Department of Educational and Counseling Psychology, University of Louisville.
Derner Institute of Advanced Psychological Studies, Adelphi University.
J Couns Psychol. 2014 Apr;61(2):280-8. doi: 10.1037/a0035753. Epub 2014 Mar 17.
The purpose of the current study was to disentangle within- and between-case variability in the adherence-outcome association. Specifically, we expected that increases or decreases in within-case adherence ratings would be positively associated with therapy outcomes.
Seventy clients (74% women, 26% men; Mage = 29.8 years, SD = 11.00) received psychodynamic psychotherapy at a university-based community outpatient clinic. Adherence to core principles of a psychodynamic treatment model were coded by independent raters at the 3rd, 9th, and termination phase sessions using a psychotherapy technique scale. Therapy outcomes were assessed at both the symptom and the broadband levels of functioning.
Within-case variability in adherence ratings was significantly associated with therapy outcomes (accounting for approximately 10% of the variance in outcomes), after controlling for alliance, between-case variability, and the proportion of outcomes attributed by therapists.
The flexibility therapists demonstrate regarding the use of technique within a given treatment appears to be related to better outcomes across their caseload in relation to therapists who are less flexible with their interventions at the individual client level. The clinical implications of flexibility in adherence to a treatment model are discussed.
本研究旨在厘清治疗依从性与疗效关联中的组内和组间变异性。具体而言，我们预计治疗依从性评分的增加或减少与治疗效果呈正相关。
70 名来访者（74%为女性，26%为男性；平均年龄=29.8 岁，标准差=11.00）在一所大学社区门诊接受心理动力学心理治疗。采用心理治疗技术量表，由独立评估者在第 3、9 和治疗结束阶段对核心心理动力学治疗模型的依从性进行编码。在症状和广谱功能水平上评估治疗效果。
在控制了联盟、组间变异性以及治疗师归因于治疗结果的比例后，治疗依从性评分的组内变异性与治疗效果显著相关（占治疗结果变异性的 10%左右）。
与在个体客户层面干预措施灵活性较低的治疗师相比，治疗师在特定治疗中使用技术的灵活性与他们的整体治疗效果更好相关。讨论了对治疗模型的依从性的灵活性的临床意义。
