Department of Psychology, Bar-Ilan University.
Department of Psychology, University of Trier.
J Consult Clin Psychol. 2015 Aug;83(4):773-84. doi: 10.1037/ccp0000015. Epub 2015 Feb 9.
The present study had 2 aims: (a) to implement West and Kenny's (2011) Truth-and-Bias model to simultaneously assess the temporal congruence and directional discrepancy between clients' and therapists' ratings of the bond facet of the therapeutic alliance, as they cofluctuate from session to session; and (b) to examine whether symptom severity and a personality disorder (PD) diagnosis moderate congruence and/or discrepancy.
Participants included 213 clients treated by 49 therapists. At pretreatment, clients were assessed for a PD diagnosis and completed symptom measures. Symptom severity was also assessed at the beginning of each session, using client self-reports. Both clients and therapists rated the therapeutic bond at the end of each session.
Therapists and clients exhibited substantial temporal congruence in their session-by-session bond ratings, but therapists' ratings tended to be lower than their clients' across sessions. Additionally, therapeutic dyads whose session-by-session ratings were more congruent also tended to have a larger directional discrepancy (clients' ratings being higher). Pretreatment symptom severity and PD diagnosis did not moderate either temporal congruence or discrepancy at the dyad level; however, during sessions when clients were more symptomatic, therapist and client ratings were both farther apart and tracked each other less closely.
Our findings are consistent with a "better safe than sorry" pattern, which suggests that therapists are motivated to take a vigilant approach that may lead both to underestimation and to attunement to fluctuations in the therapeutic bond.
本研究有两个目的：（a）实施 West 和 Kenny（2011）的真实与偏差模型，同时评估客户和治疗师对治疗联盟纽带方面的评价在每个会话中共同波动时的时间一致性和方向差异；（b）检验症状严重程度和人格障碍（PD）诊断是否调节一致性和/或差异。
参与者包括 213 名由 49 名治疗师治疗的客户。在治疗前，对客户进行 PD 诊断评估，并完成症状测量。在每个会话开始时，客户也使用自我报告评估症状严重程度。每次会话结束时，客户和治疗师都会对治疗关系进行评分。
治疗师和客户在他们的会话到会话的关系评分中表现出相当大的时间一致性，但治疗师的评分在整个会话中往往低于客户。此外，会话到会话的评分更一致的治疗对子也往往存在更大的方向差异（客户的评分更高）。治疗前的症状严重程度和 PD 诊断在对子水平上既不调节时间一致性，也不调节差异；然而，当客户的症状更严重时，治疗师和客户的评分都更离散，彼此之间的关联度也更低。
我们的发现与“宁可安全也不可冒险”的模式一致，这表明治疗师受到采取警惕方法的激励，这种方法可能导致对治疗关系波动的低估和适应。
