Heaton R K, Carr J E, Hampson J L
J Nerv Ment Dis. 1975 Apr;160(4):299-309. doi: 10.1097/00005053-197504000-00008.
For more than 10 years much of the research into the effects of therapist characteristics on psychotherapy outcome has focused on the "A-B" variable. Various A-B scales have been used to predict differential process and outcome of A and B therapist with schizophrenics and neurotics, respectively. Although significant results frequently have been reported, findings of different studies have seemed to contradict each other, and most independent replication attempts have failed. Since reliable differences in outcomes achieved by various therapists-patient pairings have not been demonstrated, the confusing proliferation of theories concerning what A-B factors "make the difference" seems rather premature. A review of outcome and process studies in this area indicates that the phenomena under investigation are much more complex than is reflected in the previous A-B hypotheses. Therapist A-B scores do not predict every kind of success with every kind of patient generically labeled "schizophrenic" or "neurotic" in every kind of treatment program. This conclusion need not arouse pessimism regarding the value of further A-Bresearch, but it clearly demands greater specificity in hypotheses and in research design. The failure of many recent studies to include true B type therapists has made their findings irrelevant to the A-B hypotheses, and has raised the question of whether the B therapist has become "extinct." To provide further information about this phenomenon of the vanishing B therapist, the present authors conducted a survey of all Seattle psychiatrists in private practice. The survey yielded a total distribution of A-B scores which is not significatly skewed in either the A or B direction. However, most of the B's had graduated from residency training prior to 1960, while most of the A's had graduated in more recent years. These results suggest that, although current residency programs may not have enough B doctors for meaningful A-B research, such doctors do exist in the community.
在过去10多年里，许多关于治疗师特征对心理治疗效果影响的研究都聚焦于“A - B”变量。各种A - B量表已被用于分别预测A类和B类治疗师与精神分裂症患者及神经症患者治疗过程和效果的差异。尽管经常有显著结果被报道，但不同研究的结果似乎相互矛盾，而且大多数独立重复研究的尝试都失败了。由于尚未证明不同治疗师 - 患者配对所取得的效果存在可靠差异，因此关于哪些A - B因素“起作用”的理论大量涌现且令人困惑，这似乎为时过早。对该领域治疗效果和治疗过程研究的综述表明，所研究的现象比先前的A - B假设所反映的要复杂得多。治疗师的A - B得分并不能一概而论地预测在每种治疗方案中，对每一种被笼统地称为“精神分裂症患者”或“神经症患者”的患者都能取得成功。这一结论不必引发对进一步A - B研究价值的悲观情绪，但显然要求在假设和研究设计上更加具体。最近许多研究未能纳入真正的B类治疗师，这使得它们的研究结果与A - B假设无关，并引发了B类治疗师是否已“绝迹”的问题。为了提供关于B类治疗师消失这一现象的更多信息，本文作者对西雅图所有私人执业的精神科医生进行了一项调查。该调查得出了A - B得分的总体分布情况，在A或B方向上都没有明显的偏差。然而，大多数B类治疗师在1960年之前就已完成住院医师培训，而大多数A类治疗师是近年来毕业的。这些结果表明，尽管目前的住院医师培训项目可能没有足够的B类医生来进行有意义的A - B研究，但这类医生在社区中确实存在。
