Ekberg Stuart, Barnes Rebecca K, Kessler David S, Mirza Selman, Montgomery Alan A, Malpass Alice, Shaw Alison R G
Queensland University of Technology,Australia.
University of Bristol,UK.
Behav Cogn Psychother. 2015 Nov;43(6):732-43. doi: 10.1017/S1352465814000241. Epub 2014 Jun 24.
Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists' initial attempts to engage clients in the therapeutic process. This article reports retrospective analysis of data from a trial of online cognitive behavioural therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients' expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention.
To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention.
Initial qualitative research using conversation analysis identified three communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data.
Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1).
Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention.
从心理治疗一开始就让来访者参与进来对治疗成功至关重要。然而，几乎没有研究评估治疗师在治疗过程中让来访者参与的最初尝试。本文报告了一项针对抑郁症的在线认知行为疗法（CBT）试验数据的回顾性分析。采用定性和定量方法来评估治疗师在治疗开始时如何管理来访者的期望以及其与治疗干预中来访者留存率的关系。
开发一个系统，用于对在线CBT初始阶段的期望管理进行编码，并评估其与留存率的关系。
最初使用对话分析的定性研究确定了治疗师在首次治疗开始时使用的三种沟通方式：无期望管理、部分期望管理和全面期望管理。这些发现被发展成一种编码方案，该方案实现了较高的评分者间一致性（加权Kappa = 0.78；95%置信区间：0.52至0.94），并应用于所有试验数据。
在对一系列来访者变量进行调整后，对147名来访者的数据进行的初步分析发现，全面期望管理与来访者在治疗中停留的时间比那些未接受期望管理的来访者长1.4个疗程相关（95%置信区间：-0.2至3.0）。包括另外21名来访者的敏感性分析支持了这一发现（1.6个疗程，95%置信区间：0.2至3.1）。
本研究结合定性和定量方法，表明在针对抑郁症的在线CBT中，期望管理与来访者留存率之间存在关系，这对专业实践具有启示意义。一项更大规模的前瞻性研究将能够更精确地估计留存率。
