Heinonen Erkki, Lindfors Olavi, Härkänen Tommi, Virtala Esa, Jääskeläinen Tuija, Knekt Paul
National Institute for Health and Welfare, Helsinki, Finland.
Clin Psychol Psychother. 2014 Nov-Dec;21(6):475-94. doi: 10.1002/cpp.1852. Epub 2013 Jun 28.
To investigate the determinants of the therapeutic working relationship and better understand its intrapersonal and interpersonal nature, this study investigated therapist characteristics as predictors of the formation and development of patient-rated and therapist-rated working alliances within a clinical trial of short-term versus long-term therapies. Short-term (solution-focused and short-term psychodynamic) and long-term (long-term psychodynamic therapy and psychoanalysis) therapies were provided by 70 volunteering, experienced therapists to 333 patients suffering from depressive and/or anxiety disorders. Therapists' professional and personal characteristics, measured prior to the start of the treatments, were assessed with the comprehensive self-report instrument, Development of Psychotherapists Common Core Questionnaire. The Working Alliance Inventory was rated by both therapists and patients at the third session and at the 7 months' follow-up point from the initiation of therapy. Therapists' self-rated basic interpersonal skills were found to predict the formation of better patient-rated alliances in both short-term and long-term therapies. Engaging, encouraging relational style fostered improvement of patients' working alliances especially in the course of short-term therapies. However, it led to patient alliance deterioration in long-term therapies, where constructive coping techniques proved more beneficial. Therapists' professional self-confidence and work enjoyment, along with their self-experiences in personal life, consistently predicted their alliances, but were less salient for patient ratings of alliance. The divergence of therapist and patient viewpoints has implications for therapist training and supervision, as characteristics found detrimental or helpful for the working relationship rated from the perspective of one party may not be predictive of the other therapy participant's experience.
为了探究治疗工作关系的决定因素,并更好地理解其内在和人际本质,本研究在一项短期与长期疗法的临床试验中,调查了治疗师的特征,作为患者评定和治疗师评定的工作联盟形成与发展的预测因素。70名志愿参与的经验丰富的治疗师为333名患有抑郁和/或焦虑症的患者提供了短期(聚焦解决疗法和短期心理动力学疗法)和长期(长期心理动力学疗法和精神分析)治疗。在治疗开始前,使用综合自我报告工具《心理治疗师共同核心问卷发展量表》评估治疗师的专业和个人特征。治疗师和患者在治疗开始后的第三次 session 以及7个月随访时对工作联盟量表进行评分。研究发现,治疗师自我评定的基本人际技能能够预测短期和长期治疗中患者评定的更好的联盟形成。积极、鼓励性的关系风格尤其在短期治疗过程中促进了患者工作联盟的改善。然而,在长期治疗中,这种风格导致患者联盟恶化,而建设性应对技巧被证明更有益。治疗师的专业自信和工作乐趣,以及他们在个人生活中的自我体验,始终能够预测他们的联盟,但对患者的联盟评分影响较小。治疗师和患者观点的差异对治疗师培训和督导具有启示意义,因为从一方角度来看对工作关系有不利或有益影响的特征,可能无法预测另一方治疗参与者的体验。