Department of General Internal Medicine and Psychosomatics.
J Consult Clin Psychol. 2021 Mar;89(3):214-226. doi: 10.1037/ccp0000628.
This study examined the reciprocal effects between therapeutic agency, working alliance, and symptoms during psychotherapy. We aimed to predict symptom improvement by previous changes in either agency or alliance. In addition, we examined whether alliance development was predicted by previous changes in agency.
A sample of 386 patients in psychodynamic outpatient psychotherapy answered the Therapeutic Agency Inventory (TAI), the Working Alliance Inventory-SR (WAI-SR), and the Symptom Checklist-K11 (SCL-K11) after Sessions 1, 5, 10, 15, and 20. Dynamic panel models were estimated using structural equation modeling. Associations were tested while controlling for autoregressive effects and differentiating within-person changes over time from between-person differences.
Increases in agency predicted subsequent symptom improvement. Similarly, increases in alliance predicted subsequent symptom improvement. For agency and alliance, we found a more complex pattern with varying reciprocal effects over time.
Findings show evidence for agency and alliance as curative change factors in psychodynamic psychotherapy. The study supports the importance of both agency and alliance and further suggests that both mechanisms may need to be balanced in successful psychotherapies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
本研究考察了治疗性代理、工作联盟和心理治疗过程中症状之间的相互影响。我们旨在通过先前代理或联盟的变化来预测症状的改善。此外，我们还考察了代理的变化是否可以预测联盟的发展。
386 名接受心理动力学门诊治疗的患者在第 1、5、10、15 和 20 次治疗后分别回答了治疗性代理量表（TAI）、工作联盟量表-修订版（WAI-SR）和症状清单-K11（SCL-K11）。使用结构方程模型估计动态面板模型。在控制自回归效应和区分随时间的个体内变化与个体间差异的同时，测试了关联。
代理的增加预测了随后的症状改善。同样，联盟的增加也预测了随后的症状改善。对于代理和联盟，我们发现了一个更复杂的模式，随着时间的推移，存在不同的相互影响。
研究结果为心理动力学心理治疗中的代理和联盟作为治疗性变化因素提供了证据。该研究支持了代理和联盟的重要性，并进一步表明，在成功的心理治疗中，这两种机制可能需要平衡。
