THERAPISTS’ VIEW OF THERAPEUTIC ACTION IN PSYCHOANALYTIC PSYCHOTHERAPY WITH YOUNG ADULTS PETER LILLIENGREN AND ANDRZEJ WERBART Stockholm University, and Stockholm County Council, Stockholm, Sweden Studying experienced therapists’ im- plicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations. In this study, 16 therapists’ views of curative factors, hindering factors, and outcome were explored in 22 interviews conducted at termination of individual psychoanalytic psychotherapy with young adults. Grounded theory methodology was used to construct a tentative model of thera- peutic action based on the therapists’ implicit knowledge. The results indi- cated that developing a close, safe and trusting relationship was viewed as the core curative factor in interaction with the patient making positive experiences outside the therapy setting and the ther- apist challenging and developing the patient’s thinking about the self. The therapeutic process was experienced as a joint activity resulting in the patient becoming a subject and acquiring an increasing capacity to think and pro- cess problems. The patient’s fear about close relationships was seen as hinder- ing treatment and leading to core prob- lems remaining. The model is discussed in relation to major theories of thera- peutic action in the psychoanalytic dis- course and previous research focusing on young adults’ view of curative and hindering factors in psychotherapy. Implications for practice and further research are suggested. Keywords: psychoanalytic psychother- apy, therapeutic action, young adults, curative and hindering factors, grounded theory A number of authors have argued that experi- enced therapists develop private “working mod- els” or “implicit theories,” which more or less overlap with their explicit theoretical orientation in how to conduct therapy (e.g., Kottler, 1986; Najavits, 1997; Sandler, 1983; Schön, 1983; Sho- ben, 1962). Implicit theories are a mix of per- sonal experiences, formal training, and profes- sional reflections and may include the therapist’s personal strategies of what to do during sessions or views about what processes are occurring in therapy. They also may include assumptions re- garding what not to do in therapy and what hin- ders treatment. According to Sandler (1983), past development of explicit theories arose when weaknesses in available theories led to the grad- Peter Lilliengren, Department of Psychology, Stockholm University, and Södermalm Psychiatric Outpatient Services, Stockholm County Council, Stockholm, Sweden; and Andrzej Werbart, Department of Psychology, Stockholm University, and Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden. This study was a part of the prospective, longitudinal Young Adult Psychotherapy Project conducted at the Institute of Psychotherapy, Stockholm County Council, and the Psy- chotherapy Section, Department of Clinical Neuroscience, Karolinska Institutet. The project was supported by grants from the Bank of Sweden, the Tercentenary Foundation (RJ 1999-0071), the Clas Groschinsky Memorial Fund (SF6 51), and the Centre for Health Care Science, Karolinska Institutet. The project has been approved by the Regional Research Ethics Committee at the Karolinska Institutet, and all partic- ipants have given their informed consent. Correspondence regarding this article should be addressed to Andrzej Werbart, PhD, Department of Psychology, Stock- holm University, SE-106 91 Stockholm, Sweden. E-mail: andrzej@werbart.se or andrzej.werbart@sll.se Psychotherapy Theory, Research, Practice, Training © 2010 American Psychological Association 2010, Vol. 47, No. 4, 570 –585 0033-3204/10/$12.00 DOI: 10.1037/a0021179 570