CSA is a complex and challenging task. However, we know little about how they proceed when uncovering CSA. More knowledge of healthcare personnel’s experience is therefore necessary to facilitate and increase CSA disclosure. The study aims to explore how CAP healthcare professionals in Norway proceed when assessing and detecting CSA, how they experience this work, and what hinders or facilitates their efforts. Methods: The study employed a mixed method approach. Data was collected through an anonymous online survey, generating both quantitative and qualitative data. The sample consisted of 111 healthcare professionals in CAP, of whom 84% were women, with a mean age of 40.7 years (range 24–72; sd = 10.8). Mean years of CAP clinical experience were 8.3 years (range 0–41; sd = 7.5). The quantitative data was analysed using descriptive statistics, correlations, and independent sample t-tests, while the qualitative data was analysed using a team-based qualitative content analysis. Results: The results showed that detection of CSA was viewed as an important, but complex task in CAP, and the existing procedures were deemed to be insufficient. The therapists mostly felt confident about how to proceed when they suspected or detected CSA, yet they seldom detected CSA. In their initial assessment they applied standardised procedures, but if their suspicion of possible CSA persisted, they seemed to rely more on clinical judgement. Specific challenges and facilitators for CSA detection were identified, both in the individual and in the organisation. Conclusions: The study highlights the challenges and complexities healthcare professionals and the CAP system face when assessing CSA, which may account for the low detection rate. The results show that healthcare professionals believe room for clinical autonomy and targeted competence development may improve CSA detection. Additionally, the findings suggest a need for CAP to define roles and responsibilities within and between agencies.

• Holbæk, Ingunn; Vrabel, KariAnne & Halvorsen, Margrethe S. (2024). “Now there are fewer of me". A qualitative study of the impact of psychoeducative groups for complex dissociative disorder. European Journal of Trauma & Dissociation. 8(2). doi: 10.1016/j.ejtd.2024.100390. Fulltekst i vitenarkiv
• Standal, Kari; Solbakken, Ole Andre; Rugkåsa, Jorun; Halvorsen, Margrethe Seeger; Abbass, Allan & Wirsching, Christopher [Vis alle 8 forfattere av denne artikkelen] (2024). Medication-Free Treatment in Mental Health Care How Does It Differ from Traditional Treatment? Patient Preference and Adherence. 18, s. 315–335. doi: 10.2147/PPA.S435610. Fulltekst i vitenarkiv Vis sammendrag

  Background: Norwegian authorities have implemented treatment units devoted to medication-free mental health treatment nation- wide to improve people’s freedom of choice. This article examines how medication-free treatment differs from treatment as usual across central dimensions. Methods: The design was mixed methods including questionnaire data on patients from a medication-free unit and two comparison units (n 59 + 124), as well as interviews with patients (n 5) and staff (n 8) in the medication-free unit. Results: Medication-free treatment involved less reliance on medications and more extensive psychosocial treatment that involved a culture of openness, expression of feelings, and focus on individual responsibility and intensive work. The overall extent of patient influence for medication-free treatment compared with standard treatment was not substantially different to standard treatment but varied on different themes. Patients in medication-free treatment had greater freedom to reduce or not use medicat

• Oddli, Hanne Berit Weie; Stänicke, Erik; Halvorsen, Margrethe S. & Lindstad, Tobias Gustum (2022). Causality in psychotherapy research: Towards evidential pluralism. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2022.2161433. Fulltekst i vitenarkiv
• Stige, Signe Hjelen; Andersen, Ann Christin; Halvorsen, Jorunn; Halvorsen, Margrethe S.; Binder, Per-Einar & Måkestad, Elida [Vis alle 7 forfattere av denne artikkelen] (2022). Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors’ and health professionals’ experiences of addressing child sexual abuse. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 17(1), s. 1–27. doi: 10.1080/17482631.2022.2103934. Fulltekst i vitenarkiv Vis sammendrag

  Background: Efforts are directed both towards prevention and early detection of Child sexual abuse (CSA). Yet, only about 50% of CSA survivors disclose before adulthood, and health professionals rarely are the first disclosure recipients. Increasing the detection rate of CSA within the context of Child and Adolescent Psychiatry (CAP) therefore represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task. We therefore argue that efforts to increase detection rates of CSA within CAP need to rest on knowledge of how both survivors and health professionals experience addressing CSA. Method: Using meta-ethnography as method, we present separate sub-syntheses as well an overarching joint synthesis of how survivors and health professionals experience addressing CSA. Results: Results show how both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA. Conclusion: The results indicate that adapting the organization of CAP to knowledge of how the survivors and health professionals experience addressing CSA is critical to facilitate earlier disclosure of CSA within CAP.

