a School of Psychology , University Witten/Herdecke , Witten , Germany.
b Georg-Elias-Müller Institute for Psychology , Georg-August-University Göttingen , Göttingen , Germany.
Psychother Res. 2019 Jan;29(1):123-138. doi: 10.1080/10503307.2017.1315464. Epub 2017 Apr 26.
This study examined psychotherapist trainees' experiences of "professional self-doubt" (PSD) and "negative personal reaction" (NPR) during cognitive behavioral therapy (CBT) and their associations with patients' symptoms and interpersonal problems.
Forty therapists treating 621 patients were analyzed. Patients' symptoms and interpersonal problems were collected repeatedly during therapy. Data about patients' interpersonal problems were available only for 106 patients and 18 therapists. Therapists' difficulties were assessed as trait-based (one assessment across all patients) and as state-based (repeated assessments for each individual patient) difficulties. Multilevel models were performed.
None of the trait-based difficulties correlated with the change of the patients' symptoms. Yet, more NPR at the trait-level predicted a more favorable change, whereas higher PSD at the trait-level showed an opposite effect on change of patients' interpersonal problems. Regarding state-based difficulties, PSD as well as NPR decreased significantly over the course of CBT. Patients whose therapists' experienced PSD to increase during CBT were at risk of a less favorable patient progress regarding symptoms, whereas the change of interpersonal problems was not significantly associated with changes in therapists' difficulties.
Patients' progress is associated with therapists' experiences of difficulties. Yet, trait- and state-based difficulties lead to different results.
本研究探讨了心理治疗师受训者在认知行为疗法（CBT）中经历的“职业自我怀疑”（PSD）和“负面个人反应”（NPR），以及它们与患者症状和人际问题的关系。
对 40 名治疗 621 名患者的治疗师进行了分析。患者的症状和人际问题在治疗过程中反复收集。只有 106 名患者和 18 名治疗师可获得有关患者人际问题的数据。治疗师的困难被评估为基于特质的（对所有患者进行一次评估）和基于状态的（对每个患者进行重复评估）困难。进行了多层次模型分析。
基于特质的困难与患者症状的变化均无相关性。然而，较高的特质 NPR 预示着患者症状的改善更有利，而较高的特质 PSD 则对患者人际问题的改善有相反的影响。关于基于状态的困难，PSD 和 NPR 在 CBT 过程中显著下降。在 CBT 期间，治疗师经历 PSD 增加的患者，其症状改善的风险较低，而人际问题的变化与治疗师困难的变化没有显著关联。
患者的进展与治疗师的困难经历有关。然而，基于特质和基于状态的困难会产生不同的结果。
