Ogrodniczuk John S, Piper William E, Joyce Anthony S
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Compr Psychiatry. 2005 May-Jun;46(3):206-13. doi: 10.1016/j.comppsych.2004.08.005.
Alexithymia is a patient characteristic that reflects deficits in the cognitive processing and regulation of emotions. It is generally considered to have an adverse effect on the outcome of psychotherapy. Little is known about the processes through which alexithymia exerts this effect. One proposed mechanism suggests that patients with alexithymia trigger negative therapist reactions that contribute to poor outcome for such patients. This study examined whether therapist reactions to a patient mediate the relationship between alexithymia and outcome in group psychotherapy for complicated grief. Alexithymia was assessed with the Toronto Alexithymia Scale-20. Therapist reactions to a patient, reflecting the therapist's perceptions of a patient's positive qualities, personal compatibility, and significance as a group member, were assessed with a cohesion questionnaire. Outcome in several areas of functioning was measured. We found that alexithymia (specifically, greater difficulty in communicating feelings and greater tendency to engage in externally oriented thinking) was associated with less favorable outcome and that this relationship was mediated by therapist reactions to a patient. The mediation provided by therapist reactions to a patient accounted for approximately one third to one half of the direct effect of alexithymia on psychotherapy outcome. This suggests that therapist reactions to a patient represent a major mechanism through which alexithymia exerts its effect.
述情障碍是一种反映情感认知加工和调节缺陷的患者特征。一般认为它会对心理治疗的结果产生不利影响。关于述情障碍产生这种影响的过程，人们了解甚少。一种提出的机制认为，述情障碍患者会引发治疗师的负面反应，这会导致此类患者的治疗效果不佳。本研究考察了在复杂性悲伤的团体心理治疗中，治疗师对患者的反应是否会介导述情障碍与治疗结果之间的关系。使用多伦多述情障碍量表-20评估述情障碍。使用凝聚力问卷评估治疗师对患者的反应，该问卷反映了治疗师对患者积极品质、个人相容性以及作为团体成员的重要性的看法。测量了几个功能领域的治疗结果。我们发现，述情障碍（具体而言，在表达情感方面有更大困难以及更倾向于进行外向性思维）与较差的治疗结果相关联，并且这种关系是由治疗师对患者的反应介导的。治疗师对患者的反应所提供的中介作用约占述情障碍对心理治疗结果直接影响的三分之一到二分之一。这表明治疗师对患者的反应是述情障碍发挥其影响的主要机制。