• Stänicke, Line Indrevoll; Hermansen, Marte Hjertås & Halvorsen, Margrethe Seeger (2022). A transitional object for relatedness and self-development—A meta-synthesis of youths' experience of engagement in self-harm content online. Child & Family Social Work. ISSN 1356-7500. doi: 10.1111/cfs.13058. Fulltekst i vitenarkiv
• Standal, Kari; Solbakken, Ole Andre; Rugkåsa, Jorun; Martinsen, Astrid Ringen; Halvorsen, Margrethe Seeger & Abbass, Allan [Vis alle 7 forfattere av denne artikkelen] (2021). Why service users choose medication-free psychiatric treatment: A mixed-method study of user accounts. Patient Preference and Adherence. 15, s. 1647–1660. doi: 10.2147/PPA.S308151. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Medication has been a central part of treatment for severe mental disorders in Western medicine since the 1950s. In 2015, Norwegian Health Authorities decided that Norwegian health regions must have treatment units devoted to medication-free mental health treatment to enhance service users’ freedom of choice. The need for these units has been controversial. The aim of this study was to examine why service users choose medica- tion-free services. This article examines what purpose these units serve in terms of the users’ reasons for choosing this service, what is important for them to receive during the treatment, and what factors lay behind their concerns in terms of medication-related views and experiences. Methods: Questionnaires were answered by 46 participants and 5 participants were inter- viewed in a mixed-method design integrated with a concurrent triangulation strategy apply- ing thematic analysis and descriptive statistics. Results: Negative effects of medications and unavailable alternatives to medication in ordinary health care were important reasons for wanting medication-free treatment. Medication use may conflict with personal values, attitudes, and beliefs. Conclusion: This study broadens the understanding of why the demand for separate medication-free units has arisen. The findings may contribute to making medication-free treatment an option in mental health care in general. To this end, clinicians are advised to communicate all treatment alternatives to service users and to be mindful of the effect of power imbalances in their interactions with them

• 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. Fulltekst i vitenarkiv
• Sønsterud, Hilda; Halvorsen, Margrethe S.; Feragen, Kristin Judith Billaud; Kirmess, Melanie & Ward, David (2020). What works for whom? Multidimensional individualized stuttering therapy (MIST). Journal of Communication Disorders. ISSN 0021-9924. 88:106052, s. 1–20. doi: 10.1016/j.jcomdis.2020.106052. Fulltekst i vitenarkiv Vis sammendrag

  Purpose This study reports outcomes from a stuttering therapy approach that combines value and awareness-based elements from Acceptance and Commitment Therapy (ACT) with those of stuttering and speech modification interventions. The approach, entitled Multidimensional Individualized Stuttering Therapy (MIST), includes a combined clinician and client selection of factors across five areas: 1) general breathing patterns and body tension, 2) breathing patterns during speech production, 3) vocal features in speech production, 4) value and mindfulness-based strategies, and 5) general communication and/or presentation skills. The aims of this study were to evaluate whether the MIST a) reduces the impact of stuttering and stuttering severity, and b) has a positive impact on speaking ability, confidence in communication, avoidance-behavior, and quality of life. Method Eighteen adults, age 21–61 years took part in an A-B-A multiple case study design. Participants underwent a pre-clinic assessment phase, followed by 10 h of therapy over four sessions administered by an experienced speech-language therapist. Outcome measures examined both psychosocial and behavioral aspects of therapy three-, six- and twelve-months post-therapy. Results Most participants chose elements from at least four of the five areas of focus. There was a significant reduction in the impact of stuttering at both 6- and 12-months post-therapy, with moderate (d = .71) to very large (d = 1.06) effect sizes. A strong association was found between overall satisfaction with MIST and improved speaking abilities. Moderate to strong associations were also found between experienced speaking abilities, confidence in communication, reduction in avoidance behaviors and improved quality of life. Discussion Findings indicate that MIST can be effective in managing adult stuttering. The findings highlight the importance of shared decision making and personal considerations using flexible therapy approaches that integrate stuttering and speech modification interventions with value and awareness-based skills. The nature of a multidimensional individualized approach, as shown in this study, highlights the importance of adjusting the relative weighting of different subcomponents according to each individual’s needs and goals. Conclusion MIST was shown to be efficacious in clinical settings and effective in real life settings. Findings were promising, despite a relatively small sample, and replication by other SLPs and with larger samples is warranted.

• Sønsterud, Hilda; Kirmess, Melanie; Howells, Kirsten; Ward, David; Feragen, Kristin Judith Billaud & Halvorsen, Margrethe S. (2019). The working alliance in stuttering treatment: a neglected variable? International journal of language and communication disorders. ISSN 1368-2822. s. 1–14. doi: 10.1111/1460-6984.12465. Fulltekst i vitenarkiv Vis sammendrag

  Background Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The ‘working alliance’ is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular. Aims To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients’ concept of motivation and treatment outcomes 6 months post‐therapy. Methods & Procedures Eighteen adults (21‐61 years) participated in this multiple single‐case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory—Short Version Revised (WAI‐SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST‐E), the Overall Assessment of Speakers’ Experience of Stuttering—Adult version (OASES‐A), the Wright & Ayre Stuttering Self‐Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS). Outcomes & Results Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post‐treatment. The association between client‐led goals and therapy tasks appeared particularly important. Conclusions & Implications The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client–clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted.

