Luborsky L, McLellan A T, Woody G E, O'Brien C P, Auerbach A
Arch Gen Psychiatry. 1985 Jun;42(6):602-11. doi: 10.1001/archpsyc.1985.01790290084010.
This study examined the relatively unexplored contribution of the therapist's performance in determining outcomes of treatment. Nine therapists were studied: three performed supportive-expressive psychotherapy; three, cognitive-behavioral psychotherapy; and three, drug counseling. Profound differences were discovered in the therapists' success with the patients in their case loads. Four potential determinants of these differences were explored: patient factors; therapist factors; patient-therapist relationship factors; and therapy factors. Results showed that patient characteristics within each case load (after random assignments) were similar and disclosed no differences that would have explained the differences in success; therapist's personal qualities were correlated with outcomes but not significantly (mean r = .32); an early-in-treatment measure of the patient-therapist relationship, the Helping Alliance Questionnaire, yielded significant correlations with outcomes (mean r = .65); among the therapy techniques, "purity" provided significant correlations with outcomes (mean r = .44), both across therapists and within each therapist's case load. The three therapist-related factors were moderately associated with each other.
本研究考察了治疗师的表现对治疗结果的影响，这方面此前尚未得到充分探索。研究了九位治疗师：三位进行支持性-表达性心理治疗；三位进行认知行为心理治疗；三位进行药物咨询。研究发现，治疗师在处理各自病例时帮助患者取得的成效存在显著差异。探讨了造成这些差异的四个潜在决定因素：患者因素、治疗师因素、患者与治疗师的关系因素以及治疗因素。结果显示，每组病例（随机分配后）中的患者特征相似，未发现能解释治疗成效差异的不同之处；治疗师的个人品质与治疗结果相关，但相关性不显著（平均r = 0.32）；治疗初期对患者与治疗师关系的一项测量指标——帮助联盟问卷，与治疗结果有显著相关性（平均r = 0.65）；在治疗技术方面，“纯度”与治疗结果有显著相关性（平均r = 0.44），无论是在不同治疗师之间还是在每位治疗师的病例组内。与治疗师相关的这三个因素之间存在适度关联。
