Iovoli Flavio, Gómez Penedo Juan Martín, Lutz Wolfgang, Rubel Julian A
Department of Psychology, Osnabrueck University.
Department of Psychology, Trier University.
Psychotherapy (Chic). 2025 Jun;62(2):208-219. doi: 10.1037/pst0000566. Epub 2025 Feb 27.
Interpersonal problems have been identified as a potential risk factor for a weaker therapeutic alliance during psychotherapy, yet their temporal relationship and underlying dynamics remain unclear. To address this, the present study explores these associations during the first 20 sessions of cognitive behavioral therapy. The data from 2,123 patients undergoing treatment in an outpatient clinic were analyzed. Interpersonal problems were assessed every fifth session with the 12-item version of the Inventory of Interpersonal Problems-12, while therapeutic alliance was measured after every session with the Session Rating Scale. Temporal associations were modeled using both a random-intercept cross-lagged panel model and an autoregressive latent trajectory model with structured residuals, as they allow the differentiation of within- and between-patient components. The random-intercept cross-lagged panel model produced more reliable and interpretable estimates. At the within-patient level, contemporaneous associations were significant, indicating that higher-than-usual interpersonal problems within a session were associated with lower-than-usual experienced therapeutic alliance at the same time point (β = -.067 to -.074, = .005). Over time, higher-than-usual interpersonal problems negatively influenced therapeutic alliance at the next assessment (β = -.052 to -.063, = .032), while higher-than-usual therapeutic alliance predicted reductions in interpersonal problems five sessions later (β = -.051 to -.083, = .002). These findings suggest a reciprocal dynamic between interpersonal problems and therapeutic alliance, where improvements in one construct are associated with beneficial changes in the other over time, highlighting the importance of addressing interpersonal difficulties to strengthen the therapeutic alliance. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
人际问题已被确定为心理治疗过程中治疗联盟较弱的一个潜在风险因素，但其时间关系和潜在动态仍不明确。为解决这一问题，本研究在认知行为治疗的前20次治疗过程中探讨了这些关联。对在门诊接受治疗的2123名患者的数据进行了分析。每隔五次治疗使用12项版本的人际问题清单-12评估人际问题，而每次治疗后使用治疗过程评定量表测量治疗联盟。使用随机截距交叉滞后面板模型和具有结构化残差的自回归潜轨迹模型对时间关联进行建模，因为它们能够区分患者内部和患者之间的成分。随机截距交叉滞后面板模型产生了更可靠且可解释的估计。在患者内部层面，同期关联显著，表明某一治疗过程中高于平常的人际问题与同一时间点低于平常的治疗联盟体验相关（β = -0.067至-0.074，p = 0.005）。随着时间的推移，高于平常的人际问题对下一次评估时的治疗联盟有负面影响（β = -0.052至-0.063，p = 0.032），而高于平常的治疗联盟预测五次治疗后人际问题会减少（β = -0.051至-0.083，p = 0.002）。这些发现表明人际问题和治疗联盟之间存在相互动态关系，即随着时间的推移，一个结构的改善与另一个结构的有益变化相关，突出了解决人际困难对加强治疗联盟的重要性。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