• Lippe, Anna Louise von der; Oddli, Hanne & Halvorsen, Margrethe S. (2019). Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency. Psychotherapy Research. ISSN 1050-3307. 29(3), s. 383–402. doi: 10.1080/10503307.2017.1373205. Fulltekst i vitenarkiv
• Fjermestad, Krister; Rø, Annika Elisabet; Espeland, Karen Elise; Halvorsen, Margrethe S. & Halvorsen, Inger (2019). “Do I exist in this world, really, or is it just her?” Youths’ perspectives of living with a sibling with anorexia nervosa. Eating Disorders. ISSN 1064-0266. 28(1), s. 80–95. doi: 10.1080/10640266.2019.1573046. Fulltekst i vitenarkiv Vis sammendrag

  Little is known about how severe anorexia nervosa (AN) in youths affects siblings and siblings’ experiences of family-based treatment for AN. Thirteen youths (M age = 15.5 years, SD = 3.0; 23% boys) who had been co-admitted with their sibling with AN and parents at an inpatient clinic for eating disorders 3 to 6 years earlier participated in qualitative interviews. Interviews were analyzed using systematic text condensation. Results showed AN is difficult to understand, particularly at onset, and is associated with confusion and lack of information for siblings. AN evokes difficult emotions, including fears of death, frustration about rigid behavior, and sadness about changed life situations. AN affects family dynamics and relations, including conflicts and disruptions at home, limited and divided family life, and less attention from parents and extended family. Siblings pay attention to other people eating habits, strive for a balanced view on eating, and experience family meals as conflictual. Siblings experience increased knowledge and personal development, and are ambivalent to family treatment. Ways of coping include creating distance, seeking social support, rationalizing, and keeping hope. In conclusion, siblings’ experiences of severe AN are complex and ambiguous. Family-based treatment for AN in young people should address siblings’ perspectives.

• Sønsterud, Hilda; Feragen, Kristin Judith Billaud; Kirmess, Melanie; Halvorsen, Margrethe S. & Ward, David (2019). What do people search for in stuttering therapy: Personal goal-setting as a gold standard? Journal of Communication Disorders. ISSN 0021-9924. s. 1–15. doi: 10.1016/j.jcomdis.2019.105944. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Stuttering affects people in individual ways, and there are multiple factors which may influence a person’s goals when seeking therapy. Even though there is a common consensus that speech-language pathologists should discuss the individual’s goals and expectations for stuttering therapy and outcomes, few studies have systematically investigated this issue. The aims of the present study were to investigate individual motivations and goal-setting related factors in stuttering therapy. The associations between self-reported impact of stuttering and the participants’ perceptions of stuttering interference in communication, speaking abilities, and relationships with other people were also investigated. Method This study is part of a wider-ranging treatment study of individualized stuttering management tailored to the participants’ personal goals and preferences. A mixed method, multiple single-case design was used to address the research questions. Twenty-one adults, age 21–61 years, took part in a pretherapy interview, which also included two quantitative measures: the Client Preferences for Stuttering Therapy-Extended version (CPST-E) and the Overall Assessment of Speakers’ Experience of Stuttering-Adult version (OASES-A). Findings from the study sample was compared with a Norwegian reference group, in order to check for the representativeness of the study sample. Results Quantitative data showed that most participants wanted to focus on both physical and psychological aspects of therapy, and that 95% considered ‘to gain a sense of control over the stuttering’ as important. Participants’ perspectives on their speaking ability and stuttering interference in communication were identified as central factors, particularly in social and professional settings. These outcomes aligned well with the finding of avoidance behaviors, such as avoiding words and speaking situations. Qualitative data identified four main areas that the participants wanted to improve: speech fluency, emotional functioning, activity and participation, and understanding of their stuttering. Conclusion The study confirms that multiple and individual factors may influence the person’s goals for therapy. Goals were mainly anchored in participants’ wish of better coping in real world settings. A high degree of avoidance behavior was reported, suggesting that anxiety, and in particular linguistic-related anxiety needs to be taken into account when addressing social anxiety in fluency disorders.

