Liese B S, Beck A T
Kansas University Medical Center, Kansas City 66160, USA.
NIDA Res Monogr. 1997;165:207-32.
Cognitive therapists who treat drug-dependent patients are likely to lose at least 50 percent of their patients to dropout. This chapter has presented a cognitive model for conceptualizing missed sessions and dropout, along with strategies for reducing the likelihood of missed sessions and dropout. The following should serve to highlight these strategies. 1. Therapists are encouraged to offer warm, empathetic, collaborative relationships in which drug-dependent patients can feel accepted, understood, and validated. 2. Therapists are encouraged to develop comprehensive, accurate case conceptualizations, with attention paid to the potential for missed sessions and dropout. Case conceptualizations should ultimately guide cognitive and behavioral techniques. 3. Therapists are encouraged to structure sessions and elicit feedback regarding their patient's thoughts and beliefs about therapy and the therapist. This feedback is facilitated by such questions as, "What do you like most about therapy?" "What do you like least?" "What has changed in your life as a result of therapy?" "How do you view our relationship?" 4. Therapists are encouraged to socialize patients in a timely, appropriate manner. 5. Similar to the process of socialization, therapists are encouraged to use cognitive and behavioral techniques in a timely, appropriate manner. It is unrealistic to think that the problems of missed sessions and dropout from drug treatment will ever be fully resolved. Nonetheless, the authors believe that the conceptual models and fundamental strategies presented in this chapter represent a significant step in addressing these problems.
治疗药物依赖患者的认知治疗师很可能会失去至少50%的患者，这些患者会中途退出治疗。本章提出了一个用于将错过治疗疗程和中途退出治疗概念化的认知模型，以及一些降低错过治疗疗程和中途退出治疗可能性的策略。以下内容应能突出这些策略。1. 鼓励治疗师建立温暖、共情、协作的关系，让药物依赖患者能感到被接纳、被理解和被认可。2. 鼓励治疗师制定全面、准确的病例概念化方案，关注错过治疗疗程和中途退出治疗的可能性。病例概念化方案最终应指导认知和行为技术。3. 鼓励治疗师安排治疗疗程并收集患者对治疗及治疗师的想法和信念的反馈。诸如“你最喜欢治疗的哪方面？”“你最不喜欢哪方面？”“治疗让你的生活有了哪些改变？”“你如何看待我们的关系？”等问题有助于收集这种反馈。4. 鼓励治疗师及时、适当地引导患者适应治疗。5. 与引导患者适应治疗的过程类似，鼓励治疗师及时、适当地运用认知和行为技术。认为药物治疗中错过治疗疗程和中途退出治疗的问题能完全解决是不现实的。尽管如此，作者们认为本章提出的概念模型和基本策略是解决这些问题的重要一步。
