Psychiatric University Clinics Basel, Basel, Switzerland.
Psychiatry Res. 2013 Aug 30;209(1):15-20. doi: 10.1016/j.psychres.2012.10.009. Epub 2012 Nov 27.
The present study examined variables related to the quality of the therapeutic alliance in out-patients with schizophrenia. We expected recovery orientation and insight to be positively, and self-stigma to be negatively associated with a good therapeutic alliance. We expected these associations to be independent from age, clinical symptoms (i.e. positive and negative symptoms, depression), and more general aspects of relationship building like avoidant attachment style and the duration of treatment by the current therapist. The study included 156 participants with DSM-IV diagnoses of schizophrenia or schizoaffective disorder in the maintenance phase of treatment. Therapeutic alliance, recovery orientation, self-stigma, insight, adult attachment style, and depression were assessed by self-report. Symptoms were rated by interviewers. Hierarchical multiple regressions revealed that more recovery orientation, less self-stigma, and more insight independently were associated with a better quality of the therapeutic alliance. Clinical symptoms, adult attachment style, age, and the duration of treatment by current therapist were unrelated to the quality of the therapeutic alliance. Low recovery orientation and increased self-stigma might undermine the therapeutic alliance in schizophrenia beyond the detrimental effect of poor insight. Therefore in clinical settings, besides enhancing insight, recovery orientation, and self-stigma should be addressed.
本研究考察了与精神分裂症门诊患者治疗联盟质量相关的变量。我们预计，康复取向和洞察力与良好的治疗联盟呈正相关，而自我污名化则与之呈负相关。我们预计这些关联独立于年龄、临床症状（即阳性和阴性症状、抑郁）以及与当前治疗师的治疗关系建立等更一般的方面，如回避型依恋风格和治疗时间。研究纳入了 156 名处于治疗维持期的 DSM-IV 精神分裂症或分裂情感障碍患者。通过自我报告评估治疗联盟、康复取向、自我污名化、洞察力、成人依恋风格和抑郁。症状由访谈者评定。分层多元回归显示，更多的康复取向、更少的自我污名化和更多的洞察力与治疗联盟质量更好独立相关。临床症状、成人依恋风格、年龄和当前治疗师的治疗时间与治疗联盟质量无关。低康复取向和自我污名化增加可能会破坏精神分裂症的治疗联盟，而洞察力差的影响更大。因此，在临床环境中，除了增强洞察力外，还应解决康复取向和自我污名化问题。
