Despite its well-established importance in psychoanalytic theory, there is a scarcity of empirical evidence on the relationship between a therapist’s transference interpretation (TI) and therapeutic outcome. The current scientific literature shows no consensus on the existence and nature of such an association. Therefore, the present study aimed to systematically review the literature on the link between TI and outcomes in psychodynamic psychotherapies. The American Psychological Association PsycInfo, MEDLINE, and the Web of Science Core Collection were selected as the primary databases for the literature search. Studies were included if they measured the frequency/ concentration of TI in psychodynamic psychotherapy [e.g., transference focused psychotherapy (TFP), supportive-expressive therapy] or compared a treatment group (e.g., high in TI and TFP) with a control group (e.g., low in TI supportive therapy) in an adult population with psychiatric symptoms. Out of 825 retrieved abstracts, 25 articles (21 studies) were included in the final synthesis. 13 out of 21 (62%) studies showed a significant improvement in at least one therapy outcome measure following the use of TI. The present systematic review also revealed high heterogeneity across studies in terms of TI measurement, outcome assessment (e.g., psychiatric symptoms, dynamic change, interpersonal functioning, therapeutic alliance), study design (e.g., experimental, quasi-experimental, naturalistic), patient population (e.g., anxiety disorders, personality disorders), and types of treatment (e.g., TFP, supportive-expressive therapy), preventing researchers from asserting solid conclusions. The results strongly highlight the urgent need for highquality research to understand which types of patients, how, and when TIs could be effective throughout the therapy process.

Antichi, L., Giannini, M., & Loscalzo, Y. (2022). Interpretation in psychodynamic psychotherapy: a systematic review. Psychodynamic Practice, 28(3), 254-274. doi: 10.1080/14753634.2022.2046140. DOI: https://doi.org/10.1080/14753634.2022.2046140

Banon, E., Evan-Grenier, M., & Bond, M. (2001). Early transference interventions with male patients in psychotherapy. Journal of Psychotherapy Practice and Research, 10(2), 79-92.

Banon, E., Perry, J. C., Semeniuk, T., Bond, M., de Roten, Y., Hersoug, A. G., & Despland, J.-N. (2013). Therapist interventions using the psychodynamic interventions rating scale (PIRS) in dynamic therapy, psychoanalysis and CBT. Psychotherapy Research, 23(2), 121-136. doi: 10.1080/10503307.2012.745955. DOI: https://doi.org/10.1080/10503307.2012.745955 Brumberg, J., & Gumz, A. (2012). [Transference interpretations and how they work: a systematic review]. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 58(3), 219-235. doi: 10.13109/zptm.2012.58.3.219. [Article in German]. DOI: https://doi.org/10.13109/zptm.2012.58.3.219

Caligor, E., Kernberg, O. F., & Clarkin, J. F. (2007). Handbook of dynamic psychotherapy for higher level personality pathology. American Psychiatric Publishing, Inc.

Clarkin, J. F., Foelsch, P. A., Levy, K. N., Hull, J. W., Delaney, J. C., & Kernberg, O. F. (2001). The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change. Journal of Personality Disorders, 15(6), 487-495. doi: 10.1521/pedi.15.6.487.19190. DOI: https://doi.org/10.1521/pedi.15.6.487.19190 Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: a multiwave study. American Journal of Psychiatry, 164, 922-928. doi: 10.1176/appi.ajp.164.6.922. DOI: https://doi.org/10.1176/ajp.2007.164.6.922 Connolly, M., Crits-Christoph, P., Shappell, S., Barber, J., Luborsky, L., & Shaffer, C. (1999). Relation of transference interpretations to outcome in the early sessions of brief supportive-expressive psychotherapy. Psychotherapy Research, 9(4), 485-495. doi: 10.1080/10503309912331332881. DOI: https://doi.org/10.1080/10503309912331332881 Conversano, C., Di Giuseppe, M., & Lingiardi V. (2023) Case report: changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa. Frontiers in Psychology, 14, 1081467. doi: 10.3389/fpsyg.2023.1081467. DOI: https://doi.org/10.3389/fpsyg.2023.1081467 Cooper, A. M. (1987). Changes in psychoanalytic ideas: transference interpretation. Journal of the American Psychoanalytic Association, 35(1), 77-98. doi: 10.1177/000306518703500104. DOI: https://doi.org/10.1177/000306518703500104

Crits-Christoph, P., & Gibbons, M. B. C. (2021). Psychotherapy process-outcome research: advances in understanding causal connections. In Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (pp 263-296).

