Gordon F. Derner School of Psychology.
Ferkauf Graduate School of Psychology.
Psychotherapy (Chic). 2022 Dec;59(4):554-566. doi: 10.1037/pst0000452. Epub 2022 Aug 1.
This exploratory study assesses the use and quality of therapeutic immediacy in short-term psychodynamic psychotherapy for depression. We aimed to identify what constitutes effective here-and-now discussions of the therapeutic relationship by examining a sample of four treatment cases drawn from a previous randomized clinical trial for depression. Transcripts of 16 treatment sessions (four time points per treatment) were analyzed using the consensual qualitative research for case study method. The therapists' contributions to therapeutic immediacy were assessed qualitatively by independent judges and then quantitatively analyzed in relation to immediate session outcome as well as overall treatment outcome (reduction in depressive symptoms). A total of 41 immediacy events were identified across 16 sessions, of which 35 were therapist-initiated and subsequently organized into 18 discrete categories. High-quality immediacy events (as assessed by the judges) were associated with higher patient involvement. Two immediacy categories were significantly different between good and poor outcome cases. Therapists "acknowledged their patient's progress in therapy" more often in good outcome cases, whereas they "assessed patients' feelings about the overall progress of therapy" more often in poor outcome cases. No significant relationship was found between frequency, rated quality of immediacy events, and treatment outcome. Four immediacy events rated by the judges as high- and low-quality are presented as clinical examples illustrating positive and negative therapists' contributions to therapeutic immediacy. Therapist behaviors that may improve the effectiveness of therapeutic immediacy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
这项探索性研究评估了短期心理动力学治疗抑郁症中治疗及时性的使用和质量。我们旨在通过检查从先前的抑郁症随机临床试验中抽取的四个治疗案例样本，确定构成治疗关系的有效即时讨论的内容。使用共识定性研究案例研究方法对 16 次治疗会议（每个治疗四个时间点）的转录本进行了分析。治疗师对治疗及时性的贡献由独立评判员进行定性评估，然后与即时会话结果以及整体治疗结果（抑郁症状减轻）进行定量分析。在 16 次会议中总共确定了 41 次及时性事件，其中 35 次是治疗师发起的，并随后组织成 18 个离散类别。高质量的及时性事件（由评判员评估）与患者更高的参与度相关。在治疗结果良好和较差的案例中，有两个及时性类别存在显著差异。在治疗结果良好的案例中，治疗师“更频繁地承认患者在治疗中的进展”，而在治疗结果较差的案例中，治疗师“更频繁地评估患者对整个治疗进展的感受”。没有发现即时事件的频率、评定质量与治疗结果之间存在显著关系。评判员评定为高质量和低质量的四个即时事件作为临床示例呈现，说明了治疗师对治疗及时性的积极和消极贡献。讨论了可能提高治疗及时性有效性的治疗师行为。（PsycInfo 数据库记录（c）2022 APA，保留所有权利）。
