Budman S H, Soldz S, Demby A, Feldstein M, Springer T, Davis M S
Department of Psychiatry, Harvard Medical School, Boston, MA.
Psychiatry. 1989 Aug;52(3):339-50. doi: 10.1080/00332747.1989.11024456.
Cohesiveness has been viewed as the group psychotherapy equivalent of the therapeutic alliance in individual treatment. Although researchers have attempted to study the concept of cohesion in group treatment, understanding of this so-called "curative" group factor remains quite primitive. In this study of 12 time-limited psychotherapy groups, with a total of 90 nonpsychotic outpatients, we explore the relationships between cohesion, alliance and treatment outcome. Our cohesion measure is a new instrument, the Harvard Community Health Plan Group Cohesiveness Scale, developed for use with group therapy videotapes. To measure alliance we have modified the Penn Helping Alliance Scale (Group Alliance Scale) to be scored from videotapes of group sessions. Both of these instruments use trained observers to make ratings for the group-as-a-whole. The outcome battery for patients in these groups included a widely varied set of measures, enabling us to view change from a number of perspectives. Our findings indicate that cohesion and alliance as measured here are related concepts. We also find that both cohesion and alliance appear to have strong relationships with improved self-esteem and reduced symptomatology for patients in these groups. In addition, it appears that outcome is most related to cohesion in the first 30 minutes of a group session. Implications of these and other findings are discussed.
凝聚力被视为团体心理治疗中与个体治疗中的治疗联盟相对应的概念。尽管研究人员试图研究团体治疗中凝聚力的概念，但对这个所谓的“治疗性”团体因素的理解仍然相当原始。在这项对12个限时心理治疗团体（共90名非精神病门诊患者）的研究中，我们探讨了凝聚力、联盟与治疗结果之间的关系。我们测量凝聚力的工具是一种新的量表，即哈佛社区健康计划团体凝聚力量表，它是为配合团体治疗录像带使用而开发的。为了测量联盟，我们对宾夕法尼亚帮助联盟量表（团体联盟量表）进行了修改，以便根据团体治疗 session 的录像带进行评分。这两种工具都使用经过培训的观察者对整个团体进行评分。这些团体中患者的结果评估包括一系列广泛的测量方法，使我们能够从多个角度看待变化。我们的研究结果表明，这里所测量的凝聚力和联盟是相关的概念。我们还发现，凝聚力和联盟似乎都与这些团体中患者自尊的提高和症状的减轻有密切关系。此外，似乎结果与团体 session 前30分钟的凝聚力最为相关。我们讨论了这些发现及其他发现的意义。