• Rønnestad, Michael Helge; Nissen-Lie, Helene A; Oddli, Hanne; Benum, Kirsten; Ekroll, Vidar Blokhus & Gullestad, Siri Erika [Vis alle 12 forfattere av denne artikkelen] (2018). Expanding the Conceptualization of Outcome and Clinical Effectiveness. Journal of Contemporary Psychotherapy. ISSN 0022-0116. 49, s. 87–97. doi: 10.1007/s10879-018-9405-z. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Benum, Kirsten; Oddli, Hanne; Stänicke, Erik & Mcleod, John (2017). How Usual is Treatment as Usual? Experienced Therapists’ Reflections on Participation in Practice-based Research. Counselling Psychology Quarterly. ISSN 0951-5070. doi: 10.1080/09515070.2017.1397502. Fulltekst i vitenarkiv Vis sammendrag

  Studies have shown that many clinicians are skeptical about research and hesitant about participating in research. In the present study, we explored this issue by studying experienced therapists’ reflections on their participation in practice-based research. Data were drawn from a practice-based research study at the University of Oslo, Norway. Twelve highly experienced therapists who had contributed to the study were invited to complete an open-ended questionnaire regarding their participation, and the text material was analyzed using a thematic analytic approach. Results indicated that research participation was experienced both as beneficial and demanding, and that being observed by others and following research procedures was experienced as affecting therapists’ clinical work. We discuss these findings in relation to the distinction between “treatment as usual” versus “treatment in a research context”, and offer suggestions for steps to increase the clinical relevance and the ecological validity of psychotherapy research. This is an Accepted Manuscript of an article published by Taylor & Francis in Counselling Psychology Quarterly on 10 Nov 2017, available online: http://www.tandfonline.com/10.1080/09515070.2017.1397502

• Oddli, Hanne; Nissen-Lie, Helene A & Halvorsen, Margrethe S. (2016). Common therapeutic change principles as "sensitizing concepts": A key perspective in psychotherapy integration and clinical research. Journal of psychotherapy integration. ISSN 1053-0479. doi: 10.1037/int0000033. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Benum, Kirsten; Haavind, Hanne & Mcleod, John (2016). A Life-Saving Therapy: The Theory-Building Case of "Cora". Pragmatic Case Studies in Psychotherapy. 12(3), s. 158–193. doi: 10.14713/pcsp.v12i3.1975. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Mcleod, John; Benum, Kirsten & Haavind, Hanne (2016). Response to Commentaries on A Life-Saving Therapy: The Theory-Building Case of "Cora": Conceptualizing the Complexity of Change in Psychotherapy: The Case of “Cora”. Pragmatic Case Studies in Psychotherapy. 12(3), s. 224–237. doi: 10.14713/pcsp.v12i3.1979. Fulltekst i vitenarkiv
• Stige, Signe Hjelen & Halvorsen, Margrethe S. (2016). From cumulative strain to available resources: A case study of the potential effects of new trauma on recovery. Illness, Crisis and Loss. ISSN 1054-1373. 26(4), s. 270–292. doi: 10.1177/1054137316664177. Fulltekst i vitenarkiv
• Oddli, Hanne & Halvorsen, Margrethe S. (2014). Experienced Psychotherapists’ Reports of Their Assessments, Predictions, and Decision Making in the Early Phase of Psychotherapy. Psychotherapy. ISSN 0033-3204. 51(2), s. 295–307. doi: 10.1037/a0029843. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. (2014). Kampen for tilværelsen. Refleksjoner fra en terapeut og terapiforsker i isødet. I Lippe, Anna Louise von der; Nissen-Lie, Helene A & Oddli, Hanne (Red.), Psykoterapeuten. En antologi om terapeutens rolle i psykoterapi. Gyldendal Akademisk. ISSN 9788205472136. s. 307–317. Fulltekst i vitenarkiv
• Benum, Kirsten & Halvorsen, Margrethe S. (2013). Terapeuten som emosjonelt anker. I Benum, Kirsten; Axelsen, Eva & Hartmann, Ellen Johanne (Red.), God Psykoterapi: Et Integrativt Perspektiv. Pax Forlag. ISSN 9788253035987. s. 219–246. Fulltekst i vitenarkiv
• Råbu, Marit; Halvorsen, Margrethe S. & Haavind, Hanne (2011). Early relationship struggles: A case study of alliance formation and reparation. Counselling and Psychotherapy Research. ISSN 1473-3145. 11(1), s. 23–33. doi: 10.1080/14733145.2011.546073. Fulltekst i vitenarkiv Vis sammendrag

