Berry Katherine, Gregg Lynsey, Lobban Fiona, Barrowclough Christine
School of Psychological Sciences, University of Manchester, 2nd Floor Zocohnis Building, Brunswick Street, Manchester, M13 9PL, UK.
School of Psychological Sciences, University of Manchester, 2nd Floor Zocohnis Building, Brunswick Street, Manchester, M13 9PL, UK.
Compr Psychiatry. 2016 May;67:73-80. doi: 10.1016/j.comppsych.2016.02.014. Epub 2016 Mar 2.
This paper examines the role of therapeutic alliance in predicting outcomes in a Randomized Controlled Trial of Motivational Interviewing and Cognitive Behavioral Therapy (MICBT) for problematic cannabis use in recent onset psychosis.
All clients were participating in a three arm pragmatic rater-blind randomized controlled trial of brief MICBT plus standard care compared with longer term MICBT plus standard care and standard care alone. Participants completed measures to assess clinical symptoms, global functioning and substance misuse at baseline, 4.5months, 9months and 18months. Clients and therapists completed the Working Alliance Inventory approximately one month into therapy. Client alliance data was available for 35 participants randomized to therapy and therapist alliance data was available for 52 participants randomized to therapy.
At baseline, poorer client-rated alliance was associated with more negative symptoms, poorer insight and greater cannabis use, whereas poorer therapist-rated alliance was only associated with amount of cannabis used per cannabis using day. Alliance ratings were also positively associated with amount of therapy: client-rated alliance was higher in the longer compared to the briefer therapy; therapist-rated alliance was associated with greater number of sessions attended (controlling for type of therapy) and therapy completion. In predicting outcome, client-rated alliance predicted total symptom scores and global functioning scores at follow-up. Neither client nor therapist alliance predicted changes in substance misuse at any time point.
Findings demonstrate that individuals with psychosis and substance misuse who form better alliances with their therapists gain greater benefits from therapy, at least in terms of improvements in global functioning.
本文探讨了在一项针对近期发病精神病患者大麻使用问题的动机性访谈与认知行为疗法（MICBT）随机对照试验中，治疗联盟在预测治疗结果方面的作用。
所有参与者均参与了一项三臂实用性评分者盲法随机对照试验，将简短的MICBT加标准护理与长期的MICBT加标准护理以及单独的标准护理进行比较。参与者在基线、4.5个月、9个月和18个月时完成了评估临床症状、整体功能和物质滥用情况的测量。客户和治疗师在治疗开始约一个月后完成了工作联盟量表。有35名随机分配接受治疗的参与者的客户联盟数据，以及52名随机分配接受治疗的参与者的治疗师联盟数据。
在基线时，客户评分的较差联盟与更多的阴性症状、较差的洞察力和更多的大麻使用相关，而治疗师评分的较差联盟仅与每日大麻使用量相关。联盟评分也与治疗量呈正相关：与简短治疗相比，长期治疗中客户评分的联盟更高；治疗师评分的联盟与参加的疗程数更多（控制治疗类型）和治疗完成情况相关。在预测结果方面，客户评分的联盟预测了随访时的总症状评分和整体功能评分。客户联盟和治疗师联盟在任何时间点都未预测物质滥用的变化。
研究结果表明，患有精神病和物质滥用问题且与治疗师建立更好联盟的个体从治疗中获得更大益处，至少在整体功能改善方面如此。
