Department of Psychology, University of Buenos Aires.
Department of Psychology, Justus-Liebig University Giessen.
J Couns Psychol. 2021 Oct;68(5):582-592. doi: 10.1037/cou0000528. Epub 2020 Aug 27.
This study analyzed patient-therapist in-session interpersonal complementarity effects on the therapeutic alliance and depression severity during the initial and working phase of cognitive-behavioral therapy for depression. It also explored whether patients' interpersonal problems moderate those complementarity effects. We drew on a sample of 90 dyads derived from a randomized controlled trial of two cognitive-behavioral therapies for depression. Using an observer-based measure, we assessed patients' and therapists' interpersonal behavior in Sessions 1, 5, 9, and 13 and computed their complementarity regarding interpersonal affiliation (i.e., correspondence) and dominance (i.e., reciprocity). Patients completed measures of interpersonal problems at baseline and session-by-session measures of depression severity and quality of the therapeutic alliance. Response surface analyses based on polynomial regressions showed that patient-therapist complementarity in higher affiliative behaviors was associated with a stronger alliance. Interpersonal problems regarding agency moderated the complementarity effects of the dominance dimensions on depression severity. Overly dominant patients benefited more from a nonreciprocal relationship in the dominance dimension, whereas submissive patients benefited more from complementarity in that dimension. Furthermore, interpersonal problems of communion significantly moderated the effects of complementarity in affiliative behaviors on both the alliance and outcome. These results suggest the relevance of both interpersonal correspondence and reciprocity for the psychotherapy process, informing clinical practice in terms of interpersonal responsiveness. The moderation effects of interpersonal problems provide preliminary evidence, which should be replicated in future research, to determine relevant markers indicating for whom a complementary approach would be beneficial in cognitive therapy for depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
本研究分析了患者-治疗师在会话中的人际互补效应对认知行为治疗抑郁症初始和工作阶段的治疗联盟和抑郁严重程度的影响。它还探讨了患者的人际问题是否会调节这些互补效应。我们从一项针对两种认知行为疗法治疗抑郁症的随机对照试验中抽取了 90 对患者-治疗师的样本。使用基于观察者的测量方法，我们评估了患者和治疗师在第 1 、5 、9 和 13 次会话中的人际行为，并计算了他们在人际亲和（即对应）和主导（即互惠）方面的互补性。患者在基线和每次会话时完成人际问题、抑郁严重程度和治疗联盟质量的测量。基于多项式回归的响应面分析表明，较高亲和性行为的患者-治疗师互补性与更强的联盟相关。关于能动性的人际问题调节了主导维度对抑郁严重程度的互补效应。过于主导的患者从主导维度的非互惠关系中获益更多，而顺从的患者从该维度的互补中获益更多。此外，沟通的人际问题显著调节了亲和性行为互补对联盟和结果的影响。这些结果表明，人际对应和互惠对心理治疗过程都很重要，为临床实践提供了关于人际反应性的信息。人际问题的调节效应提供了初步证据，这应该在未来的研究中得到复制，以确定相关的标记，表明在认知治疗抑郁症中，互补方法对哪些人有益。