Crits-Christoph, P., & Gibbons, M. B. C. (2001). Relational interpretations. Psychotherapy: Theory, Research, Practice, Training, 38(4), 423-428. doi: 10.1037/0033-3204.38.4.423. DOI: https://doi.org/10.1037//0033-3204.38.4.423 Cutler, J. L., Goldyne, A., Markowitz, J. C., Devlin, M. J., & Glick, R. A. (2004). Comparing cognitive behavior therapy, interpersonal psychotherapy, and psychodynamic psychotherapy. American Journal of Psychiatry, 161(9), 1567-1573. doi: 10.1176/appi.ajp.161.9.1567. DOI: https://doi.org/10.1176/appi.ajp.161.9.1567 Diamond, D., Keefe, J. R., Hörz-Sagstetter, S., Fischer-Kern, M., Doering, S., & Buchheim, A. (2023). Changes in attachment representation and personality organization in transference-focused psychotherapy. American Journal of Psychotherapy, 76(1), 31-38. doi: 10.1176/appi.psychotherapy.20220018. DOI: https://doi.org/10.1176/appi.psychotherapy.20220018 Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P., & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. British Journal of Psychiatry, 196(5), 389-395. doi: 10.1192/bjp.bp.109.070177. DOI: https://doi.org/10.1192/bjp.bp.109.070177 Fischer-Kern, M., Doering, S., Taubner, S., Hörz, S., Zimmermann, J., Rentrop, M., Schuster, P., Buchheim, P., & Buchheim, A. (2015). Transference-focused psychotherapy for borderline personality disorder: change in reflective function. British Journal of Psychiatry, 207(2), 173-174. doi: 10.1192/bjp.bp.113.143842. DOI: https://doi.org/10.1192/bjp.bp.113.143842

Freud, S. (1912). The dynamics of transference. In Classics in Psychoanalytic Techniques, 12, 97-108.

Freud, S. (1917). Introductory lectures on psycho-analysis. The Standard Edition of the Complete Psychological Works of Sigmund Freud, 16,241-463.

Gabbard, G. O. (2004). Long-term psychodynamic psychotherapy: a basic text. American Psychiatric Publishing, Inc.

Gabbard, G. O., & Horowitz, M. J. (2009). Insight, transference interpretation, and therapeutic change in the dynamic psychotherapy of borderline personality disorder. American Journal of Psychiatry, 166(5), 517-521. doi: 10.1176/appi.ajp.2008.08050631. DOI: https://doi.org/10.1176/appi.ajp.2008.08050631 Gabbard, G. O., Horwitz, L., Allen, J. G., Frieswyk, S., Newsom, G., Colson, D. B., & Coyne, L. (1994). Transference interpretation in the psychotherapy of borderline patients: a high-risk, high-gain phenomenon. Harvard Review of Psychiatry, 2(2), 59-69. doi: 10.3109/10673229409017119. DOI: https://doi.org/10.3109/10673229409017119

Giovacchini, P. L. (1979). Treatment of primitive mental states. Jason Aranson.

Godwin, M., Ruhland, L., Casson, I., MacDonald, S., Delva, D., Birtwhistle, R., Lam, M., & Seguin, R. (2003). Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity. BMC Medical Research Methodology, 3(1), 28. doi: 10.1186/1471-2288-3-28. DOI: https://doi.org/10.1186/1471-2288-3-28

Goodman, G. (2011). An attachment-based pathways model depicting the psychology of therapeutic relationships. In A. M. Columbus (Ed.), Advances in psychology research. (pp. 105-125). Nova Science Publishers.

