Elliott Katherine P, Westmacott Robin, Hunsley John, Rumstein-McKean Orly, Best Marlene
School of Psychology, University of Ottawa, Ottawa, Canada.
Ottawa Couple and Family Institute, Ottawa, Canada.
Clin Psychol Psychother. 2015 Sep-Oct;22(5):399-408. doi: 10.1002/cpp.1900. Epub 2014 Apr 24.
Seeking psychotherapy can be conceptualized as having three stages: deciding that therapy might help, deciding to seek therapy and contacting a therapist. The present study examined the duration and difficulty of clients' decisions to seek psychotherapy and whether these experiences were predictive of expected difficulty and commitment to the therapy process. One-hundred and fifty-five adults seeking individual psychological services from a university training clinic were assessed before intake; 107 of these participants also completed measures between the third and fourth therapy sessions and at post-therapy. Deciding that therapy might help was reported to be the most difficult step and took the longest, with each subsequent step becoming easier and briefer. At each step, the more difficult the decision, the more time participants took to make it. Higher distress was associated with more difficulty in deciding that therapy might help and deciding to seek therapy. Duration and difficulty of decisions to seek therapy were positively correlated with expectations of difficulty in therapy as measured prior to treatment and following the third session but were not associated with participants' commitment to therapy. The implications of these results for clinicians and mental health services are discussed.
The most difficult and time-consuming step for those who seek mental health services is recognizing that their distressing experiences are connected to mental health; clinicians may aid this challenge by providing information on the nature of mental disorders and common symptoms of emotional distress on websites or through other means (e.g., physicians' waiting rooms and advertising campaigns). The next most difficult and time-consuming step for those who seek mental health services is deciding that psychotherapy may help; by providing easily accessible information (e.g., on websites) about what psychotherapy entails, including clinicians' expectations of clients and the benefits/challenges of therapy, potential clients may be able to progress through this step more rapidly and with less difficulty. Clients' expectations of the value of psychotherapy and their commitment to engage in therapy do not appear to be affected by how long it took, or how difficult it was, to obtain psychotherapy. Factors such as forming a strong therapeutic alliance and providing support and guidance during the initial sessions of therapy may be more important in helping potential clients commit to therapy than what they experienced in their efforts to receive psychotherapy.
寻求心理治疗可分为三个阶段：认定治疗可能有帮助、决定寻求治疗以及联系治疗师。本研究考察了来访者决定寻求心理治疗的时长和难度，以及这些经历是否能预测治疗过程中预期的难度和投入程度。155名从大学培训诊所寻求个体心理服务的成年人在接受治疗前接受了评估；其中107名参与者还在第三次和第四次治疗 sessions 之间以及治疗后完成了测量。据报告，认定治疗可能有帮助是最困难的步骤，耗时最长，随后的每一步都变得更容易且耗时更短。在每一步中，决策越困难，参与者做出决策所需的时间就越长。更高的痛苦程度与认定治疗可能有帮助和决定寻求治疗时更大的困难相关。寻求治疗的决策时长和难度与治疗前及第三次治疗后测量的对治疗难度的预期呈正相关，但与参与者对治疗的投入程度无关。讨论了这些结果对临床医生和心理健康服务的意义。
对于寻求心理健康服务的人来说，最困难和最耗时的步骤是认识到他们的痛苦经历与心理健康有关；临床医生可以通过在网站上或通过其他方式（如医生候诊室和广告活动）提供关于精神障碍的性质和情绪困扰的常见症状的信息来帮助应对这一挑战。对于寻求心理健康服务的人来说，下一个最困难和最耗时的步骤是决定心理治疗可能有帮助；通过提供易于获取的信息（如在网站上），说明心理治疗包括什么，包括临床医生对来访者的期望以及治疗的益处/挑战，潜在来访者可能能够更快速、更轻松地完成这一步骤。来访者对心理治疗价值的期望以及他们参与治疗的投入程度似乎不受获得心理治疗所需的时间或难度的影响。在帮助潜在来访者投入治疗方面，诸如建立牢固的治疗联盟以及在治疗初期提供支持和指导等因素可能比他们在寻求心理治疗过程中的经历更为重要。
