Nissen-Lie Helene A, Havik Odd E, Høglend Per A, Rønnestad Michael Helge, Monsen Jon T
Department of Psychology, University of Oslo, Oslo, Norway.
Department of Clinical Psychology, University of Bergen, Bergen, Norway.
Clin Psychol Psychother. 2015 Jul-Aug;22(4):317-27. doi: 10.1002/cpp.1891. Epub 2014 Feb 26.
Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in-session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in-session anxiety affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist-rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment.
The findings of this study suggest that the working alliance is influenced by therapists' self-reported practice experiences, which presumably are communicated through the therapists' in-session behaviours. The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance. Specifically, practitioners' self-reported difficulties in practice, such as their negative reactions to patients and their in-session anxiety, affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of 'flow' during sessions impacted only the therapist-rated alliance. Practitioners should note that patient alliance ratings were more likely to be influenced by therapists' negative practice experiences than by positive ones. The divergence in the patient and therapist viewpoints has potential implications for therapist training and supervision and everyday self-reflection.
研究表明，对于治疗结果而言，治疗师对治疗联盟的贡献比患者的贡献更为重要（例如，鲍德温、万波尔德和伊梅尔，2007年）；然而，关于哪些治疗师特征与治疗联盟的建立和发展相关，目前尚缺乏相关知识。本研究的目的是探讨工作联盟（使用工作联盟量表）的发展情况，该联盟由患者和治疗师根据治疗师的治疗过程体验进行评分。治疗师的体验通过心理治疗师共同核心问卷（奥林斯基和伦内斯塔德，2005年）收集。使用了来自挪威心理治疗过程与结果多地点研究（哈维克等人，1995年）的数据。对第3、12、20和40次治疗的联盟得分进行的多层次增长曲线分析表明，治疗师因素对工作联盟水平或增长的预测因联盟是由患者还是治疗师评分而有所不同。例如，结果显示治疗师对患者的负面反应及其治疗过程中的焦虑会影响患者评分的联盟，但不会影响治疗师评分的联盟，而治疗师在治疗过程中的流畅体验（奇克森特米哈伊，1990年）仅会影响治疗师评分的联盟。本研究中观察到的模式表明，治疗师应特别注意，当患者在治疗过程中评估工作联盟时，他们的负面治疗体验会被患者注意到并似乎会影响患者。
本研究结果表明，工作联盟受治疗师自我报告的实践经验影响，这些经验大概通过治疗师的治疗过程行为得以传达。研究发现，在评估工作联盟时，影响治疗师的实践经验与影响患者的实践经验之间存在显著差异。具体而言，从业者自我报告的实践困难，如他们对患者的负面反应及其治疗过程中的焦虑，会影响患者评分的联盟，但不会影响治疗师评分的联盟，而治疗师在治疗过程中的“流畅”体验仅会影响治疗师评分的联盟。从业者应注意，患者对联盟的评分更可能受治疗师的负面实践经验而非正面经验影响。患者和治疗师观点的差异对治疗师培训、督导及日常自我反思具有潜在影响。
