Department of Psychology, Uppsala University, Sweden.
Psychol Psychother. 2017 Dec;90(4):600-616. doi: 10.1111/papt.12128. Epub 2017 May 6.
This study of directiveness draws on the literature on patient-therapist matching, neutrality, and resistance. Our aim was to investigate how psychotherapists conceptualize directiveness as an attitude, with a focus on pantheoretical aspects of directiveness.
Our data are narratives from 18 interviews with psychotherapists of different theoretical orientations (cognitive-behavioural, family-systems, humanistic-experiential, and psychodynamic), and from focus-group discussions with six other psychotherapists.
The analysis yielded four general themes: expression of directiveness (behaviour, agency, structure), its presence (depending on phase of and goals for therapy), its positive and negative outcomes (for patients and therapists, respectively), and therapist awareness (initial and shifting, depending on theoretical orientation).
Directiveness may be construed as an attitude. It supposedly increases via certain responses, but only a few of these are considered positive by therapists at large. Directiveness may be more present in early and late phases of therapy, and more warranted with patients that function poorly. There are both positive and negative outcomes of directiveness, but therapists are more prone to disclose the former.
Therapist directiveness supposedly increases via advice, questions, clarifications, steering to topics, goal setting, self-disclosure, and session management. Directiveness is seen as more present in early and late phases of therapy. Directing is more warranted with patients who function poorly. Possible positive outcomes of directiveness are clarity, feeling of security, and saving time; negative outcomes are decrease of agency, increase of resistance, and less patient self-attribution of improvement. It is unlikely that therapists disclose adverse directive behaviours. Those who do, attribute them to psychotherapy structure if their attitudes are negative, and to personal choice if they are positive. This may hamper therapists managing their own level of directiveness.
本研究借鉴了关于医患匹配、中立性和阻抗的文献。我们的目的是调查心理治疗师如何将直接性概念化为一种态度，并重点研究直接性的泛理论方面。
我们的数据来自 18 名不同理论取向（认知行为、家庭系统、人本体验和心理动力学）的心理治疗师的访谈叙述，以及另外 6 名心理治疗师的焦点小组讨论。
分析产生了四个一般主题：直接性的表达（行为、能动性、结构）、它的存在（取决于治疗的阶段和目标）、它的积极和消极结果（分别为患者和治疗师）以及治疗师的意识（初始和转变，取决于理论取向）。
直接性可以被理解为一种态度。它通过某些反应增加，但治疗师普遍认为只有少数反应是积极的。直接性在治疗的早期和晚期阶段可能更为明显，对于功能较差的患者更有必要。直接性既有积极的结果，也有消极的结果，但治疗师更倾向于披露前者。
治疗师的直接性据称通过建议、问题、澄清、引导话题、设定目标、自我暴露和会议管理来增加。直接性在治疗的早期和晚期阶段被认为更为明显。指导对于功能较差的患者更有必要。直接性的可能积极结果是清晰度、安全感和节省时间；消极结果是能动性降低、阻抗增加以及患者自我归因改善减少。治疗师不太可能披露不利的直接行为。那些披露的人，如果他们的态度是消极的，就会将其归因于心理治疗结构，如果他们的态度是积极的，就会将其归因于个人选择。这可能会阻碍治疗师管理自己的直接性水平。
