White Melissa M, Lambert Michael J, Ogles Benjamin M, Mclaughlin Stevie B, Bailey Russell J, Tingey K Morgan
a Department of Psychology , Brigham Young University , Provo , UT , USA.
b Department of Counseling and Psychological Services , Brigham Young University , Provo , UT , USA.
Psychother Res. 2015;25(6):724-34. doi: 10.1080/10503307.2015.1009862. Epub 2015 Mar 9.
The Clinical Support Tools (CSTs) were developed to help therapists organize and target potential problems that might account for negative outcomes in psychotherapy. The core of CST feedback is the Assessment for Signal Clients. The purpose of this study was to describe and identify patterns of problems that typically characterize off-track cases.
The responses and scores from 107 off-track clients from a hospital-based outpatient clinic were analyzed.
A cluster analysis of the 107 off-track clients revealed three client types: those whose problems were characterized by alliance and motivational difficulties; those characterized by social support and life event difficulties; and those whose problems had an indistinguishable pattern. Log-linear modeling showed that if patients had less therapeutic alliance problems they were also less likely to have motivational problems. Findings were also consistent with the cluster analysis, which showed that a relatively higher percentage of not-on-track participants received signal alerts for the social support items and scale.
Individuals whose progress goes off-track while in psychotherapy appear to have their greatest difficulty with social support, followed closely by motivation for therapy and therapeutic alliance.
临床支持工具（CSTs）旨在帮助治疗师梳理并找出可能导致心理治疗出现负面结果的潜在问题。CST反馈的核心是针对有明显问题的来访者的评估。本研究的目的是描述并识别偏离正轨案例的典型问题模式。
对一家医院门诊诊所的107名偏离正轨的来访者的回答和分数进行了分析。
对107名偏离正轨的来访者进行聚类分析，发现了三种来访者类型：问题表现为治疗联盟和动机困难的来访者；问题表现为社会支持和生活事件困难的来访者；以及问题模式不明显的来访者。对数线性模型显示，如果患者的治疗联盟问题较少，那么他们出现动机问题的可能性也较小。研究结果也与聚类分析一致，聚类分析表明，相对较高比例的偏离正轨的参与者收到了关于社会支持项目和量表的信号警报。
在心理治疗过程中进展偏离正轨的个体，似乎在社会支持方面存在最大困难，其次是治疗动机和治疗联盟。
