Henry W P, Strupp H H, Butler S F, Schacht T E, Binder J L
Department of Psychology, Vanderbilt University, Nashville, Tennessee 37240.
J Consult Clin Psychol. 1993 Jun;61(3):434-40. doi: 10.1037//0022-006x.61.3.434.
Sixteen therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant-observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways.
作为范德比尔特二期限时动力心理治疗研究的一部分，16名治疗师参加了为期一年的手册化培训项目。使用范德比尔特治疗策略量表（一种依从性测量工具）、范德比尔特心理治疗过程量表（VPPS）以及运用社会行为结构分析（SASB）进行的人际过程编码来测量治疗师行为的变化。培训项目成功地使治疗师的技术干预符合手册化方案。培训后，更加注重治疗过程中的情感表达、治疗关系的探索、参与者-观察者立场的改善以及更多地使用开放式问题。通过VPPS和SASB评分衡量，治疗在某些人际和互动方面也出现了意外的恶化迹象。这些结果质疑了这样一种假设，即通过手册和依从性量表能直接实现对治疗变量的更好控制。改变或规定特定的治疗师行为以实现技术依从性，可能会以意想不到甚至适得其反的方式改变其他治疗变量。
