Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
Psychotherapy (Chic). 2012 Sep;49(3):276-90. doi: 10.1037/a0029564.
The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d = 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d = 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychodynamic psychotherapy to enable further elucidation of principles that evidently work.
本研究旨在探讨在心理动力学心理治疗中使用特定于研究的程序对治疗效果的影响程度，以及哪些变量调节了这种潜在关系。研究考察了会谈的音频/视频记录、使用治疗手册和治疗保真度检查的效果。对心理动力学心理治疗的随机对照试验进行了荟萃分析。共纳入了 46 个独立的治疗样本，总计 1615 名患者。在所有研究（45 个治疗样本）中，从治疗前到治疗后的总体结果的变化幅度很大（d = 1.01），并且在治疗后和平均 12.8 个月的随访（d = 0.18）之间观察到进一步的改善。比较使用特定于研究的程序和未使用特定于研究的程序的研究的亚组分析表明，对于治疗后数据，治疗效果没有差异。然而，使用治疗手册和保真度检查与治疗结束和随访评估之间的改善显著相关。在分析的限制范围内，这些数据初步表明，在心理动力学心理治疗中使用特定于研究的程序不会对治疗后结果产生负面影响，并且它们的使用有助于随着时间的推移出现积极的差异。这些发现虽然具有观察性，但为重新考虑如何在心理动力学心理治疗中整合临床实用性和实验控制的维度以进一步阐明显然有效的原则提供了依据。
