Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.
Clin Psychol Psychother. 2018 Jan;25(1):e60-e85. doi: 10.1002/cpp.2135. Epub 2017 Sep 29.
Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory-Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self-esteem outcomes. There was evidence for specific client-related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client-rated alliance, whereas baseline negative symptoms were associated with worse therapist-rated alliance. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan-theoretical, well-validated alliance measures to determine causal predictor variables.
治疗联盟是治疗结果的一个关键预测因素。对于精神分裂症患者来说，联盟可能尤为重要，因为这一群体通常有过人际关系创伤和关系困难的病史，包括与精神卫生工作人员的关系困难。本综述旨在确定：（a）精神分裂症患者与其治疗师之间的治疗联盟质量；（b）联盟是否预测治疗结果；以及（c）与联盟相关的变量。从创建数据库开始到 2015 年 4 月进行了数据库搜索。搜索产生了 4586 篇文章，最终有 26 项符合条件的研究，涉及 18 个独立样本。加权平均患者和治疗师的工作联盟量表-短式总分分别为 64.51 和 61.26。有证据表明联盟预测总体精神病症状结果，初步证据表明联盟预测再入院、药物使用和自尊结果。有证据表明特定的患者相关因素与联盟的不同视角有关。例如，较差的洞察力和以前的性虐待与较差的患者评定联盟有关，而基线阴性症状与较差的治疗师评定联盟有关。治疗师和治疗相关因素，包括治疗师的真诚、值得信赖和同理心，与更好的患者评定联盟有关，而治疗的适宜性、家庭作业依从性和出勤率与更好的治疗师评定联盟有关。主要的临床意义包括在治疗过程中以及培训和监督中需要从患者和治疗师的角度考虑联盟，以增强促进良好联盟的治疗师素质。未来的研究需要进行具有更大样本量的纵向研究，包括泛理论、经过良好验证的联盟测量，以确定因果预测变量。
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