Jahoda Andrew, Selkirk Mhairi, Trower Peter, Pert Carol, Stenfert Kroese Biza, Dagnan Dave, Burford Bronwen
University of Glasgow, Glasgow, Scotland, UK.
Br J Clin Psychol. 2009 Mar;48(Pt 1):63-77. doi: 10.1348/014466508X360746. Epub 2008 Oct 10.
Establishing a collaborative relationship is a cornerstone of cognitive behavioural therapy (CBT). Increasingly CBT is being offered to people with intellectual disabilities who may have problems with receptive and expressive communication, and a history of disadvantage or discrimination in their relationships with those in positions of power. Consequently, they may have difficulty establishing a collaborative interaction with their therapist. This paper uses a novel method of interactional analysis to examine if collaboration increases as therapy progresses.
Fifteen participants with borderline to mild intellectual disabilities and significant problems of depression, anxiety and anger were recruited from specialist clinical services to participate in this study. Verbatim transcripts of therapy sessions 4 and 9 were coded using an initiative-response method of analysing power distribution in dialogue, to investigate collaboration at the level of therapeutic interaction.
The initiative-response scores indicated that power was relatively equally distributed between clients and therapists. On this measure there was no significant increase in collaboration as therapy progressed, as the dialogues were relatively equal from session 4. Analyses of the pattern of interaction showed that whilst the therapists asked most questions, the clients contributed to the flow of the analysis and played an active part in dialogues.
The implications of these findings are discussed, along with the possible uses of such interactional analyses in identifying barriers to communication and ways of establishing effective therapeutic dialogue.
建立合作关系是认知行为疗法（CBT）的基石。越来越多的智力障碍者开始接受CBT治疗，他们可能在接受性和表达性沟通方面存在问题，并且在与有权势者的关系中存在不利或受歧视的历史。因此，他们可能难以与治疗师建立合作互动。本文采用一种新颖的互动分析方法来研究随着治疗的推进合作是否会增加。
从专科临床服务机构招募了15名患有边缘性至轻度智力障碍且存在严重抑郁、焦虑和愤怒问题的参与者参与本研究。使用一种主动性 - 反应性方法对第4次和第9次治疗会话的逐字记录进行编码，以分析对话中的权力分配，从而在治疗互动层面研究合作情况。
主动性 - 反应性得分表明，权力在客户和治疗师之间相对平均分配。就这一衡量标准而言，随着治疗的推进，合作并没有显著增加，因为从第4次会话开始对话就相对平等。对互动模式的分析表明，虽然治疗师问的问题最多，但客户对分析流程有贡献，并在对话中发挥了积极作用。
讨论了这些发现的意义，以及这种互动分析在识别沟通障碍和建立有效治疗对话方式方面的可能用途。