  Aim: A good alliance established during the early sessions of psychotherapy will most likely lead to a good outcome. As a result, there is much to learn from a case in which both the patient and therapist regarded the alliance as being poor for an extended period (the first 15 sessions), yet still managed to develop a solid and stable alliance and reach a successful completion of therapy. The aim is to give a close inspection of this reparation process. Methods and analysis: Ratings on the Working Alliance Inventory (WAI) were used to guide the strategic selection of a case in which a depressed woman in her thirties sought help from an experienced senior male psychotherapist. A detailed analysis of the therapeutic dialogue brought forth what the parties expected from each other and how they responded to explicit and implicit expressions about how to proceed. Post-termination interviews revealed their subjective configurations of events in therapy and their corresponding reflections. Findings and discussion: Important steps and hallmarks of the alliance formation and reparation were identified: (i) Early in the process, incompatible expectations about what the relationship could achieve led to repetitious struggles. (ii) Their conflicting notions came forward in a more open dialogue about two specific issues (her medication and sick leave). (iii) Through the recognition of different viewpoints they were able to expand on their interactional pattern and develop playful ways to explore her decision making in everyday life. (iv) Temporary breaks seemed to consolidate her autonomy. (v) Late in the course of therapy, the therapist introduced a literary metaphor that seemed to further consolidate the alliance. This is an Author's Accepted Manuscript of an article published in British Association for Counselling and Psychotherapy, available online

• Monsen, Jon T.; Lippe, Anna Louise von der; Lippe, Anna Louise von der; Havik, Odd E.; Halvorsen, Margrethe S. & Eilertsen, Dag E. (2007). Validation of the SASB introject surface in a Norwegian clinical and nonclinical sample. Journal of Personality Assessment. ISSN 0022-3891. 88(2), s. 235–245. Fulltekst i vitenarkiv
• Halvorsen, Margrethe Seeger & Monsen, Jon Trygve (2007). Self-image as a moderator of change in psychotherapy. Psychotherapy Research. ISSN 1050-3307. 17(2), s. 205–217. doi: 10.1080/10503300600608363. Fulltekst i vitenarkiv
• Halvorsen, Margrethe Seeger; Hagtvet, Knut Arne & Monsen, Jon Trygve (2006). The reliability of self-image change scores in psychotherapy research: An application of generalizability theory. Psychotherapy. ISSN 0033-3204. 43, s. 308–321. Fulltekst i vitenarkiv
• Halvorsen, Margrethe Seeger & Joner, Andreas (1999). Oppvekst i lesbiske parforhold. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. s. 514–522. Fulltekst i vitenarkiv

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• Oddli, Hanne Berit Weie; Nissen-Lie, Helene, Amundsen; Hagen, Roger; Halvorsen, Margrethe S.; Råbu, Marit & Solbakken, Ole Andre [Vis alle 8 forfattere av denne artikkelen] (2022). Psykoterapi har god effekt – selv om NRK sår tvil. Morgenbladet. ISSN 0805-3847. Fulltekst i vitenarkiv
• Solbakken, Ole Andre; Nissen-Lie, Helene, Amundsen; Oddli, Hanne Berit Weie; Råbu, Marit; Stänicke, Erik & Hagen, Roger [Vis alle 8 forfattere av denne artikkelen] (2022). Folkeopplysningens konklusjon er misvisende. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. s. 1051–1052. Fulltekst i vitenarkiv
• Sønsterud, Hilda; Kirmess, Melanie; Feragen, Kristin Judith Billaud; Ward, David & Halvorsen, Margrethe S. (2018). Minding the body in speecy: Individualized therapy for adults who stutter. Fulltekst i vitenarkiv
• Sønsterud, Hilda; Howells, Kirsten; Halvorsen, Margrethe S.; Feragen, Kristin Judith Billaud; Ward, David & Kirmess, Melanie (2018). The importance of the working alliance in stuttering therapy: Client perceptions. Fulltekst i vitenarkiv
• Sønsterud, Hilda; Kirmess, Melanie; Halvorsen, Margrethe S.; Feragen, Kristin Judith Billaud & Ward, David (2018). Individualized therapy for adults who stutter: An evaluation on speech and avoidance behaviour. Fulltekst i vitenarkiv Vis sammendrag

