Center for Anxiety and Related Disorders, Boston University.
J Couns Psychol. 2012 Jul;59(3):368-78. doi: 10.1037/a0028078. Epub 2012 Apr 30.
Although a potentially important factor in case conceptualization and treatment planning, the impact of previous treatment on subsequent counseling response has received little empirical attention. Using archival data, this study aimed to (a) report the prevalence of previous treatment utilization in a counseling population, (b) examine potential differences in symptom severity by treatment history, and (c) test whether the rate of change in symptoms over a course of counseling is moderated by previous treatment utilization, when also accounting for initial severity. A sample of 1,262 college students presenting for treatment in university/college counseling centers across the United States provided information on previous treatment history and completed the Counseling Center Assessment of Psychological Symptoms, administered at intake and up to 4 additional time points, with an average of 3-5 weeks between assessments. Data from the 13-item Depression subscale were used for the present study. Half the clients reported previous counseling, one third psychotropic medication, and one tenth psychiatric hospitalization. Previous treatment was associated with increased baseline depressive symptom severity. Results from latent growth curve models showed that previous counseling and medication correlated with a slower rate of symptom response, and previous counseling reduced the probability of being labeled a treatment responder. Previous counseling remained a significant predictor of counseling response when controlling for baseline severity. Hypothesized mechanisms through which previous treatment experience impacts subsequent treatment response remain largely theoretical and should be the focus of future research.
虽然之前的治疗对后续咨询反应的影响是个案概念化和治疗计划中的一个潜在重要因素，但很少有实证研究关注这一问题。本研究使用档案数据，旨在：(a)报告咨询人群中之前治疗的利用情况；(b)考察治疗史对症状严重程度的潜在影响；(c)在考虑初始严重程度的同时，检验咨询过程中症状变化的速度是否受到之前治疗利用的调节。来自美国各地大学/学院咨询中心的 1262 名大学生接受了治疗，他们提供了之前治疗史的信息，并完成了《咨询中心心理症状评估》，在接受治疗时以及最多 4 个额外时间点进行评估，评估之间的平均间隔为 3-5 周。本研究使用了 13 项抑郁子量表的数据。一半的客户报告了之前的咨询，三分之一的客户使用了精神药物，十分之一的客户住院治疗。之前的治疗与基线时更严重的抑郁症状严重程度有关。潜在增长曲线模型的结果表明，之前的咨询和药物治疗与症状反应速度较慢有关，之前的咨询降低了被标记为治疗反应者的可能性。在控制基线严重程度后，之前的咨询仍然是咨询反应的一个显著预测因素。之前的治疗经验如何影响后续治疗反应的假设机制在很大程度上仍停留在理论层面，应该成为未来研究的重点。
