Saxler Eva, Schindler Theresa, Philipsen Alexandra, Schulze Marcel, Lux Silke
Deutsches Zentrum für Neurodegnerative Erkrankungen, University Clinic of Bonn, Bonn, Germany.
Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
Front Psychol. 2024 Jun 27;15:1293851. doi: 10.3389/fpsyg.2024.1293851. eCollection 2024.
The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review.
We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively.
A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments ( = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures ( = 14), based on literature searches ( = 3) or on an empirical survey ( = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments.
The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.
治疗联盟（TA）是面对面心理治疗（F2F）和在线心理治疗（Online-PT）中治疗结果的一个强大且具有泛理论性的预测指标。许多作者提出了TA的几种概念化定义，并且这些定义常常被操作化。本综述呈现了由此产生的概念化定义和测量方法的多样性。
我们针对成人个体自愿性F2F心理治疗中TA的自我报告工具进行了三部分的文献检索（1. 利用过往综述，2. 系统文献检索得出5205篇文章，3. 参考文献列表）。类似地，我们针对在线环境中TA的工具进行了系统文献检索（得出200篇文章）。此外，我们对这些工具的内容进行了定性分析。
呈现了48种测量TA的工具的当前概述（46种用于F2F心理治疗，2种用于在线心理治疗），包括它们的概念背景、特点和主要内容方面。大多数工具（=24种）对TA的一种或多种理论概念化定义进行了操作化。其他工具是现有测量方法的改编/综合（=14种），基于文献检索（=3种）或实证调查（=3种），还有两种工具未提供概念背景信息。这些工具的内容主要集中在以下方面：1. 自我表露与真实性；2. 一致性；3. 积极参与、动机与依从性；4. 信任与安全依恋；5. 考虑患者的需求/能力/愿望。此外，还对TA概念化的各种方法进行了叙述性综述，并将其与相应的工具联系起来。
TA概念化定义和测量方法的广泛多样性使得关于TA的连贯研究变得困难。存在一些概念性挑战，例如依恋风格在TA中的作用仍有待阐明。当前的概念化定义和测量方法没有充分纳入心理治疗师和患者的实践经验与专业知识。基于对心理治疗师和患者的实证调查的TA的元理论概念化定义和测量方法可能会解决这些问题。
