Ibrahim Maliha, Levy Suzanne, Gallop Bob, Krauthamer Ewing Stephanie, Hogue Aaron, Chou Jessica, Diamond Guy
Sangath Foundation, New Delhi, India.
Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA.
Fam Process. 2022 Mar;61(1):183-197. doi: 10.1111/famp.12660. Epub 2021 Apr 27.
In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.
在心理治疗研究中，依从性指的是治疗师按照预期提供治疗的程度。本研究考察了治疗师对两种不同手册化治疗的依从性是否与改善来访者的治疗结果相关，以及这种关联是否受到治疗联盟的调节。研究样本包括来自一项随机对照试验（RCT）中118个案例的320段治疗会话视频记录，该试验比较了基于依恋的家庭治疗（ABFT）和家庭强化非指导性支持治疗（FE-NST）。记录选取自治疗的早期、中期和后期阶段。依从性测量由24个项目组成，代表了两种治疗中治疗师的关键干预措施。经过培训的评分者对两种疗法的录像带进行编码。在第4次治疗会话时测量青少年对联盟的自我报告。对ABFT的依从性与治疗中期家庭凝聚力的显著增加相关，但在治疗后则不然。对FE-NST的依从性与治疗后自杀意念的增加显著相关。将治疗联盟作为调节变量，对ABFT的依从性与治疗后自杀意念的减少、家庭冲突的减少以及更高的来访者满意度显著相关。联盟并未对FE-NST依从性与治疗结果之间的关联产生积极影响。研究结果表明，当青少年与治疗师建立起强烈的联盟时，对ABFT干预措施的依从性可能与治疗结果有更好的关联。探讨了对未来研究和治疗师培训的启示。
