Cropp Carola, Streeck-Fischer Annette, Jaeger Ulrich, Masuhr Oliver, Schröder Annette, Leichsenring Falk
Asklepios Fachklinikum Tiefenbrunn, DE-37124 Rosdorf.
Z Kinder Jugendpsychiatr Psychother. 2008 May;36(3):205-13. doi: 10.1024/1422-4917.36.3.205.
Examined here is the degree to which particular aspects of treatment experience in the inpatient psychotherapy of children and adolescents correlate significantly with the actual success of treatment.
Data of 95 patients hospitalised between 2002 and 2006 in the Department of Child and Adolescent Clinical Psychotherapy at the NLKH Tiefenbrunn were analysed. To assess the relationships multiple regression analyses were carried out, whereby the dependent variable was on the one hand, the retrospective estimate of treatment success by the patients by means of the Questionnaire to Assess Treatment (Fragebögen zur Beurteilung der Behandlung/FBB), and on the other, the difference on the General-Severity-Index (GSI) of the Symptom Checklist 90-R (SCL-90-R) between the time of admission and release from hospital. Patients' experience of treatment was assessed by MEANS OF THE WARD EXPERIENCE QUESTIONNAIRE (STATIONSERFAHRUNGSBOGEN/SEB) BY SAMMET AND SCHAUENBURG (1999).
The direct measurement of success (FBB-P-Scale Success of Treatment) correlated highly significantly with the SEB scales Expectation of Self-Efficacy, Individual Therapeutic Relationship, Atmosphere among Co-Patients, Group Cohesion, Relationship to Therapy Team, Intensity of Treatment, and with the Difference in the Estimate of Individual Therapeutic Relationship between Patient and Therapist. The indirect measure of success also correlated highly significantly with the Atmosphere among Co-Patients and the perceived Expectation of Self-Efficacy. The relationship between the Relationship to Therapy Team was also significant at the 5% level. In the subsequent regression analyses the SEB scales explained 51% of the variance between the retrospective estimates of success (FBB). The subscales Relationship to Therapy Team (beta= 0.47, t(df) = 4.15(84), p < .01) and Expectation of Self-Efficacy (beta = 0.32, t(df) = 3.30(84), p < .01) proved to be significant predictors of treatment success. Using the difference in the GSI values on the SCL-90-R as the dependent variable, the SEB scales explained 23% of the variance in treatment success, whereby Atmosphere among Co-Patients was the only significant individual subscale (beta = 0.35, t(df) = 2.63(84), p < .01).
The success of inpatient psychotherapy treatment among children and adolescents in the sample studied correlated significantly with particular aspects of treatment experience. In this connection, the reduction in symptoms apparent in the comparison of values at admission with those at release seems to be primarily related to the Atmosphere among Co-Patients, whereas the success of treatment as estimated directly by the patients correlates more strongly with Relationship to Therapy Team and Expectation of Self-Efficacy. Due to the correlative design of the study, the issue of causality could not be completely resolved.
本研究旨在考察儿童和青少年住院心理治疗中治疗体验的特定方面与治疗实际成效之间的关联程度。
对2002年至2006年间在NLKH铁芬布伦儿童与青少年临床心理治疗科住院的95名患者的数据进行分析。为评估各变量之间的关系,进行了多元回归分析,其中因变量一方面是患者通过治疗评估问卷(Fragebögen zur Beurteilung der Behandlung/FBB)对治疗成效的回顾性评价,另一方面是症状自评量表90修订版(SCL - 90 - R)的一般严重程度指数(GSI)在入院时与出院时的差值。患者的治疗体验通过萨梅特和绍恩堡(1999年)编制的病房体验问卷(STATIONSERFAHRUNGSBOGEN/SEB)进行评估。
治疗成效的直接测量指标(FBB - P量表治疗成效)与SEB量表中的自我效能期望、个体治疗关系、病友间氛围、团体凝聚力、与治疗团队的关系、治疗强度以及患者与治疗师之间个体治疗关系评估的差异高度显著相关。治疗成效的间接测量指标也与病友间氛围和感知到的自我效能期望高度显著相关。与治疗团队的关系在5%的水平上也具有显著意义。在后续的回归分析中,SEB量表解释了成功的回顾性评价(FBB)之间51%的方差。治疗团队关系子量表(β = 0.47,t(df) = 4.15(84),p <.01)和自我效能期望子量表(β = 0.32,t(df) = 3.30(84),p <.01)被证明是治疗成功的显著预测指标。以SCL - 90 - R上GSI值的差异作为因变量,SEB量表解释了治疗成功方差的23%,其中病友间氛围是唯一显著的个体子量表(β = 0.35,t(df) = 2.63(84),p <.01)。
在所研究的样本中,儿童和青少年住院心理治疗的成功与治疗体验的特定方面显著相关。就此而言,入院时与出院时数值比较中明显的症状减轻似乎主要与病友间氛围有关,而患者直接评估的治疗成功与与治疗团队的关系和自我效能期望的关联更强。由于本研究的相关性设计,因果关系问题未能完全解决。