Cirasola Antonella, Midgley Nick, Fonagy Peter, Martin Peter
Research Department of Clinical, Educational and Health Psychology.
Department of Psychiatry.
Psychotherapy (Chic). 2021 Mar;58(1):95-108. doi: 10.1037/pst0000366.
A growing body of research has consistently demonstrated a relationship between alliance and treatment outcomes in youth psychotherapy. However, previous research often suffered methodological issues that prevented detailed investigation of temporal relationships between alliance and symptomatology. The current study explored the directions of effect between alliance and outcome by examining the associations between early alliance and subsequent outcome while controlling for patients' baseline severity and prior symptom change. It also examined potential moderators of this association. Data were drawn from the IMPACT study, a randomized controlled trial comparing cognitive-behavioral therapy and short-term psychoanalytic psychotherapy versus a brief psychosocial intervention in the treatment of adolescent depression. Adolescents (N = 224) and therapist (n = 139) rated the alliance 6 weeks after randomization. Depression severity and overall psychopathology were assessed at baseline, 6, 12, 36, 52, and 86 weeks after randomization. Patients' age, gender, baseline depression severity, conduct disorder symptoms, and treatment type were examined as potential moderators of the alliance-outcome association. Data were analyzed using multilevel models. Findings suggested that higher early alliance ratings were associated with subsequent symptom reduction, even after controlling for prior symptom change and baseline severity. There was some evidence that the strength of this association was strongest in cognitive-behavioral therapy, weaker in short-term psychoanalytic psychotherapy, and statistically indistinguishable from zero in brief psychosocial intervention. These findings suggest that early therapeutic alliance with adolescents may influence subsequent outcome independent of prior symptom change and initial severity but that the effect of the alliance on outcome might vary across treatment types. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
越来越多的研究一致表明，在青少年心理治疗中，治疗联盟与治疗效果之间存在关联。然而，以往的研究常常存在方法学问题，妨碍了对治疗联盟与症状学之间时间关系的详细调查。本研究通过考察早期治疗联盟与后续治疗效果之间的关联，同时控制患者的基线严重程度和先前的症状变化，探讨了治疗联盟与治疗效果之间的影响方向。研究还考察了这种关联的潜在调节因素。数据取自IMPACT研究，这是一项随机对照试验，比较了认知行为疗法、短期精神分析心理治疗与一种简短的社会心理干预对青少年抑郁症的治疗效果。青少年（N = 224）和治疗师（n = 139）在随机分组6周后对治疗联盟进行了评分。在随机分组后的基线、6周、12周、36周、52周和86周对抑郁严重程度和整体精神病理学进行了评估。将患者的年龄、性别、基线抑郁严重程度、品行障碍症状和治疗类型作为治疗联盟与治疗效果关联的潜在调节因素进行了考察。数据采用多层次模型进行分析。研究结果表明，即使在控制了先前的症状变化和基线严重程度之后，较高的早期治疗联盟评分仍与随后的症状减轻相关。有证据表明，这种关联的强度在认知行为疗法中最强，在短期精神分析心理治疗中较弱，在简短的社会心理干预中在统计学上与零无差异。这些研究结果表明，与青少年的早期治疗联盟可能独立于先前的症状变化和初始严重程度影响后续治疗效果，但治疗联盟对治疗效果的影响可能因治疗类型而异。（PsycInfo数据库记录（c）2021美国心理学会，保留所有权利）
