Ribeiro António P, Gonçalves Miguel M, Silva Joana R, Brás Andreia, Sousa Ines
CIPsi - Psychology Research Center, Psychotherapy and Psychopathology Research Unit, School of Psychology, University of Minho, Braga, Portugal.
Department of Mathematics and Applications, University of Minho, Braga, Portugal.
Clin Psychol Psychother. 2016 Mar-Apr;23(2):166-75. doi: 10.1002/cpp.1945. Epub 2015 Mar 25.
Research on the identification of poor outcome predictors is crucial for the prevention of therapeutic failure. Previous research suggests that clients' persistent ambivalence is one possible path to unsuccessful psychotherapy. The present study analyses ambivalence--here operationalized as return-to-the-problem markers (RPMs)--in five recovered and five unchanged cases of narrative psychotherapy for major depression. The results suggest that both recovered and unchanged cases presented a similar proportion of RPMs at baseline and a decreasing pattern of these ambivalence markers throughout therapy. However, the decreasing was more accentuated in recovered than in unchanged cases, and at the end of the treatment, the proportion of RPMs of the unchanged cases was significantly higher. The results are discussed in light of previous research on ambivalence in psychotherapy, focusing on the meaning of ambivalence and its clinical implications.
Ambivalence towards change, here operationalized as RPMs, seems to be a common process in both recovered and unchanged cases, perhaps signalling the uncertainty and anxiety that change may elicit. Although the number of RPMs decreased in both the recovered and unchanged cases, this reduction was significantly higher in the recovered group. Moreover, at the end of therapy, the recovered group revealed a significantly lower proportion of RPMs than the unchanged group, suggesting that ambivalence resolution (or lack thereof) may play a determining role in the therapy's evolution and outcome. RPMs in later stages of therapy may be operationalized as 'red flags' for the therapist to acknowledge the client's stuckness and adapt his or her intervention efforts, turning these instances into developmental opportunities.
识别不良预后预测因素的研究对于预防治疗失败至关重要。先前的研究表明，来访者持续的矛盾心理是心理治疗不成功的一条可能途径。本研究分析了矛盾心理——在此被操作化为问题重现标记（RPMs）——在5例康复的和5例未康复的重度抑郁症叙事心理治疗案例中的情况。结果表明，康复案例和未康复案例在基线时呈现出相似比例的RPMs，并且在整个治疗过程中这些矛盾心理标记呈下降趋势。然而，康复案例中的下降比未康复案例更明显，并且在治疗结束时，未康复案例的RPMs比例显著更高。根据先前关于心理治疗中矛盾心理的研究对结果进行了讨论，重点关注矛盾心理的意义及其临床意义。
对改变的矛盾心理，在此被操作化为RPMs，似乎在康复案例和未康复案例中都是一个常见过程，可能预示着改变可能引发的不确定性和焦虑。尽管康复案例和未康复案例中的RPMs数量都有所减少，但康复组的减少幅度明显更大。此外，在治疗结束时，康复组的RPMs比例明显低于未康复组，这表明矛盾心理的解决（或未解决）可能在治疗的进展和结果中起决定性作用。治疗后期的RPMs可以被操作化为“红旗信号”，让治疗师认识到来访者的停滞状态并调整其干预措施，将这些情况转化为发展机会。
