South Oxford Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Oxford, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Clin Psychol Psychother. 2019 Mar;26(2):167-174. doi: 10.1002/cpp.2339. Epub 2018 Nov 20.
Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.
个案概念化被认为在治疗关系的发展和治疗变化的启动过程中都很重要。认知分析疗法（CAT）以书面（重新表述信）和图表形式（连续图表重新表述）描述了客户问题的发展起源和维持。本研究旨在调查这些重新表述工具对洞察力和症状变化的影响。采用小样本重复测量设计，从六对治疗师/客户中收集定量和定性措施。参与治疗师记录他们提供 CAT 重新表述工具的情况。参与客户每四次会议完成自我反思和洞察力量表的洞察力子量表，每次会议完成常规评估 10 的临床结果量表。使用模板分析探索关于他们对 CAT 的体验和归因的客户变化访谈中的定性数据。参与者在干预过程中表现出（症状减轻和洞察力提高）的改善。重新表述工具的管理并未始终导致洞察力和症状测量的显著变化。然而，参与者认为这些工具会导致良好治疗关系背景下的洞察力和情感变化。这些发现表明，真正的治疗关系是一种重要的变化机制，通过 CAT 特定工具运作并得到加强。