Henriksen, A. K., Ulberg, R., Tallberg, B. P. U., Løvgren, A., & Johnsen Dahl, H. S. (2021). Conflicted anger as a central dynamic in depression in adolescents—a double case study. International Journal of Environmental Research and Public Health, 18(12), 6466. doi: 10.3390/ijerph18126466. DOI: https://doi.org/10.3390/ijerph18126466 Hersoug, A. G., Ulberg, R., & Høglend, P. (2014). When is transference work useful in psychodynamic psychotherapy? Main results of the first experimental study of transference work (FEST). Contemporary Psychoanalysis, 50(1-2), 156-174. doi: 10.1080/00107530.2014.880314. DOI: https://doi.org/10.1080/00107530.2014.880314 Hobson, R. P., & Kapur, R. (2005). Working in the transference: clinical and research perspectives. Psychology and Psychotherapy: Theory, Research and Practice, 78(3), 275-295. doi: 10.1348/147608305X25801. DOI: https://doi.org/10.1348/147608305X25801

Høglend, P. (2004). Analysis of transference in psychodynamic psychotherapy: a review of empirical research. Canadian Journal of Psychoanalysis/Revue Canadienne de Psychanalyse, 12, 280-300.

Høglend, P., Amlo, S., Marble, A., Bøgwald, K.-P., Sørbye, Ø., Sjaastad, M. C., & Heyerdahl, O. (2006). Analysis of the patient-therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations. American Journal of Psychiatry, 163(10), 1739-1746. doi: 10.1176/ajp.2006.163.10.1739. DOI: https://doi.org/10.1176/ajp.2006.163.10.1739 Høglend, P., Bøgwald, K.-P., Amlo, S., Marble, A., Ulberg, R., Sjaastad, M. C., Sørbye, Ø., Heyerdahl, O., & Johansson, P. (2008). Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? American Journal of Psychiatry, 165(6), 763-771. doi: 10.1176/appi.ajp.2008.07061028. DOI: https://doi.org/10.1176/appi.ajp.2008.07061028

Høglend, P., Sørlie, T., Heyerdahl, O., Sørbye, Ø., & Amlo, S. (1993). Brief dynamic psychotherapy. Journal of Psychotherapy Practice and Research, 2(3), 230-241.

Joseph, B. (1985). Transference: the total situation. International Journal of Psychoanalysis, 66, 447-454.

Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: overview and update. International Journal of Psychoanalysis, 89(3), 601-620. doi: 10.1111/j.1745-8315.2008.00046.x. DOI: https://doi.org/10.1111/j.1745-8315.2008.00046.x Klein, C., Milrod, B. L., Busch, F. N., Levy, K. N., & Shapiro, T. (2003). A preliminary study of clinical process in relation to outcome in psychodynamic psychotherapy for panic disorder. Psychoanalytic Inquiry, 23(2), 308-331. doi: 10.1080/07351692309349035. DOI: https://doi.org/10.1080/07351692309349035

Klein, M. (1952). The origins of transference. International Journal of Psychoanalysis, 33, 433-438.

Kohut, H. (1971). The analysis of the self. University of Chicago Press.

Langs, R. J. (1973). The patient’s view of the therapist: reality or fantasy? International Journal of Psychoanalytic Psychotherapy, 2(4), 411-431.

Leichsenring, F., Abbass, A., Hilsenroth, M. J., Leweke, F., Luyten, P., Keefe, J. R., Midgley, N., Rabung, S., Salzer, S., & Steinert, C. (2017). Biases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research. Psychological Medicine, 47(6), 1000-1011. doi: 10.1017/S003329171600324X. DOI: https://doi.org/10.1017/S003329171600324X Leichsenring, F., Hiller, W., Weissberg, M., & Leibing, E. (2006). Cognitive-behavioral therapy and psychodynamic psychotherapy: techniques, efficacy, and indications. American Journal of Psychotherapy, 60, 233-259. doi: 10.1176/appi.psychotherapy.2006.60.3.233. DOI: https://doi.org/10.1176/appi.psychotherapy.2006.60.3.233 Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. British Journal of Psychiatry, 199(1), 15-22. doi: 10.1192/bjp.bp.110.082776. DOI: https://doi.org/10.1192/bjp.bp.110.082776 Levy, K. N., Clarkin, J. F., Yeomans, F. E., Scott, L. N., Wasserman, R. H., & Kernberg, O. F. (2006). The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. Journal of Clinical Psychology, 62(4), 481-501. doi: 10.1002/jclp.20239. DOI: https://doi.org/10.1002/jclp.20239 Levy, K. N., & Scala, J. W. (2012). Transference, transference interpretations, and transference-focused psychotherapies. Psychotherapy, 49(3), 391-403. doi: 10.1037/a0029371. DOI: https://doi.org/10.1037/a0029371

