Todd David M, Deane Frank P, Bragdon Rodney A
Department of Psychology, University of Massachusetts at Amherst, 01003, USA.
J Clin Psychol. 2003 Jan;59(1):133-47. doi: 10.1002/jclp.10123.
While the comparison of client and therapist reasons for termination might shed light on their respective views of outcome and process, only one published study has examined directly the reasons given by therapist-client pairs. One barrier to such research is the absence of a systematic conceptualization of reasons for termination that incorporates both therapist and client perspectives. This article describes a comprehensive conceptualization, drawn from the existing literature, and applies a coding system based on that conceptualization to naturalistic clinical data from 123 therapist-client pairs in a psychology training clinic. Coders were able to categorize reliably open-ended client data into reasons for termination. For therapist and client data, the relationships between coding categories and participants' outcome ratings, generally were consistent with expectations, providing limited validation. Some support was found for concordance between therapist and client reasons, especially for those related to therapist or client departures, which were prominent in this setting. As expected, however, therapists were more likely than clients to endorse success as a reason for termination. Negative client feelings about therapy, including dissatisfaction, were reported infrequently as reasons for termination, and with little agreement between clients and therapists, but this may be due to methodological limitations.
虽然比较来访者和治疗师终止治疗的原因可能有助于了解他们对治疗结果和过程的各自看法，但只有一项已发表的研究直接考察了治疗师-来访者对给出的原因。此类研究的一个障碍是缺乏一个将治疗师和来访者观点都纳入的终止治疗原因的系统概念化。本文描述了一个从现有文献中得出的全面概念化，并将基于该概念化的编码系统应用于心理学培训诊所中123对治疗师-来访者的自然临床数据。编码员能够将开放式的来访者数据可靠地归类为终止治疗的原因。对于治疗师和来访者的数据，编码类别与参与者的结果评分之间的关系总体上与预期一致，提供了有限的验证。发现治疗师和来访者的原因之间存在一定程度的一致性，特别是对于那些与治疗师或来访者离开相关的原因，这在这种情况下很突出。然而，正如预期的那样，治疗师比来访者更有可能认可将治疗成功作为终止治疗的原因。来访者对治疗的负面感受，包括不满，很少被报告为终止治疗的原因，而且来访者和治疗师之间的意见也很少一致，但这可能是由于方法上的局限性。
