Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden.
Department of Psychology, Stockholm University, Stockholm, Sweden.
Psychother Res. 2020 Jan;30(1):13-22. doi: 10.1080/10503307.2018.1516306. Epub 2018 Aug 31.
Evidence is inconclusive on whether variability in alliance ratings within or between therapists is a better predictor of treatment outcome. The objective of the present study was to explore between and within patient and therapist variability in alliance ratings, reciprocity among them, and their significance for treatment outcome. A large primary care psychotherapy sample was used. Patient and therapist ratings of the working alliance at session three and patient ratings of psychological distress pre-post were used for analyses. A one-with-many analytical design was used in order to address problems associated with nonindependence. Within-therapist variation in alliance ratings accounted for larger shares of the total variance than between-therapist variation in both therapist and patient ratings. Associations between patient and therapist ratings of the alliance for the individual therapists and their average treatment outcome were weak but the associations between alliance ratings and treatment outcome within therapies were strong. The results indicated a substantial dyadic reciprocity in alliance ratings. Within-therapist variation in alliance was a better predictor of treatment outcome than between-therapist variation in alliance ratings.
关于治疗师内部或之间的联盟评级变化是否能更好地预测治疗结果，证据尚无定论。本研究的目的是探索患者和治疗师之间以及他们之间的联盟评级变化、相互关系及其对治疗结果的意义。研究使用了大量的初级保健心理治疗样本。分析使用了治疗的第 3 次会谈中患者和治疗师对工作联盟的评估，以及患者在治疗前后的心理困扰评估。为了解决非独立性相关的问题，使用了一对一的多分析设计。在患者和治疗师的联盟评估中，治疗师内部的变化比治疗师之间的变化占总方差的比例更大。个别治疗师的患者和治疗师对联盟的评估之间存在弱关联，但治疗师内部的联盟评估与治疗结果之间存在强关联。结果表明，联盟评估存在实质性的双向互惠关系。治疗师内部的联盟变化比治疗师之间的联盟变化更能预测治疗结果。
