Miller Grant D, Iverson Katherine M, Kemmelmeier Markus, Maclane Chelsea, Pistorello Jacqueline, Fruzzetti Alan E, Crenshaw Katrina Y, Erikson Karen M, Katrichak Barrie M, Oser Megan, Pruitt Larry D, Watkins Melanie M
University of Nevada, Reno.
Prof Psychol Res Pr. 2010 Jun;41(3):228-235. doi: 10.1037/a0019118.
Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist-patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research.
心理治疗师在提供心理治疗时经常会经历压力，尤其是在处理诸如自杀倾向等棘手的情况时。作为一项关于治疗近期有自杀倾向的边缘型特质大学生的大型研究的一部分，6名实习治疗师在与2名选定的客户进行治疗前后，立即采集了自己的唾液样本进行α-淀粉酶（AA）和皮质醇（C）分析。在为期一年的研究中，平均为同一治疗师-患者组合采集样本，以确保数据反映治疗师在治疗各阶段的反应。治疗师还完成了一份工作联盟问卷，并在每次选定的治疗后立即对感知到的治疗难度进行评分。与预期相反，与治疗后水平相比，治疗师在治疗前通过AA和C测量的压力水平有所升高。更大的治疗难度与AA更明显的下降有关，而更强的工作联盟则与C更明显的降低有关。结果表明，在与近期有自杀倾向的边缘型特质客户合作时，生理压力反应主要表现为治疗前的预期焦虑，而AA和C的变化可能受到治疗难度和工作联盟等因素的不同影响。这是一项试点研究，受样本量限制，但设计、结果以及生理测量的纳入是一项重要研究方向的初步步骤。
