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首次治疗环节至关重要:边缘型人格障碍治疗中治疗师的反应能力与治疗联盟

The first session matters: Therapist responsiveness and the therapeutic alliance in the treatment of borderline personality disorder.

作者信息

Culina Ines, Fiscalini Elsa, Martin-Soelch Chantal, Kramer Ueli

机构信息

General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.

Unit of Clinical and Health Psychology, Department of Psychology, University Fribourg, Fribourg, Switzerland.

出版信息

Clin Psychol Psychother. 2023 Jan;30(1):131-140. doi: 10.1002/cpp.2783. Epub 2022 Sep 20.

DOI:10.1002/cpp.2783
PMID:36066208
Abstract

OBJECTIVES

The focus of the present research is to investigate the impact of therapist responsiveness at the very first session of therapy on the evaluation of therapeutic alliance from the therapist's perspective and from patient's perspective in the context of guideline-based treatment for borderline personality disorder.

DESIGN

The study has a correlational and longitudinal design applied to a 10-session therapy in a naturalistic setting.

METHODS

A total of four trained raters evaluated therapist responsiveness during the first session of therapy. After each therapy session, therapists and patients filled out the short form of the Working Alliance Inventory measuring working alliance; the sample included 13 therapists and 47 patients. Correlational analysis as well as hierarchical linear modelling exploring the relationship between first session therapist responsiveness and working alliance were performed.

RESULTS

The global evaluation of responsiveness revealed a significant relationship with the temporal evolution of the alliance rated from the therapists' perspective.

DISCUSSION

There is the necessity to further explore therapist appropriate responsiveness which could potentially explain several psychotherapy research results. Moreover, it could help in finding alternatives in order to facilitate patients' early engagement in therapy as well as facilitating the building process of therapeutic alliance. Finally, an effort should be made in order to study more individualized operationalization of responsiveness.

摘要

目的

本研究的重点是在基于指南的边缘型人格障碍治疗背景下,从治疗师和患者的角度,调查治疗第一阶段治疗师反应性对治疗联盟评估的影响。

设计

该研究采用相关和纵向设计,应用于自然环境中的10次治疗疗程。

方法

共有4名经过培训的评估者在治疗的第一阶段评估治疗师的反应性。每次治疗后,治疗师和患者填写测量工作联盟的工作联盟量表简表;样本包括13名治疗师和47名患者。进行了相关分析以及探索第一阶段治疗师反应性与工作联盟之间关系的分层线性建模。

结果

反应性的总体评估显示与从治疗师角度评定的联盟的时间演变存在显著关系。

讨论

有必要进一步探索治疗师适当的反应性,这可能解释一些心理治疗研究结果。此外,它有助于寻找替代方法,以促进患者尽早参与治疗,并促进治疗联盟的建立过程。最后,应该努力研究更个性化的反应性操作化。

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