Barzilay Shira, Yaseen Zimri S, Hawes Mariah, Gorman Bernard, Altman Rachel, Foster Adriana, Apter Alan, Rosenfield Paul, Galynker Igor
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, United States.
Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, United States.
Front Psychiatry. 2018 Apr 5;9:104. doi: 10.3389/fpsyt.2018.00104. eCollection 2018.
Mental health professionals have a pivotal role in suicide prevention. However, they also often have intense emotional responses, or countertransference, during encounters with suicidal patients. Previous studies of the Therapist Response Questionnaire-Suicide Form (TRQ-SF), a brief novel measure aimed at probing a distinct set of suicide-related emotional responses to patients found it to be predictive of near-term suicidal behavior among high suicide-risk inpatients. The purpose of this study was to validate the TRQ-SF in a general outpatient clinic setting.
Adult psychiatric outpatients ( = 346) and their treating mental health professionals ( = 48) completed self-report assessments following their first clinic meeting. Clinician measures included the TRQ-SF, general emotional states and traits, therapeutic alliance, and assessment of patient suicide risk. Patient suicidal outcomes and symptom severity were assessed at intake and one-month follow-up. Following confirmatory factor analysis of the TRQ-SF, factor scores were examined for relationships with clinician and patient measures and suicidal outcomes.
Factor analysis of the TRQ-SF confirmed three dimensions: (1) affiliation, (2) distress, and (3) hope. The three factors also loaded onto a single general factor of negative emotional response toward the patient that demonstrated good internal reliability. The TRQ-SF scores were associated with measures of clinician state anger and anxiety and therapeutic alliance, independently of clinician personality traits after controlling for the state- and patient-specific measures. The total score and three subscales were associated in both concurrent and predictive ways with patient suicidal outcomes, depression severity, and clinicians' judgment of patient suicide risk, but not with global symptom severity, thus indicating specifically suicide-related responses.
The TRQ-SF is a brief and reliable measure with a 3-factor structure. It demonstrates construct validity for assessing distinct suicide-related countertransference to psychiatric outpatients. Mental health professionals' emotional responses to their patients are concurrently indicative and prospectively predictive of suicidal thoughts and behaviors. Thus, the TRQ-SF is a useful tool for the study of countertransference in the treatment of suicidal patients and may help clinicians make diagnostic and therapeutic use of their own responses to improve assessment and intervention for individual suicidal patients.
心理健康专业人员在预防自杀方面发挥着关键作用。然而，他们在与有自杀倾向的患者接触时，也常常会产生强烈的情绪反应，即反移情。先前对治疗师反应问卷 - 自杀量表（TRQ - SF）的研究发现，该简短新颖的量表旨在探究对患者一系列独特的与自杀相关的情绪反应，它能够预测高自杀风险住院患者的近期自杀行为。本研究的目的是在普通门诊环境中验证TRQ - SF。
成年精神科门诊患者（n = 346）及其治疗心理健康专业人员（n = 48）在首次门诊就诊后完成自我报告评估。临床医生的测量包括TRQ - SF、一般情绪状态和特质、治疗联盟以及对患者自杀风险的评估。在患者就诊时和随访一个月时评估患者的自杀结局和症状严重程度。在对TRQ - SF进行验证性因素分析后，检查因素得分与临床医生和患者测量指标以及自杀结局之间的关系。
TRQ - SF的因素分析确认了三个维度：（1）情感联系，（2）痛苦，（3）希望。这三个因素还加载到一个对患者负面情绪反应的单一总体因素上，显示出良好的内部信度。在控制了状态和患者特定测量指标后，TRQ - SF得分与临床医生的愤怒和焦虑状态以及治疗联盟的测量指标相关，与临床医生的人格特质无关。总分和三个子量表在同时性和预测性方面都与患者的自杀结局、抑郁严重程度以及临床医生对患者自杀风险的判断相关，但与总体症状严重程度无关，从而表明是与自杀相关的特定反应。
TRQ - SF是一种具有三因素结构的简短可靠测量工具。它在评估对精神科门诊患者独特的与自杀相关的反移情方面具有结构效度。心理健康专业人员对患者的情绪反应同时具有指示性，并能前瞻性地预测自杀想法和行为。因此，TRQ - SF是研究自杀患者治疗中反移情的有用工具，可能有助于临床医生利用自身反应进行诊断和治疗，以改善对个体自杀患者的评估和干预。
