Notsu Haruka, Kivity Yogev, Levy Kenneth N, Kolly Stéphane, Kramer Ueli
Department of Psychology, Pennsylvania State University, University Park (Notsu, Levy); Department of Psychology, Bar-Ilan University, Ramat Gan, Israel (Kivity); Department of Psychiatry (Kolly, Kramer) and Institute of Psychotherapy (Kramer), Lausanne University Hospital, Lausanne, Switzerland.
Am J Psychother. 2024 Dec 12;77(4):160-166. doi: 10.1176/appi.psychotherapy.20230032. Epub 2024 Oct 7.
This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem.
Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem.
Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level.
This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.
本研究旨在通过一种新颖的数据分析方法来量化心理治疗过程变量的不稳定性。该研究探讨了在10次治疗过程中工作联盟的不稳定性及其与自尊的关系。
数据取自瑞士一项针对边缘型人格障碍的短期干预随机对照试验。60名被诊断为边缘型人格障碍的患者被随机分配接受10次良好精神科管理简版（GPM-BV）治疗，或GPM-BV联合一种名为动机导向治疗关系的关系原则治疗。计算患者和治疗师对联盟不稳定性评分的连续平方差。使用多层次模型来检验联盟不稳定性与自尊在个体内和个体间的关联。
尽管一些初步分析显示在心理治疗开始时联盟越稳定与自尊越高之间存在关联，但随着时间推移联盟并未变得更稳定。在个体内或个体间水平，联盟不稳定性均与自尊无关。
本研究突出了将连续平方差应用于心理治疗研究数据的优点、程序和挑战。结果表明工作联盟以复杂的方式发展，并表明继续使用新颖方法来捕捉动态心理治疗过程的重要性。
