School of Psychology, University of Minho, Braga, Portugal.
Psychol Psychother. 2013 Sep;86(3):294-314. doi: 10.1111/j.2044-8341.2012.02066.x. Epub 2012 May 4.
The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy.
We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system - the therapeutic collaboration coding system (TCCS) - designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding system's psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the client's therapeutic zone of proximal development, defined as the space between the client's actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist.
We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy.
The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship.
治疗联盟的核心——治疗协作的质量和强度，与积极的治疗结果可靠相关。临床医生和研究人员面临的紧迫挑战是构建一个概念框架，将促进协作的辩证工作与客户在治疗中取得进展的模型整合起来。
我们提出了一个关于治疗中的协作如何变得具有治疗性的概念性解释。此外，我们还报告了一个编码系统的构建——治疗协作编码系统（TCCS），旨在分析和跟踪治疗师和客户之间的互动，实时进行。初步证据表明了该编码系统的心理测量特性。TCCS 评估每个发言回合，并评估治疗师是否以及如何在客户的治疗性最近发展区（定义为客户的实际治疗发展水平与其在与治疗师合作下可以达到的潜在发展水平之间的空间）内工作。
我们将 TCCS 应用于五个案例：叙事治疗的一个良好和一个不良结果案例、认知行为治疗的一个良好和一个不良结果案例，以及叙事治疗的一个辍学案例。
TCCS 提供了一些标记，可能有助于研究人员更实时地理解治疗协作，并帮助治疗师更好地调节关系。