  Abstract. Purpose: Evidence suggests that there is considerable individual variation in response to stuttering interventions. Despite this knowledge, stuttering research has so far mainly focused on demonstrating outcomes from a particular stuttering treatment approach at the time. There is a need to investigate personal variation in stuttering symptoms and manage that variability through personalized and holistic based management plans. This approach is context sensitive and places the individual’s specific concerns at the core of therapy. One approach which has increased in popularity within the stuttering field, is Acceptance and Commitment Therapy (ACT). The main goal in ACT is to foster psychological flexibility, which is achieved through the six core processes of acceptance, diffusion, self as context, committed action, values, and contact with the present moment. In this study ACT was used as a working frame. Based on the individual’s perspective, ACT was used flexibly, and was combined with stuttering-, and speech modification elements. We categorized stuttering- and speech modification-, and mindfulness-based elements into five areas of focus: 1) Awareness of body tension and posture, 2) Awareness of breath support in speech production, 3) Awareness in speech production to promote easier voicing, 4) Awareness of acceptance, affective and mindfulness-based strategies, and 5) Awareness presentation skills. We call this the ‘Minding the body in speech’-approach. Aims: The aims of this study were twofold: 1) To evaluate whether the ‘Minding the body in speech’-approach reduces stuttering severity for participants with overt stuttering. 2) To evaluate the extent to which the ‘Minding the body in speech’-approach has a positive impact on confidence in communication, avoidance behavior, and quality of life. Methods: Eighteen adults, age 21-61 years (mean age 35,5) took part in a multiple single case design study. Participants underwent a six-week pre-clinic assessment phase, followed by an eight-week explorative therapy period comprising a total of 10 hours within four therapy sessions administered by an experienced speech and language therapist specialized in fluency disorders. Each participant was re-tested for speech and a range of cognitive and emotional variables immediately after therapy, and again at six, and 12 months post-therapy. Results: Sustained improvements are demonstrated in the participants’ speech behavior, communication, and quality of life. Significant reduction in avoidance behavior on both individual-, and group-level is documented. At group level, the ‘Minding the body in speech’-approach was associated with positive statistical, clinical and personal significance. On an individual basis, the variability in response to the holistic multi-faceted approach was substantial. The findings indicated significantly greater improvement in outcomes for participants who reported an intensive home-based training compared to those who reported ‘now-and then’-training. Conclusion: As shown in this study, the relative weighting between the areas of focus needed to vary from individual to individual. Multiple factors were found to influence stuttering and stuttering related psychological variables at post-therapy. The intensity of the self-managed practice was a key factor in achieving long-lasting, positive change.

