Hobson R P, Patrick M P, Valentine J D
Developmental Psychopathology Research Unit, Tavistock Clinic, London.
Br J Psychiatry. 1998 Aug;173:172-7. doi: 10.1192/bjp.173.2.172.
There is widespread scepticism concerning the reliability and validity psychoanalytic judgements of patient-therapist transactions. We predicted that (a) in reviewing the initial part of 14 videotaped assessment interviews with borderline and dysthymic subjects, dynamic psychotherapists would agree in their ratings of psychoanalytically relevant characteristics of subjects' interpersonal relations; (b) inter-correlations among the ratings would conform with those expected from psychoanalytic descriptions of paranoid-schizoid' and 'depressive position' states of mind; and (c) these ratings would differentiate between borderline and dysthymic groups.
Six trained psychotherapists who were blind to the design of the study, independently rated qualities of interpersonal relatedness during the first 30 minutes of each interview, on a 30-item 'personal relatedness profile'.
There was satisfactory interrater reliability in judgements among the raters, and evidence that the items were interrelated. There was also a significant difference between the two subject groups.
It is possible to make reliable psychoanalytic judgements about qualities of interpersonal relatedness. Moreover, there is evidence that paranoid-schizoid and depressive positive aspects of psychological functioning do constitute a meaningful constellation of clinically grounded phenomena.
人们普遍怀疑对患者与治疗师互动进行精神分析判断的可靠性和有效性。我们预测:(a)在回顾14段对边缘型和恶劣心境障碍患者的录像评估访谈的初始部分时,动力心理治疗师对患者人际关系中与精神分析相关特征的评分会达成一致;(b)评分之间的相互关联将符合精神分析对“偏执分裂样”和“抑郁性”心理状态描述所预期的情况;(c)这些评分将区分边缘型和恶劣心境障碍组。
六位对研究设计不知情的受过训练的心理治疗师,根据一份30项的“人际关联概况”,在每次访谈的前30分钟独立对人际关联质量进行评分。
评分者之间的判断具有令人满意的评分者间信度,且有证据表明各项目之间相互关联。两个患者组之间也存在显著差异。
有可能对人际关联质量做出可靠的精神分析判断。此外,有证据表明心理功能的偏执分裂样和抑郁性积极方面确实构成了一组基于临床的有意义的现象。