Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany.
Department of Psychosomatic Medicine, Charité University Medicine Berlin, Berlin, Germany.
Acta Psychiatr Scand. 2023 Aug;148(2):208-216. doi: 10.1111/acps.13543. Epub 2023 Mar 20.
Side effects of psychotherapy are common. Therapists and patients must recognize negative developments to take countermeasure. Therapists can be reluctant to talk about problems of their own treatment. The hypothesis could be that talking about side effects can impair the therapeutic relationship.
We examined whether a systematic monitoring and discussion of side effects has a negative effect on therapeutic alliance. Intervention group (IG) therapists and patients filled in the UE-PT scale (unwanted events in the view of patient and therapists scale) and discussed their mutual ratings (IG, n = 20). As unwanted events can be independent of therapy, but also be treatment-related side effects, the UE-PT-scale first asks for UE and then for their relation to the ongoing treatment. In the control group (CG, n = 16) treatment was done without any special side effect monitoring. Both groups filled in the Scale for Therapeutic Alliance (STA-R).
IG-therapists reported various unwanted events in 100% and patients in 85% of cases: complexity of problems, burdensome or overdemanding therapy, problems with work, and symptom deterioration. Any side effect was reported in 90% by therapists and in 65% by patients. Most frequent side effects were demoralization and worsening of symptoms. IG therapists observed an improvement of global therapeutic alliance in STA-R (M = 3.08 to M = 3.31, p = 0.024, interaction effect in ANOVA with two groups and measurement repetition), and reduced patient fear (M = 1.21 to M = 0.91, p = 0.012). IG patients perceived improvement in bond (M = 3.45 to M = 3.70, p = 0.045). In the CG no comparable changes were seen (alliance M = 2.97 to M = 3.00; patient fear M = 1.20 to M = 1.36; patient-perceived bond M = 3.41 to M = 3.36).
The initial hypothesis must be rejected. The results suggest that monitoring, and discussion of side effects can even improve the therapeutic alliance. Therapists must not be afraid that this will endanger the therapeutic process. The use of a standardized instrument like the UE-PT-scale seems helpful.
心理治疗的副作用很常见。治疗师和患者必须认识到负面的发展，以便采取对策。治疗师可能不愿意谈论自己治疗中的问题。假设是谈论副作用可能会损害治疗关系。
我们研究了系统监测和讨论副作用是否会对治疗联盟产生负面影响。干预组（IG）治疗师和患者填写 UE-PT 量表（患者和治疗师视角的不良事件量表）并讨论他们的相互评分（IG，n=20）。由于不良事件可能与治疗无关，但也可能与治疗相关的副作用有关，因此 UE-PT 量表首先询问不良事件，然后询问其与正在进行的治疗的关系。在对照组（CG，n=16）中，没有进行任何特殊的副作用监测。两组均填写治疗联盟量表（STA-R）。
IG 治疗师报告称，100%的案例中出现了各种不良事件，85%的患者报告称出现了不良事件：问题的复杂性、治疗负担过重或要求过高、工作问题和症状恶化。治疗师报告了 90%的任何副作用，而患者报告了 65%的任何副作用。最常见的副作用是士气低落和症状恶化。IG 治疗师观察到 STA-R 中全球治疗联盟的改善（M=3.08 至 M=3.31，p=0.024，ANOVA 中两组和测量重复的交互效应），并降低了患者的恐惧（M=1.21 至 M=0.91，p=0.012）。IG 患者认为关系得到改善（M=3.45 至 M=3.70，p=0.045）。在 CG 中，没有观察到类似的变化（联盟 M=2.97 至 M=3.00；患者恐惧 M=1.20 至 M=1.36；患者感知的关系 M=3.41 至 M=3.36）。
最初的假设必须被拒绝。结果表明，监测和讨论副作用甚至可以改善治疗联盟。治疗师不必担心这会危及治疗过程。使用 UE-PT 量表等标准化工具似乎很有帮助。
