Clark James J
College of Social Work, University of Kentucky, Lexington, Kentucky 40506-0027, USA.
Subst Use Misuse. 2009;44(1):42-61. doi: 10.1080/10826080802523228.
This article provides an overview of the major findings of psychotherapy research and discusses the possible implications of these findings for substance user treatment researchers and practitioners. While the centrality of relationship for human change processes was historically understood, twentieth century research tended to see relationship and person variables as secondary to operationalized "mechanisms of action" unique to particular psychotherapies. Interestingly, recent meta-analytic investigations have uncovered the weakness of randomized controlled trials (RCT) comparison investigations that have, until recently, represented the "gold standard" for the field. There has been a resurgent interest in the "common factors" that appear to be important across many effective psychotherapies. In addition, psychiatric anthropologists have contributed important information about the problems of client noncompliance with mental health treatment that parallel quantitative investigations. Substance misuse researchers have also found that client characteristics, especially clients' readiness to engage treatment, are important to investigate. The importance of the "therapeutic alliance" and the characteristics of clients and clinicians have become central areas for study, rather than variables to be controlled or excluded. Emphasis on these factors may represent the future for research in psychotherapy and substance user treatment, especially if researchers and community practitioners can join together to overcome methodological feasibility and dissemination problems that plague effectiveness research. However, the continued attractiveness of comparative studies and treatment efficacy studies may represent longstanding epistemological assumptions and responses to economic incentives that will be difficult to challenge.
本文概述了心理治疗研究的主要发现，并探讨了这些发现对物质使用障碍治疗研究人员和从业者可能产生的影响。虽然关系在人类改变过程中的核心地位在历史上已为人所理解，但20世纪的研究倾向于将关系和个体变量视为特定心理治疗所独有的可操作化“作用机制”的次要因素。有趣的是，最近的荟萃分析研究揭示了随机对照试验（RCT）比较研究的弱点，而直到最近，此类研究一直代表着该领域的“金标准”。人们对许多有效心理治疗中似乎都很重要的“共同因素”重新产生了兴趣。此外，精神病人类学家提供了关于客户不遵守心理健康治疗问题的重要信息，这些信息与定量研究相辅相成。物质滥用研究人员还发现，客户特征，尤其是客户参与治疗的意愿，是值得研究的重要因素。“治疗联盟”以及客户和临床医生的特征已成为研究的核心领域，而不是需要控制或排除的变量。对这些因素的强调可能代表了心理治疗和物质使用障碍治疗研究的未来，特别是如果研究人员和社区从业者能够共同克服困扰有效性研究的方法可行性和传播问题。然而，比较研究和治疗效果研究持续具有吸引力，这可能代表了长期以来的认识论假设以及对经济激励的回应，而这些假设和回应将难以挑战。
