{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T07:13:42Z","timestamp":1776410022581,"version":"3.51.2"},"reference-count":59,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T00:00:00Z","timestamp":1513900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","award":["17527"],"award-info":[{"award-number":["17527"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Psychology and Psychoth"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:p>This study suggests some potential pathways leading towards maintained gains or further growth versus deterioration after naturalistic psychotherapy with experienced clinicians. This is explored in a way that transcends specific theoretical orientations. Sixteen therapies, all showing reliable improvement on Outcome Questionnaire 45.2 (OQ\u201045)\u00a0at treatment termination but varying in later post\u2010therapy development, were included in this study. Building on previous content and correlational analyses, individual cases were explored qualitatively in search for developmental patterns of potential relevance for long\u2010term outcome. Patterns re\u2010emerging across several cases were described in light of the OQ\u201045 trajectories of clients providing them. Six pathways, associated with different long\u2010term outcomes, emerged. Four of these, \u201cReflective route towards regulation of affects,\u201d \u201cGaining autonomy through a secure holding relationship,\u201d \u201cOpening up as a new relational\/emotional experience,\u201d and \u201cLasting acceptance of \u00abreality\u00bb,\u201d re\u2010emerged in clients showing maintained\/growing treatment effects. Two pathways, entitled \u201cResidual problems grow and overshadow progress\u201d and \u201cCore problems remain beneath superficial change,\u201d seemed linked to deterioration after termination of therapy. We suggest the former pathways as some possible routes towards enduring good outcome, and the latter as some patterns to avoid when trying to secure therapy gains will not be only temporary.<\/jats:p>","DOI":"10.1002\/cpp.2162","type":"journal-article","created":{"date-parts":[[2017,12,23]],"date-time":"2017-12-23T20:41:46Z","timestamp":1514061706000},"page":"292-301","source":"Crossref","is-referenced-by-count":2,"title":["Pathways towards different long\u2010term outcomes after naturalistic psychotherapy"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-6825","authenticated-orcid":false,"given":"Vidar Blokhus","family":"Ekroll","sequence":"first","affiliation":[{"name":"Department of Psychology University of Oslo  Oslo Norway"},{"name":"Akershus University Hospital  L\u00f8renskog Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Helge","family":"R\u00f8nnestad","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Oslo  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,12,22]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Psychoanalytic therapy","author":"Alexander F.","year":"1946"},{"key":"e_1_2_10_3_1","volume-title":"Meditations","author":"Aurelius M.","year":"2003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780198570905.001.0001"},{"key":"e_1_2_10_5_1","series-title":"Attachment and loss","volume-title":"Attachment","author":"Bowlby J.","year":"1969"},{"key":"e_1_2_10_6_1","volume-title":"A secure base: Parent\u2010child attachment and healthy human development","author":"Bowlby J.","year":"1988"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2005.07.003"},{"key":"e_1_2_10_8_1","volume-title":"The myth of Sisyphus","author":"Camus A.","year":"1955"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/11532-000"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/13747-000"},{"key":"e_1_2_10_11_1","first-page":"298","volume-title":"Bergin and Garfield's handbook of psychotherapy and behavioral change","author":"Crits\u2010Christoph P.","year":"2013"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503300600756402"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2345"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2015.1119326"},{"key":"e_1_2_10_15_1","article-title":"Exploring associations between therapy factors and post\u2010therapy development after naturalistic psychotherapies","author":"Ekroll V. B.","year":"2017","journal-title":"Journal of Contemporary Psychotherapy"},{"key":"e_1_2_10_16_1","first-page":"219","volume-title":"Bergin and Garfield's handbook of psychotherapy and behavioral change","author":"Elliott R.","year":"2013"},{"key":"e_1_2_10_17_1","first-page":"147","volume-title":"A handbook of research methods in clinical and health psychology","author":"Elliott R.","year":"2005"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/00030651070550020401"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2007.01727.x"},{"key":"e_1_2_10_20_1","first-page":"213","article-title":"Formulations on the two principles of mental functioning","volume":"12","author":"Freud S.","year":"1911","journal-title":"Standard Edition"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/075910639404500105"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000273025"},{"key":"e_1_2_10_23_1","first-page":"2","article-title":"Embracing your demons: An overview of acceptance and commitment therapy","volume":"12","author":"Harris R.","year":"2006","journal-title":"Psychotherapy in