Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraβe 10, Leipzig, Germany.
BMC Med Res Methodol. 2012 Feb 3;12:10. doi: 10.1186/1471-2288-12-10.
Recent research indicates that temporary deteriorations of variables monitored continuously in the course of the therapeutic relationship are important characteristics of psychotherapeutic change. These so-called rupture-repair episodes were assessed by different authors using different mathematical methods.
The study deals with the criteria for identifying rupture-repair episodes that have been established in previous studies. It proposes modifications of these criteria which prospectively could make it possible to identify rupture-repair episodes more precisely and consistently. The authors developed an alternative criterion. This criterion is able to include crisis patterns which had not been considered before, as well as to characterize the length of the crises. As a sample application, the different criteria were applied to continuously measured assessments of the therapeutic interaction in psychodynamic therapy courses (ten shorter processes and one long-term therapy).
The analysis revealed that the number of the identified rupture-repair episodes differed depending on the criterion that was used. Considerably more crises were identified with the newly developed criterion. The authors developed a classification of crisis patterns. They distinguished five patterns of crises and their resolution in therapy processes and ascertained the frequency of distribution. The most frequent pattern was the simple V-shape. The second most common pattern was a decline over more than one session with a sudden repair. The longest downward trend comprised a period of six sessions.
The findings of the study give insight into basic mechanisms of change within the therapeutic relationship. A phenomenological discussion of how a crisis is defined is useful to create a methodological approach to the operationalization of crises, to differentiate specific characteristics and to specifically link these characteristics to the outcome in future studies. The methodological deliberations might be applyable to different research areas where the analysis of fluctuations in a variable of interest over time is relevant.
最近的研究表明，治疗关系过程中连续监测的变量的暂时恶化是心理治疗变化的重要特征。这些所谓的破裂-修复事件是由不同的作者使用不同的数学方法评估的。
本研究涉及先前研究中确定的破裂-修复事件的识别标准。它提出了对这些标准的修改，这些修改可以前瞻性地更准确和一致地识别破裂-修复事件。作者提出了一种替代标准。该标准能够包括以前未考虑的危机模式，并能够描述危机的持续时间。作为样本应用，不同的标准被应用于心理动力学治疗过程中连续测量的治疗互动评估（十个较短的过程和一个长期治疗）。
分析结果表明，所使用的标准不同，识别出的破裂-修复事件的数量也不同。使用新开发的标准可以识别出更多的危机。作者制定了一种危机模式分类。他们区分了治疗过程中的五种危机模式及其解决方式，并确定了其分布频率。最常见的模式是简单的 V 形。第二种最常见的模式是一个以上的疗程持续下降，突然修复。最长的下降趋势持续了六个疗程。
这项研究的发现深入了解了治疗关系中变化的基本机制。对危机定义的现象学讨论有助于为危机的操作化创建一种方法学方法，区分特定特征，并将这些特征与未来研究中的结果具体联系起来。方法上的考虑可能适用于不同的研究领域，在这些领域中，随着时间的推移，对感兴趣变量的波动进行分析是相关的。
