Bassler M, Hoffmann S O
Klinik und Poliklinik für Psychosomatische Medizin, Universität Mainz.
Psychother Psychosom Med Psychol. 1993 Sep-Oct;43(9-10):325-32.
Within psychotherapy-research a kind of paradigm has almost established itself, maintaining that--with high probability--a positive therapeutic relationship early on permits to expect a favourable therapeutic outcome. These conclusions were mainly derived from an outpatient psychotherapy setting of under 30 hours. In our own study we wanted to examine whether an early prognosis of success under such conditions was also possible for psychoanalytically oriented inpatient psychotherapy. We examined a sample--representative by age, sex and diagnosis--of 76 patients with an average duration of treatment of 12 weeks. For the patients' self-rating of therapeutic alliance we translated a questionnaire from Luborsky (1984) into German, whereas for the therapists' rating we conceived our own questionnaire. Contrary to our expectations, we were not able to demonstrate clinically significant correlations between the initial quality of the therapeutic relationship and therapy success later on (patients' rating: r = 0.28, p < 0.01, therapists' rating: r = 0.09, p > 0.10). One hypothesis on this surprising finding seems to be especially plausible: In our opinion a substantial strength of inpatient psychotherapy (regardless of it being shaped more by psychoanalytic or behavioral orientation) is the following: it offers less motivated patients of lower social status and level of education an opportunity to experience essential processes of communicative learning and motivation especially within the first weeks of treatment.
在心理治疗研究领域，一种范式几乎已确立起来，即认为——很有可能——早期积极的治疗关系预示着良好的治疗效果。这些结论主要源自时长不足30小时的门诊心理治疗。在我们自己的研究中，我们想探究在这种情况下，对于以精神分析为导向的住院心理治疗，早期成功预后是否也可行。我们研究了一个由76名患者组成的样本，该样本在年龄、性别和诊断方面具有代表性，平均治疗时长为12周。对于患者对治疗联盟的自评，我们将鲁伯斯基（1984年）的一份问卷翻译成德语，而对于治疗师的评分，我们设计了自己的问卷。与我们的预期相反，我们未能证明治疗关系的初始质量与后期治疗成功之间存在临床上显著的相关性（患者评分：r = 0.28，p < 0.01；治疗师评分：r = 0.09，p > 0.10）。关于这一惊人发现的一个假设似乎特别合理：在我们看来，住院心理治疗的一个显著优势（无论其更多是由精神分析还是行为导向塑造）如下：它为社会地位和教育水平较低、积极性不高的患者提供了一个机会，尤其是在治疗的最初几周内，去体验沟通学习和动机的关键过程。
