Howard K I, Lueger R J, Maling M S, Martinovich Z
Department of Psychology, Northwestern University, Evanston, Illinois 60208-2710.
J Consult Clin Psychol. 1993 Aug;61(4):678-85. doi: 10.1037//0022-006x.61.4.678.
A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 x 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.
提出了一种心理治疗结果的三阶段模型，该模型需要逐步改善主观体验到的幸福感、减轻症状以及增强生活功能。该模型还预测，进入治疗后期阶段取决于早期阶段是否取得进展。因此，主观幸福感的临床改善会促进症状改善，而症状困扰的临床减轻会促进生活功能改善。一大群心理治疗患者在开始个体心理治疗之前以及在可能的第2、4和17次治疗之后，提供了主观幸福感、症状困扰和生活功能的自我报告。在此期间，幸福感、症状困扰和生活功能均值的变化与三阶段模型一致。将患者在这三个变量上的状态测量值转换为在治疗开始时与第2、4和17次治疗每次之间的二分改善-未改善分数。对由这些二分测量生成的2×2交叉分类表的分析表明，幸福感的改善先于症状困扰的减轻，并且是症状困扰减轻的概率必要条件，而症状改善先于生活功能的改善，并且是生活功能改善的概率必要条件。
