Nuetzel Eric J, Larsen Randy J, Prizmic Zvjezdana
St. Louis Psychoanalytic Institute, MO 63124, USA.
J Am Psychoanal Assoc. 2007 Fall;55(4):1321-53. doi: 10.1177/000306510705500411.
The therapeutic relationship is the source of major concepts in psychoanalytic clinical theory. Such concepts as resistance, transference, countertransference, and the alliance are fundamental, even though there may be shifts in meaning between theoretical schools and clinical contexts. In the clinical psychoanalytic literature, disagreement exists over the nature of the alliance and its essential components. Empirical studies using reliable patient, therapist, and observer scales to assess the alliance demonstrate a correlation with psychotherapeutic gains. In the study reported here, thirteen patients were followed for 6 to 33 months of psychodynamic psychotherapy, during which time their views of the therapeutic relationship were assessed, and several experiential measures taken, all on a weekly basis. Statistical analyses reveal that the therapeutic relationship, as reflected in the patients' weekly responses to the St. Louis Therapeutic Relationship Rating Scale, has four distinct components: therapeutic alliance, resistance, transference love, and negative transference. On a week-by-week basis, the therapeutic alliance was the strongest predictor of improvement in patient-reported general adjustment, as reflected in such areas as self-esteem, positive affect, social relations, work productivity, satisfaction, and optimism. Time plots of the variables show the typical time course for the components of the therapeutic relationship, as well as for improvement on the experiential variables. Results indicate that the therapeutic alliance, transference, and resistance are central components of the psychotherapeutic relationship, which in turn predict the ongoing life experience of the patient.
治疗关系是精神分析临床理论中主要概念的来源。诸如阻抗、移情、反移情和联盟等概念是基础性的，尽管不同理论流派和临床情境下这些概念的含义可能会有所变化。在临床精神分析文献中，对于联盟的本质及其基本组成部分存在分歧。使用可靠的患者、治疗师和观察者量表来评估联盟的实证研究表明，联盟与心理治疗效果存在相关性。在本文所报告的研究中，对13名患者进行了为期6至33个月的心理动力学心理治疗随访，在此期间，每周评估他们对治疗关系的看法，并采取了几项体验性测量措施。统计分析表明，患者每周对圣路易斯治疗关系评定量表的反应所反映的治疗关系有四个不同的组成部分：治疗联盟、阻抗、移情性爱和负性移情。逐周来看，治疗联盟是患者报告的总体适应改善的最强预测因素，这体现在自尊、积极情感、社会关系、工作效率、满意度和乐观等方面。变量的时间图显示了治疗关系各组成部分以及体验性变量改善的典型时间进程。结果表明，治疗联盟、移情和阻抗是心理治疗关系的核心组成部分，而这反过来又预测了患者的持续生活体验。
