Lilliengren Peter, Falkenström Fredrik, Sandell Rolf, Mothander Pia Risholm, Werbart Andrzej
Department of Psychology, Stockholm University.
Center for Clinical Research Sörmland, Uppsala University.
J Couns Psychol. 2015 Jan;62(1):1-13. doi: 10.1037/cou0000044. Epub 2014 Sep 15.
Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.
我们采用一种全新的方法，通过患者叙述来评估其对治疗师的依恋程度（患者对治疗师依恋评定量表；PAT-RS），在一个接受精神分析心理治疗的70名年轻成年人样本中，研究了对治疗师的安全依恋、患者评定的治疗联盟与治疗结果之间的关系。一系列控制了治疗时长和治疗师效应的线性混合效应模型表明，治疗结束时对治疗师的安全依恋与症状改善、整体功能和人际关系问题的改善相关。在控制了治疗联盟后，这些关系在症状和整体功能方面依然存在。此外，在随访期间，我们发现了一种抑制效应，即当将两个变量一起建模时，对治疗师的安全依恋预示着整体功能的持续改善，而治疗联盟则预示着功能恶化。尽管受相关设计的限制，但本研究表明，对治疗师形成安全依恋与治疗获益相关，并且可以预测治疗后功能的改善。未来的研究应更密切地调查对治疗师依恋的时间发展及其与治疗联盟和治疗结果的相互作用。为确保与患者评定的治疗联盟区分开来，应考虑采用基于观察者的对治疗师依恋的测量方法。