Lilliengren, P. (2017). Comprehensive compilation of randomized controlled trials (RCTs) involving psychodynamic treatments and interventions.

Luborsky, L., Crits-Christoph, P., Mintz, J., & Auerbach, A. (1988). Who will benefit from psychotherapy? Predicting therapeutic outcomes. Basic Books.

Luyten, P., Fonagy, P., Lowyck, B., & Vermote, R. (2012). Assessment of mentalization. In Handbook of mentalizing in mental health practice (pp. 43-65). American Psychiatric Publishing, Inc.

Marmar, C. R., Weiss, D. S., & Gaston, L. (1989). Toward the validation of the California therapeutic alliance rating system. Psychological Assessment: a Journal of Consulting and Clinical Psychology, 1(1), 46-52. doi: 10.1037/1040-3590.1.1.46. DOI: https://doi.org/10.1037/1040-3590.1.1.46 Marziali, E. A. (1984). Prediction of outcome of brief psychotherapy from therapist interpretive interventions. Archives of General Psychiatry, 41(3), 301-304. doi: 10.1001/archpsyc.1984.01790140091011. DOI: https://doi.org/10.1001/archpsyc.1984.01790140091011 McCullough, L., Winston, A., Farber, B. A., Porter, F., Pollack, J., Vingiano, W., Laikin, M., & Trujillo, M. (1991). The relationship of patient-therapist interaction to outcome in brief psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 28(4), 525-533. doi: 10.1037/0033-3204.28.4.525. DOI: https://doi.org/10.1037/0033-3204.28.4.525

Milbrath, C., Bond, M., Cooper, S., Znoj, H., Horowitz, M., & Perry, J. (1999). Sequential consequences of therapists’ interventions. Journal of Psychotherapy Practice and Research, 8, 40-54.

