Karno Mitchell P, Longabaugh Richard
University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, California 90025, USA.
J Stud Alcohol. 2005 Nov;66(6):825-32. doi: 10.15288/jsa.2005.66.825.
This study examined the interactions of therapist directiveness with patient anger and patient reactance among an alcohol-treatment-seeking sample.
Participants in the study consisted of 139 individuals with alcohol abuse or dependence who received treatment at a single clinical research unit of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Analyses tested for the independence of the two interactions, identified components within the directiveness construct and examined the relationship between those components and the patient attributes.
Results showed that the interactions between directiveness and anger and between directiveness and reactance each accounted for unique variance in predicting posttreatment alcohol use as measured by percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Principal components analysis of the directiveness construct generated two underlying components that were interpreted to be confrontation and structure. Significant interactions were observed between patient reactance and both the confrontation and structure components. Confrontation also interacted with patient anger; however, no interaction was found between anger and structure.
The interactions of therapist directiveness with patient anger and reactance demonstrated both shared and unique qualities. These results highlight the importance of focusing on specific aspects of directiveness to better understand the effect of patient-treatment interactions on alcohol use. This study has implications for theory and research as well as for the delivery of treatment services.
本研究考察了在寻求酒精治疗的样本中，治疗师的指导性与患者愤怒及患者反抗之间的相互作用。
该研究的参与者包括139名患有酒精滥用或酒精依赖的个体，他们在“匹配酒精成瘾治疗与患者异质性”项目（MATCH）的一个临床研究单位接受治疗。分析检验了这两种相互作用的独立性，确定了指导性结构中的组成部分，并考察了这些组成部分与患者属性之间的关系。
结果显示，指导性与愤怒之间以及指导性与反抗之间的相互作用，在通过戒酒天数百分比（PDA）和重度饮酒天数百分比（PHDD）来衡量的预测治疗后酒精使用情况方面，各自解释了独特的方差。对指导性结构进行主成分分析产生了两个潜在成分，被解释为对抗和结构化。观察到患者反抗与对抗和结构化成分之间存在显著的相互作用。对抗也与患者愤怒相互作用；然而，未发现愤怒与结构化之间存在相互作用。
治疗师的指导性与患者愤怒及反抗之间的相互作用表现出了共同和独特的特质。这些结果凸显了关注指导性的特定方面对于更好地理解患者 - 治疗相互作用对酒精使用的影响的重要性。本研究对理论和研究以及治疗服务的提供都具有启示意义。
