Slade Karstin, Lambert Michael J, Harmon S Cory, Smart David W, Bailey Russ
Brigham Young University, Provo, UT.
Clin Psychol Psychother. 2008 Sep-Oct;15(5):287-303. doi: 10.1002/cpp.594.
The benefits of psychotherapy have been well documented; however, 5-10% of clients worsen while in treatment and another minority shows no response. The effects of feedback timing (delayed or immediate) and type (progress feedback and Clinical Support Tool [CST] feedback), aimed at reducing deterioration and improving outcomes, were examined in a sample of 1101 clients whose outcome was contrasted across experimental groups and with two archival groups: a delayed progress feedback and CST feedback group (n = 1374) and a treatment-as-usual control group (n = 1445). Progress feedback to therapists improved outcomes, especially for cases at risk for a negative outcome, but direct progress feedback to clients did not. Effects were significantly enhanced by using the manual-based CST. There were no significant differences in outcome between the 1-week-delayed CST feedback and 2-week-delayed CST feedback groups; however, clients in the week-delayed CST feedback timing condition attended three less sessions, on average, than their 2-week-delayed CST feedback counterparts while maintaining similar treatment gains. Results were interpreted as supporting the value of monitoring client progress and feeding back this information to therapists as well as assisting therapists in problem solving with cases at risk for treatment failure.
心理治疗的益处已有充分记录；然而，5%至10%的来访者在治疗期间病情恶化，另有一小部分来访者没有反应。本研究在1101名来访者样本中考察了反馈时机（延迟或即时）和类型（进展反馈与临床支持工具[CST]反馈）对减少病情恶化和改善治疗效果的影响，并将实验组的结果与两个档案组进行对比：一个是延迟进展反馈和CST反馈组（n = 1374），另一个是常规治疗对照组（n = 1445）。向治疗师提供进展反馈可改善治疗效果，尤其是对于有负面结果风险的病例，但直接向来访者提供进展反馈则没有效果。使用基于手册的CST可显著增强效果。1周延迟CST反馈组和2周延迟CST反馈组在治疗效果上没有显著差异；然而，在1周延迟CST反馈时机条件下的来访者平均比2周延迟CST反馈条件下的来访者少参加三次治疗，同时保持相似的治疗收益。研究结果被解释为支持监测来访者进展并将此信息反馈给治疗师以及协助治疗师解决有治疗失败风险病例的价值。