Ogrodniczuk, J. S., Piper, W. E., Joyce, A. S., & McCallum, M. (1999). Transference interpretations in short-term dynamic psychotherapy. Journal of Nervous and Mental Disease, 187(9), 571-578. doi: 10.1097/00005053-199909000-00007. DOI: https://doi.org/10.1097/00005053-199909000-00007 Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery, 88, 105906. DOI: https://doi.org/10.31222/osf.io/v7gm2 Perez, D. L., Vago, D. R., Pan, H., Root, J., Tuescher, O., Fuchs, B. H., Leung, L., Epstein, J., Cain, N. M., Clarkin, J. F., Lenzenweger, M. F., Kernberg, O. F., Levy, K. N., Silbersweig, D. A., & Stern, E. (2016). Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder. Psychiatry and Clinical Neurosciences, 70(1), 51-61. doi: 10.1111/pcn.12357. DOI: https://doi.org/10.1111/pcn.12357 Piper, W. E., Azim, H. F. A., Joyce, A. S., & McCallum, M. (1991). Transference interpretations, therapeutic alliance, and outcome in short-term individual psychotherapy. Archives of General Psychiatry, 48(10), 946-953. doi: 10.1001/archpsyc.1991.01810340078010. DOI: https://doi.org/10.1001/archpsyc.1991.01810340078010 Piper, W. E., Debbane, E. G., Bienvenu, J.-P., de Carufel, F., & Garant, J. (1986). Relationships between the object focus of therapist interpretations and outcome in short-term individual psychotherapy. British Journal of Medical Psychology, 59(1), 1-11. doi: 10.1111/j.2044-8341.1986.tb02659.x. DOI: https://doi.org/10.1111/j.2044-8341.1986.tb02659.x Piper, W. E., Ogrodniczuk, J. S., Joyce, A. S., McCallum, M., Rosie, J. S., O’Kelly, J. G., & Steinberg, P. I. (1999). Prediction of dropping out in time-limited, interpretive individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 36, 114-122. doi: 10.1037/h0087787. DOI: https://doi.org/10.1037/h0087787 Ryum, T., Stiles, T. C., Svartberg, M., & McCullough, L. (2010). The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders. Psychotherapy: Theory, Research, Practice, Training, 47, 442-453. doi: 10.1037/a0021183. DOI: https://doi.org/10.1037/a0021183 Sahin, Z., Vinnars, B., Gorman, B. S., Wilczek, A., Åsberg, M., & Barber, J. P. (2018). Clinical severity as a moderator of outcome in psychodynamic and dialectical behavior therapies for borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 9(5), 437-446. doi: 10.1037/per0000276. DOI: https://doi.org/10.1037/per0000276 Schut, A. J., Castonguay, L. G., Flanagan, K. M., Yamasaki, A. S., Barber, J. P., Bedics, J. D., & Smith, T. L. (2005). Therapist interpretation, patient-therapist interpersonal process, and outcome in psychodynamic psychotherapy for avoidant personality disorder. Psychotherapy: Theory, Research, Practice, Training, 42(4), 494-511. doi: 10.1037/0033-3204.42.4.494. DOI: https://doi.org/10.1037/0033-3204.42.4.494 Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi: 10.1037/a0018378. DOI: https://doi.org/10.1037/a0018378 Silberschatz, G., Fretter, P. B., & Curtis, J. T. (1986). How do interpretations influence the process of psychotherapy?. Journal of Consulting and Clinical Psychology, 54(5), 646-652. doi: 10.1037/0022-006X.54.5.646. DOI: https://doi.org/10.1037//0022-006X.54.5.646 Steinert, C., Munder, T., Rabung, S., Hoyer, J., & Leichsenring, F. (2017). Psychodynamic therapy: as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes. American Journal of Psychiatry, 174(10), 943-953. doi: 10.1176/appi.ajp.2017.17010057. DOI: https://doi.org/10.1176/appi.ajp.2017.17010057

Strachey, J. (1934). The nature of the therapeutic action of psycho-analysis. International Journal of Psycho-Analysis, 15, 127-159.

Tyndale, A. (1999). How far is transference interpretation essential to psychic change? In Psychoanalytic Psychotherapy in the Independent Tradition. Routledge.

Ulberg, R., Amlo, S., & Høglend, P. (2014). Manual for transference work scale; a micro-analytical tool for therapy process analyses. BMC Psychiatry, 14(1), 291. doi: 10.1186/s12888-014-0291-y. DOI: https://doi.org/10.1186/s12888-014-0291-y Ulberg, R., Hummelen, B., Hersoug, A. G., Midgley, N., Høglend, P. A., & Dahl, H.-S. J. (2021). The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study. BMC Psychiatry, 21(1), 106. doi: 10.1186/s12888-021-03055-y. DOI: https://doi.org/10.1186/s12888-021-03055-y

Winnicott, D. W. (1949). Hate in the countertransference. International journal of psychoanalysis, 30(2), 69-74.

Zetzel, E. R. (1956). Current concepts of transference. International Journal of Psychoanalysis, 37, 369-375.

Zilcha-Mano, S., Fisher, H., Dolev-Amit, T., Keefe, J. R., & Barber, J. P. (2023). A systematic review of the association between interpretations and immediate, intermediate, and distal outcomes. Psychotherapy, 60(3), 266-282. doi: 10.1037/pst0000479. DOI: https://doi.org/10.1037/pst0000479 Zilcha-Mano, S., Keefe, J. R., Fisher, H., Dolev-Amit, T., Veler-Poleg, N., & Barber, J. P. (2023). Is the use of interpretations associated with treatment outcome? A systematic review and meta-analytic answer. Clinical Psychology: Science and Practice, 31(1). doi: 10.1037/cps0000158. DOI: https://doi.org/10.1037/cps0000158