• Ahlers, Imke; Smet, Melissa de; Halvorsen, Margrethe S.; Oddli, Hanne & Below, Camilla von (2018). The perks and hazards of qualitative research in the field of psychotherapy. Structured discussion. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. (2017). Uforsvarlig drift eller politisk maktspill? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 54(12), s. 1200–1201. Fulltekst i vitenarkiv
• Sønsterud, Hilda; Halvorsen, Margrethe S.; Feragen, Kristin Judith Billaud; Ward, David & Kirmess, Melanie (2017). What do people search for in stuttering therapy -personal goal-setting as a gold standard? Aim. Fulltekst i vitenarkiv
• Sønsterud, Hilda; Kirmess, Melanie; Halvorsen, Margrethe S.; Feragen, Kristin Judith Billaud & Ward, David (2017). Individualized stuttering therapy for adults - what works for whom? Fulltekst i vitenarkiv
• Sønsterud, Hilda; Howells, Kirsten; Halvorsen, Margrethe S.; Feragen, Kristin Judith Billaud; Ward, David & Kirmess, Melanie (2017). The working alliance in stuttering therapy: A neglected variable? Fulltekst i vitenarkiv
• Oddli, Hanne; Nissen-Lie, Helene A; Mcleod, John; Rønnestad, Michael Helge & Halvorsen, Margrethe S. (2017). Goal consensus between client and therapist. A mixed-method study. Fulltekst i vitenarkiv
• Andenæs, Agnes; Benum, Kirsten; Carlquist, Erik; Halvorsen, Margrethe S.; Hauge, Mona-Iren & Madsen, Ole Jacob [Vis alle 15 forfattere av denne artikkelen] (2017). Sneversynt om psykologisk kunnskap. Morgenbladet. ISSN 0805-3847. 198(5), s. 28–29. Fulltekst i vitenarkiv
• Benum, Kirsten; Halvorsen, Margrethe S.; Oddli, Hanne; Øiestad, Guro & Mcleod, John (2016). The journey towards becoming an integrative psychotherapist: Teaching integration in as a perspective on theory, research and practice. Fulltekst i vitenarkiv
• Oddli, Hanne; Benum, Kirsten; Halvorsen, Margrethe S. & Stänicke, Erik (2015). Expert therapists as clinicians and research participants. Fulltekst i vitenarkiv
• Stänicke, Erik; Benum, Kirsten; Halvorsen, Margrethe S. & Oddli, Hanne (2015). Timing som et aspekt ved terapeutisk ekspertise. Fulltekst i vitenarkiv
• Stänicke, Erik; Benum, Kirsten; Halvorsen, Margrethe S. & Oddli, Hanne (2015). Timing as an aspect of expertise. Fulltekst i vitenarkiv
• Oddli, Hanne; Benum, Kirsten; Halvorsen, Margrethe S. & Stänicke, Erik (2015). Klinisk ekspertise – hva er det og hvordan viser det seg i praksis? Analyser av ekspertterapeuter som klinikere, lærere og forskningsdeltakere. Fulltekst i vitenarkiv
• Stänicke, Erik; Oddli, Hanne; Halvorsen, Margrethe S. & Benum, Kirsten (2015). Psykoterapiforskningen støtter ikke pakkeforløp. Morgenbladet. ISSN 0805-3847. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Benum, Kirsten; Stänicke, Erik & Oddli, Hanne (2015). How usual is treatment as usual? Experienced therapists’ reflections on research participation. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Benum, Kirsten; Stänicke, Erik & Oddli, Hanne (2015). How usual is treatment as usual? Erfarne terapeuters refleksjoner over forskningsdeltagelse. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. (2015). Bedringens tap. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 8, s. 788–790. Fulltekst i vitenarkiv
• Benum, Kirsten; Halvorsen, Margrethe S.; Oddli, Hanne & Stänicke, Erik (2015). The expert therapist reflecting on high Referential Activity (symbolization) in a session. Fulltekst i vitenarkiv
• Benum, Kirsten; Halvorsen, Margrethe S.; Oddli, Hanne & Stänicke, Erik (2015). Hvordan jobber erfarne terapeuter i praksis? Kasusstudier som metode. Fulltekst i vitenarkiv
• Benum, Kirsten; Halvorsen, Margrethe S.; Oddli, Hanne & Stänicke, Erik (2015). En terapeut sine refleksjoner over en time med høyt nivå av Referential Activity. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. (2014). Ut-trette eller ut-rette? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 12. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Benum, Kirsten; Haavind, Hanne; Lippe, Anna Louise Von der; Nissen-Lie, Helene A & Oddli, Hanne [Vis alle 9 forfattere av denne artikkelen] (2014). How does alliance work develop in phases of psychotherapy? Fulltekst i vitenarkiv
• Benum, Kirsten & Halvorsen, Margrethe S. (2013). The researcher, the therapist and the client: Integrating different voices in a case study of bond formation. Fulltekst i vitenarkiv
• Oddli, Hanne & Halvorsen, Margrethe S. (2011). Experienced therapists’ reports of their assessments, predictions and decision-making in the early phase of psychotherapy. Fulltekst i vitenarkiv
• Benum, Kirsten & Halvorsen, Margrethe S. (2011). A life saving bond. When the therapeutic alliance is threatened by persistent suicidality. Fulltekst i vitenarkiv
• Råbu, Marit; Halvorsen, Margrethe S. & Haavind, Hanne (2010). Early relationship struggles. A case study of alliance formation and reparation. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S.; Rønnestad, Michael Helge; Lippe, Anna Louise Von der; Axelsen, Eva; Haavind, Hanne & Gullestad, Siri Erika [Vis alle 8 forfattere av denne artikkelen] (2010). Convergence of alliance ratings in a sample of highly experienced teacher-therapists and their clients. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. (2007). Hvilken betydning har pasienters selvbilde for endring i psykoterapi? Fulltekst i vitenarkiv
• Halvorsen, Margrethe Seeger (2003). Aspects of self-image and changes in psychotherapy. Fulltekst i vitenarkiv
• Halvorsen, Margrethe Seeger (2003). Self-image and changes in psychotherapy. Fulltekst i vitenarkiv
• Holbæk, Ingunn; Halvorsen, Margrethe S. & Vrabel, Kari-Anne (2026). Bridging Disconnection: A Qualitative Study Exploring Lived Change in Complex Dissociative Disorders. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  This study explores experiences of change related to treatment among individuals with complex dissociative disorders (CDD). Their first-person accounts shed light on their experiences with a psychoeducative skills-training group, the impressions it left, and their broader sense of recovery over time. CDD is a severe condition associated with wide variability in functioning and intense internal symptom pressure (Diagnostic and Statistical Manual of Mental Disorders [DSM-5 TR], American Psychiatric Association [APA], 2022; International Society for the Study of Trauma and Dissociation [ISSTD], 2011). Individuals may struggle with memory for current situations, altered time perception, and significant internal conflict (Marais et al., 2023; Parry et al., 2018). CDD typically present with multiple comorbid disorders (Rodewald et al., 2011) and elevated risk of self-harm and suicidality (Leonard et al., 2005; Webermann et al., 2017). Studies suggest that many receive other diagnoses first and that CDD diagnosis often is delayed (Spiegel et al., 2011). Relative to its prevalence and clinical significance, CDD has received little empirical attention, and key determinants of effective treatment remain unclear. The field