Australia"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptr\/kpg031"},{"key":"e_1_2_10_25_1","volume-title":"How does psychotherapy work: Through gain of insight or through gain of affective awareness?","author":"H\u00f8glend P.","year":"2015"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2010.05.006"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.57.102904.190044"},{"key":"e_1_2_10_28_1","volume-title":"Inventory of interpersonal problems manual","author":"Horowitz L. M.","year":"2000"},{"key":"e_1_2_10_29_1","first-page":"367","article-title":"Individuation and relatedness: Not opposing but distinct and complementary","volume":"129","author":"Imamoglu E. O.","year":"2003","journal-title":"Genetic, Social & General Psychology Monographs"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.03.018"},{"key":"e_1_2_10_31_1","volume-title":"Contemporary interpersonal theory and research: Personality, psychopathology and psychotherapy","author":"Kiesler D. J.","year":"1996"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1080\/01062301.2006.10592775"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.05.003"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.3109\/08039488.2012.680910"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-0879(199612)3:4<249::AID-CPP106>3.0.CO;2-S"},{"key":"e_1_2_10_36_1","volume-title":"Administration and scoring manual for the OQ\u201045.2","author":"Lambert M. J.","year":"1996"},{"key":"e_1_2_10_37_1","volume-title":"Interpersonal diagnosis of personality","author":"Leary T.","year":"1957"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.7.1223"},{"key":"e_1_2_10_39_1","volume-title":"Effective Ingredients of Successful Psychotherapy","author":"Liberman B. L.","year":"1978"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8260.1988.tb00779.x"},{"key":"e_1_2_10_41_1","volume-title":"Cognitive\u2010behavioral therapy and relapse prevention for depression and anxiety","author":"Ludgate J. W.","year":"2009"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.72.1.31"},{"key":"e_1_2_10_43_1","volume-title":"Qualitative research in conselling and psychotherapy","author":"McLeod J.","year":"2011"},{"key":"e_1_2_10_44_1","volume-title":"Freud and beyond","author":"Mitchell S. A.","year":"1995"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.1977"},{"key":"e_1_2_10_46_1","first-page":"307","volume-title":"Bergin and Garfield's handbook of psychotherapy and behavior change","author":"Orlinsky D. E.","year":"2004"},{"key":"e_1_2_10_47_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.31887\/DCNS.2008.10.4\/espaykel","article-title":"Partial remission, residual symptoms, and relapse in depression","volume":"10","author":"Paykel E. S.","year":"2008","journal-title":"Dialogues in Clinical Neuroscience"},{"key":"e_1_2_10_48_1","unstructured":"R\u00f8nnestad M. H.(2009).An intensive process\u2010out\u2010come study of the interpersonal aspects of psychotherapy. Application for the council of research. Department of Psychology University of Oslo August 2009. Retrieved fromhttp:\/\/www.psykologi.uio.no\/personer\/vit\/helgero_linker\/process%20_outcome_study.Pdf."},{"key":"e_1_2_10_49_1","unstructured":"R\u00f8nnestad M. H. Gullestad S. E. Halvorsen M. Haavind H. Lippe A. L.von der \u2026Reichelt S.(2014).The outcomes of therapies conducted by highly experienced therapists. Paper presented at SPR\u2010conference Copenhagen."},{"key":"e_1_2_10_50_1","volume-title":"Mindfulness\u2010based cognitive therapy for depression","author":"Segal Z.","year":"2002"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2011.583696"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.75.4.523"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1080\/08039480801960123"},{"key":"e_1_2_10_54_1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1037\/0022-006X.75.3.404","article-title":"Sudden gains in cognitive therapy of depression and depression relapse\/recurrence","volume":"75","author":"Tang T. Z.","year":"2007","journal-title":"Journal of Consulting and Clinical Psychology"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029564"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psychotherapy.2009.63.3.227"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1177\/073428299701500104"},{"key":"e_1_2_10_58_1","volume-title":"How do highly experienced therapists succeed with \u2018difficult\u2010to\u2010treat\u2019 clients?","author":"Lippe A. L.","year":"2014"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203582015"},{"key":"e_1_2_10_60_1","volume-title":"Existential psychotherapy","author":"Yalom I. D.","year":"1980"}],"container-title":["Clinical Psychology &amp; Psychotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcpp.2162","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpp.2162","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T06:15:19Z","timestamp":1695536119000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cpp.2162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,22]]},"references-count":59,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1002\/cpp.2162"],"URL":"https:\/\/doi.org\/10.1002\/cpp.2162","archive":["Portico"],"relation":{},"ISSN":["1063-3995","1099-0879"],"issn-type":[{"value":"1063-3995","type":"print"},{"value":"1099-0879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,22]]}}}