患者和治疗师对治疗联盟的看法:相似性、差异性及其与治疗效果的关系。

Clients' and therapists' views of the therapeutic alliance: similarities, differences and relationship to therapy outcome.

机构信息

Université Laval, Quebec, Canada.

出版信息

Clin Psychol Psychother. 2013 Mar-Apr;20(2):118-35. doi: 10.1002/cpp.792. Epub 2011 Nov 14.

Abstract

UNLABELLED

To better understand how clients' and therapists' views of the therapeutic alliance differ and overlap, this study investigated, first, the components of the alliance that are relevant to the therapy participants; second, their relationship to post-therapy outcome; and third, the relationships between participants' alliance constructs. To identify participants' views, exploratory factor analyses were performed on clients' (n = 176) and therapists' (n = 133 observations) ratings of the Working Alliance Inventory (short form), the Helping Alliance Questionnaire and the California Psychotherapy Alliance Scales and conducted both on each measure separately and on the three measures combined. The results of the separate analyses indicated in general poor correspondence between the participant-derived components and each measure's a priori constructs. Results of the joint analyses suggested that clients view the alliance in terms of six basic components (Collaborative Work Relationship, Productive Work, Active Commitment, Bond, Non-disagreement on Goals/Tasks and Confident Progress), five of which were found to predict client-rated and/or therapist-rated post-therapy outcome. Results for therapists suggested four basic components (Collaborative Work Relationship, Therapist Confidence & Dedication, Client Commitment & Confidence, Client Working Ability), of which three predicted post-therapy outcome. Findings of significant, but modest to low moderate, correlations between several client and therapist joint factors suggested that despite similarities, the therapy partners' views of the alliance differ in important ways. Compared with therapists, clients appear to place greater emphasis on helpfulness, joint participation in the work of therapy and negative signs of the alliance. Implications of these findings are discussed.

KEY PRACTITIONER MESSAGE

Therapists should not assume that their views of the therapeutic relationship and therapeutic work are shared by their clients and are encouraged to seek the client's feedback. Therapists may benefit from conveying that the client's perspective on problems and relevant work is valued and that they are working with the client as a team. Therapists may need to explicitly address how the therapeutic work is helpful and conducive to desired changes.

摘要

未加标签

为了更好地理解客户和治疗师对治疗联盟的看法有何不同和重叠,本研究首先调查了与治疗参与者相关的联盟组成部分;其次,研究了它们与治疗后结果的关系;最后,研究了参与者联盟结构之间的关系。为了确定参与者的观点,对客户(n=176)和治疗师(n=133)对工作联盟量表(短表)、帮助联盟问卷和加利福尼亚心理治疗联盟量表的评分进行了探索性因素分析,分别对每个量表进行了分析,并对三个量表进行了联合分析。单独分析的结果表明,参与者得出的组成部分与每个量表的先验结构之间总体上对应不佳。联合分析的结果表明,客户根据六个基本组成部分(协作工作关系、富有成效的工作、积极的承诺、纽带、目标/任务上的一致意见和有信心的进展)来看待联盟,其中五个被发现可以预测客户评定的和/或治疗师评定的治疗后结果。治疗师的结果表明了四个基本组成部分(协作工作关系、治疗师的信心和奉献精神、客户的承诺和信心、客户的工作能力),其中三个预测了治疗后结果。几个客户和治疗师联合因素之间存在显著但适度到中度的相关性的发现表明,尽管存在相似之处,但治疗伙伴对联盟的看法在重要方面存在差异。与治疗师相比,客户似乎更强调治疗的帮助性、共同参与治疗工作以及联盟的负面迹象。讨论了这些发现的意义。

关键从业者信息

治疗师不应假设他们对治疗关系和治疗工作的看法与他们的客户共享,并鼓励他们寻求客户的反馈。治疗师可能会受益于传达客户对问题和相关工作的看法是有价值的,并且他们正在与客户作为一个团队合作。治疗师可能需要明确说明治疗工作是如何有帮助的,并有助于实现期望的改变。

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