is marked by conceptual debates (e.g., the definition and scope of dissociation; Dorahy & Gold, 2023; Nijenhuis & van der Hart, 2011), etiological disagreements (e.g., trauma versus sociocognitive models; Dalenberg et al., 2012; Lynn et al., 2012), and treatment controversies (e.g., phase-oriented vs. exposure-based approaches; De Jongh et al., 2016; Stavropoulos & Elliott, 2023; van Vliet et al., 2018). This thesis is shaped by all of these debates, in which participants’ experiences of change relate to how dissociation is defined, how its origins are understood, and, consequently, what may constitute effective treatment. In this contested field, the treatment debate is especially relevant to the present study. Despite ongoing disagreements, international guidelines currently recommend a phase oriented, dissociation-specific approach (ISSTD, 2011; Brand et al., 2012). Such treatment is not yet strictly operationalized, and empirical studies of its effectiveness remain limited. Although a recent randomized controlled trial (RCT) of a psychoeducative intervention and a systematic review indicate some support for phase-oriented treatment (Brand et al., 2025; Griffiths et al., 2025), there are no comparative studies of different types of interventions. And we still know little about how treatment works, how it is experienced, which interventions are perceived as helpful, what individuals with CDD long for, and how to assess change when dissociation complicates self-report. To address some of the knowledge gaps related to first-person perspectives on change and treatment, we conducted a qualitative, longitudinal study at a Norwegian trauma outpatient clinic in Oslo. Participants also took part in an RCT examining the effects of a 20 week psychoeducative group-intervention. The longitudinal sample comprised 26 adults with CDD who had extensive histories of childhood trauma, high comorbidity, and long treatment trajectories. They were interviewed six months (Paper I) and two years (Paper II) after the group intervention. A smaller subsample, also interviewed at pre-treatment, contributed to Paper III. Across papers, we examined participants’ accounts of change using hermeneutic phenomenological qualitative analyses. In Paper I we aimed to explore participants’ experience and perceived impact of the group intervention with interviews conducted six months post-intervention. The key findings were movement toward a more coherent sense of self and an increased sense of agency. Psychoeducation provided non-stigmatizing language and skills such as grounding and dual attention helped reestablish presence and the capacity to notice and engage with internal conflicts. Recovery was experienced as coordinating parts of the personality, not eliminating them. Being with others in the group had a substantial impact, normalizing experiences that had often set them apart, fostering belonging, and reducing detachment. Paper II aimed to identify long-term patterns and variations of change two years after the intervention. The main finding was movement along three pathways of change: (1) increased ability to stay present in life, (2) approaching and negotiating internal conflicts among parts of the personality, and (3) increased ownership (“mineness”) of past and present. The majority of participants used coping strategies that helped them tolerate and relate to their internal conflicts. They reported greater ownership of their reactions and their histories. A smaller group relied on regulation strategies to maintain functioning and prevent breakdowns. They experienced less change in their ability to engage in negotiating internal conflicts. Paper III followed six participants longitudinally from pre-treatment through six months and two years post-intervention. We explored trajectories of change in relation to what they longed for before treatment. These longings clustered around identity, self-trust, safety, relational authenticity, and contributing to society. Over time, change consolidated into restoring the self, restoring safety, and restoring connectedness. These changes culminated in an overarching theme: “restoring the sense of next,” understood as a renewed capacity to imagine and take the next step in life. Validation from the therapist, careful pacing, and regulating rest and activity were described as important. The findings across Papers I–III are discussed in terms of what changed, how treatment affected those changes, and how we can measure whether change has occurred. Methodological limitations are also addressed. Across the three papers, this thesis offers lived-experience insights that may have implications for other individuals with CDD: • A patient-centered, longitudinal map of change. These studies highlight the importance of discerning patients’ longings, building capacities to stay present, maintaining dual attention, and tolerate internal states. Negotiating internal conflicts appeared to support ownership and integration of past and present experiences into a more coherent narrative. • Practical guidance on what facilitates change. Psychoeducation explaining why dissociation occurs and what internal conflicts express, was experienced as helpful. Skills that increased capacity to relate to mental content seemed to contribute to a stronger sense of agency. A helpful therapeutic alliance included careful pacing and validation of experiences. Meeting others in similar situations normalized experiences and reduced shame. • An assessment frame aligned with different phases of treatment. Early perceived changes can be meaningful even if they do not immediately produce significant shifts on symptom scales. Changes in the dissociative structure seem often to emerge later in treatment or when directly targeted. Combining symptoms and functioning measures with process sensitive markers, and using measures suitable for longer-term follow-up, better captures what patients experience as meaningful progress. • A hopeful, mechanism-informed view of change in CDD. The findings suggest that substantial structural and existential changes may be possible when treatment aligns with longings and capacities, helping individuals “gather themselves” into a more coherent, agentic self with a renewed sense of next.

• Oddli, Hanne; Halvorsen, Margrethe S. & Rønnestad, Michael Helge (2014). Expertise demonstrated: What does it mean to be an expert psychotherapist? Society for the Advancement of Psychotherapy, Div 29 of the American Psychological Association. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. (2006). Self-Image and Psychotherapy: Measurement, Predictor and Outcome Issues. Universitetet i Oslo. Fulltekst i vitenarkiv
• Halvorsen, Margrethe S. & Joner, Andreas (2001). Lesbian families in Norway: A comparative study of child and family functioning in lesbian, single mother, and heterosexual families. UiT Norges arktiske universitet. Fulltekst i vitenarkiv

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