Ullevaal University Hospital, Oslo, Norway.
Br J Clin Psychol. 2011 Sep;50(3):283-97. doi: 10.1348/014466510X517406. Epub 2011 Mar 8.
OBJECTIVES. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome. DESIGN. In this dismantling, randomized clinical study, 100 out-patients who sought psychotherapy due to depression, anxiety, and personality disorders, were assigned to 1 year of dynamic psychotherapy with and without transference interpretation. METHODS. Patients' pre-treatment target expectancies and global expectancy were measured in this clinical trial. Tests of mediation were performed with two patient-rated and one therapist-rated measure of the therapeutic alliance, using regression analyses. Six putative moderators of the mediational paths were explored. RESULTS. Global Optimism was significantly associated with two clinician-rated outcome measures - the Psychodynamic Functioning Scales and Global Assessment of Functioning. Both patient ratings, but not the therapist rating of alliance mediated the association between global expectancy and clinician-rated outcome. None of the putative moderators had a significant effect. CONCLUSION. The results, together with previous findings, indicate that the expectancy-alliance-outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment.
半个多世纪以来，患者预期一直被认为是心理治疗结果的一个重要预测指标。近年来，有证据表明治疗联盟可能在预期与结果之间起中介作用。
在这项分解式、随机临床试验中，将 100 名因抑郁、焦虑和人格障碍而寻求心理治疗的门诊患者分配到为期 1 年的动力性心理治疗，其中一部分接受移情解释，另一部分则不接受。
本临床试验中对患者治疗前的目标预期和总体预期进行了测量。使用回归分析，通过两个患者自评和一个治疗师评定的治疗联盟测量工具，对中介作用进行了检验，并对 6 个中介路径的潜在调节因素进行了探讨。
总体乐观与两个临床评定的结果指标——心理动力学功能量表和总体功能评定显著相关。患者自评的两种治疗联盟测量结果，而不是治疗师评定的治疗联盟，都在总体预期与临床评定结果之间起中介作用。没有一个潜在的调节因素有显著影响。
这些结果与先前的发现一起表明，预期-联盟-结果的中介链是一种普遍现象，不仅限于特定的患者亚组或治疗模式。
