Briffault X, Thurin M, Lapeyronnie B, Thurin J-M
Cesames (CNRS, UMR 8136; Inserm U611; Univ Paris Descartes, CESAMES, Paris 75006), 45, rue des Saints-Pères, 75270 Paris cedex 06, France.
Encephale. 2007 Dec;33(6):911-23. doi: 10.1016/j.encep.2006.08.008. Epub 2007 Sep 5.
A recent report of the French research institute INSERM, based on a comprehensive review of the work done on the evaluation of psychotherapies Psychothérapies: trois approches évaluées, has shown the lack of research in France on this topic, notably in psychodynamic psychotherapy. The development of such research is needed. The first part of the paper deals with the limits of the third generation of studies on psychotherapy (medical model, use of RCT, DSM...) on which the INSERM report is based and reviews the existing propositions for a fourth generation of research in the field. METHODOLOGICAL FINDINGS: In the second part, a process-outcome research protocol developed by the authors, according to these new proposals as well as several on-going researches [J Clin Psychol, 27 2 (1998) 217-26, J Pragm Case Stud 3 (2000)(2), Arch Gen Psychiatry 59 (2002) 505-10, Psychother Res 12 3 (2002) 251-72 and Br J Psychiatry 165 (1994) 4-8] is presented. The proposed methodology is based on controlled single case studies. Quantitative and qualitative data are associated for the definition of the diagnosis, as well as initial, intermediate and final measures. Process analysis is used to describe the main characteristics of the on-going psychotherapy at different moments in time. It is thus possible to gain access to what is really done during the therapy and not only to what is supposed to be done, based on a manual or even on the name of the theory used by the therapist.
This methodology was tested during a one-year pilot study, in true conditions of psychotherapy with outpatients. The different phases of the analysis are presented: several tools dedicated to the observation, formalisation and data analysis are integrated in a coherent iterative process during the whole therapy. The interests and limits of each tool (ESM, DSM, PPQS, Hoglend, CORE...) are described together with the first results of the pilot study.
The overall architecture of a database designed to collect, search and analyse data is provided in the last part of the paper.
This framework offers two possibilities at the same time: it provides therapists with the ability to follow the evolution of their cases and to compare them with similar cases. It provides researchers with the ability to drive true comparative analysis, based on psychotherapies conducted in real situations and on detailed-enough descriptions to obtain significant outcomes.
法国国家健康与医学研究院（INSERM）近期发布的一份报告，基于对心理治疗评估相关工作的全面综述《心理治疗：三种评估方法》，显示法国在这一主题上缺乏研究，尤其是在心理动力心理治疗方面。开展此类研究很有必要。本文第一部分探讨了INSERM报告所依据的第三代心理治疗研究（医学模式、随机对照试验的使用、《精神疾病诊断与统计手册》……）的局限性，并综述了该领域第四代研究的现有提议。
在第二部分，作者根据这些新提议以及多项正在进行的研究[《临床心理学杂志》，27卷2期（1998年）217 - 26页；《实用案例研究》3卷（2000年）（2）期；《普通精神病学档案》59卷（2002年）505 - 10页；《心理治疗研究》12卷3期（2002年）251 - 72页；《英国精神病学杂志》165卷（1994年）4 - 8页]，介绍了一个过程 - 结果研究方案。所提议的方法基于对照单病例研究。定量和定性数据用于诊断的定义以及初始、中期和最终测量。过程分析用于描述不同时间点正在进行的心理治疗的主要特征。这样就有可能了解治疗过程中实际发生的情况，而不仅仅是基于手册甚至治疗师所使用理论的名称所假定会发生的情况。
该方法在一项为期一年的试点研究中进行了测试，研究对象为门诊心理治疗的真实案例。文中呈现了分析的不同阶段：在整个治疗过程中，几种用于观察、形式化和数据分析的工具被整合到一个连贯的迭代过程中。文中描述了每种工具（电子自我监测、《精神疾病诊断与统计手册》、患者问题清单、霍格兰德方法、临床结果评价量表……）的优点和局限性以及试点研究的初步结果。
本文最后一部分提供了一个旨在收集、搜索和分析数据的数据库的总体架构。
这个框架同时提供了两种可能性：它使治疗师能够跟踪其案例的进展并与类似案例进行比较。它使研究人员能够基于实际进行的心理治疗以及足够详细的描述来开展真正的比较分析，从而获得有意义的结果。
