Heinonen Erkki, Knekt Paul, Lindfors Olavi
Department of Psychology, University of Oslo, Oslo, Norway.
Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
Front Psychiatry. 2022 Jul 5;13:848408. doi: 10.3389/fpsyt.2022.848408. eCollection 2022.
Across different types of psychotherapy, one of the most robust predictors of better therapeutic outcomes is a good working alliance between patient and therapist. Yet there is little comparative research on whether particular patients more likely achieve a better alliance in certain treatments which represent particular therapeutic approaches or durations.
326 patients suffering from depressive and/or anxiety disorder were randomized into two short-term (solution-focused or psychodynamic) and one long-term (psychodynamic) therapy models. Treatments lasted ~7 and 36 months, respectively. Before randomization, patients were assessed with the interview-based Suitability for Psychotherapy Scale and filled Childhood Family Atmosphere and Life Orientation Test questionnaires. Patients filled Working Alliance Inventory after 3rd therapy session and at end of treatment; the long-term therapy patients, additionally, at 7 months' time point. Linear regression models were used.
Greater psychological resources (e.g., capacity for self-reflection, affect regulation, flexible interaction) had little effect on alliance during the course of the short-term therapies. However, they did predict better working alliances at end of long-term as opposed to short-term therapy. Childhood adversities impacted alliances already at 7 months.
Although patients with certain qualities achieve better alliances in long-term as opposed to short-term therapies, apparently the theoretical orientation of therapy makes little difference. For patients with childhood adversities, differences between long-term (psychodynamic) treatment vs. various brief therapy models may be particularly salient.
在不同类型的心理治疗中，治疗效果较好的最有力预测因素之一是患者与治疗师之间良好的工作联盟。然而，关于特定患者在某些代表特定治疗方法或疗程的治疗中是否更有可能达成更好的联盟，几乎没有比较研究。
326名患有抑郁和/或焦虑症的患者被随机分为两种短期治疗模式（聚焦解决疗法或心理动力疗法）和一种长期治疗模式（心理动力疗法）。治疗分别持续约7个月和36个月。在随机分组前，使用基于访谈的心理治疗适宜性量表对患者进行评估，并让患者填写童年家庭氛围和生活取向测试问卷。患者在第3次治疗 session 后和治疗结束时填写工作联盟量表；长期治疗的患者还在7个月时间点填写。使用线性回归模型。
在短期治疗过程中，较强的心理资源（如自我反思能力、情绪调节能力、灵活互动能力）对联盟的影响较小。然而，与短期治疗相比，它们确实能预测长期治疗结束时更好的工作联盟。童年逆境在7个月时就对联盟产生了影响。
虽然具有某些特质的患者在长期治疗而非短期治疗中能达成更好的联盟，但显然治疗的理论取向影响不大。对于有童年逆境的患者，长期（心理动力）治疗与各种短期治疗模式之间的差异可能尤为显著。
