Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands.
Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
Psychol Psychother. 2021 Dec;94(4):915-928. doi: 10.1111/papt.12346. Epub 2021 Apr 26.
To promote functional recovery in persons diagnosed with a psychotic disorder, vocational interventions have emerged over the last few decades which range from sheltered employment to supported employment in the community.
Using data from a 6-month vocational rehabilitation programme, we examined whether assessments of the therapeutic alliance were related to the quality of work performed in this work placement. Our first hypothesis was that stronger alliances would be related to better work performance. Second, we expected that client assessments of the TA would better predict outcomes than therapist assessments. Third, we expected that the discrepancy between assessment scores from the client and therapist (client rating minus therapist rating) would be a better predictor for outcome than individual assessments by the therapists or clients.
Clients systematically rated the alliance higher than therapists. Modelling the data longitudinally, we found both therapist and client ratings predictive of outcome, though client assessments over time were inversely related to work performance.
Discrepancy in scores was also shown to be predictive of work performance during the program. Clinicians are advised to routinely assess the therapeutic alliance from both client and therapist perspectives and calculate the discrepancy between them as they may indicate ruptures are occurring and thus hamper the intervention.
Clinicians are advised to regularly assess the therapeutic alliance from both their own and the client's perspective. Growing discrepancy in scores may impede intervention effectiveness. Therapeutic alliance may help buffer against work stresses experienced by participants in a vocational programme. Be aware that therapists tend to rate the alliance lower than their clients.
为了促进被诊断患有精神障碍的人的功能康复，过去几十年来出现了各种职业干预措施，从庇护性就业到社区支持性就业。
我们使用了一项为期 6 个月的职业康复计划的数据，研究了治疗联盟的评估是否与工作安置中的工作表现质量相关。我们的第一个假设是，更强的联盟将与更好的工作表现相关。其次，我们预计客户对 TA 的评估将比治疗师的评估更好地预测结果。第三，我们预计客户和治疗师评估分数之间的差异（客户评分减去治疗师评分）将比治疗师或客户的个体评估更好地预测结果。
客户系统地对联盟的评价高于治疗师。对数据进行纵向建模，我们发现治疗师和客户的评估都对结果有预测作用，但随着时间的推移，客户的评估与工作表现呈反比关系。
研究还表明，在项目期间，分数的差异也可以预测工作表现。建议临床医生定期从客户和治疗师的角度评估治疗联盟，并计算它们之间的差异，因为这可能表明出现了破裂，从而阻碍了干预。
建议临床医生定期从自己和客户的角度评估治疗联盟。评分差异的增加可能会阻碍干预的有效性。治疗联盟可能有助于缓冲职业计划参与者所经历的工作压力。注意，治疗师往往比他们的客户对联盟的评价更低。
