循证心理治疗解析

心理治疗服务的有效性得到研究证据支持,但在临床中采用循证实践很难。本文简介心理治疗循证实践的模式、研究成果和现状,分析工作中推行循证实践困难的原因,介绍一种新循证方式——循效施治。该方式能被整合到心理治疗中,以一种临床治疗师不感到胁迫的方式使其积极参与收集和反思证据的过程,并且允许其以创新方式将证据运用到实践中。     

心理治疗中的循证实践及其哲学思考

心理治疗中的循证实践是指治疗者根据个体已有的临床技能与经验,利用最佳的研究证据,在考虑病人人格、文化及偏好等因素的情况下进行的心理治疗实践。通过描述心理治疗中循证实践运动发展的两个阶段,考察其哲学基础及存在的问题,对其发展趋势及对整个心理学发展的意义进行了展望。     

心理治疗循证实践中“证据”的四个基本问题

循证实践正在成为西方心理治疗发展的主流方向。但如何理解循证实践的"证据"仍是见仁见智。部分社会大众甚至心理学专家仅将"循证"当作一种"修辞"或"时尚",顾名思义地界定"证据",或按主观信仰随意地选择与应用"证据"。文章以"证据"为研究焦点,试图建构系统理解"证据"的全面图景,探讨了心理治疗循证实践中关于"证据"的4个基本问题:(1)从历史考察与理论分析的视角出发,探讨了"心理治疗为什么需要证据";(2)从证据的类型范围、生产者及存在形式三个视角,描述了"心理治疗存在哪些证据";(3)从证据的科学程度、研究设计的严谨程度及解决实践问题的契合程度出发,阐述了"哪些证据才是好的证据";(4)从6个步骤推广证据及创新研究设计两个方面展开,分析了"在现实世界中如何推广与应用证据"。     

青少年抑郁症患者的团体人际心理治疗

青少年抑郁症患者的团体人际心理治疗是建立在人际心理理论基础之上,具有循证医学理论依据的心理治疗方法.它是将原本应用于治疗成人抑郁症的人际心理治疗理论和程序经过修正后应用于青少年抑郁症的治疗.实践表明,青少年抑郁症的团体治疗目标明确,实施领城广泛,具有校为明显的疗效和多方面的积极作用.但是该疗法仍然有许多未解决的问题,需要更进一步的理论突破和实务研究.     

家庭心理治疗：一种科学的治疗理念

家庭心理治疗作为一种新的、科学的治疗理念正引起心理治疗专家和学者的普遍兴趣和关注。它着眼于家庭和家庭内部关系,把一种新的治疗理念引入了心理治疗领域。在介绍家庭心理治疗基本问题和国内外发展概况的基础上,论述其在中国存在和发展的必然性及可能性,旨在为我国家庭心理治疗的发展和应用提供参考。     

家庭心理治疗:一种科学的治疗理念

家庭心理治疗作为一种新的、科学的治疗理念正引起心理治疗专家和学者的普遍兴趣和关注.它着眼于家庭和家庭内部关系,把一种新的治疗理念引入了心理治疗领域.在介绍家庭心理治疗基本问题和国内外发展概况的基础上,论述其在中国存在和发展的必然性及可能性,旨在为我国家庭心理治疗的发展和应用提供参考.     

循证医学指导疾病治疗的面面观

循证医学 (evidence -basedmedicine ,EBM )概念是加拿大临床流行病学家Sackett创立的 ,并于1992年被正式提出[1] ,是一种评价某种治疗或保健方案的法则。自从 1993年美国JAMA开始发表有关循证医学的文章以来 ,循证医学的概念风靡全球。该概念引入我国后 ,在规范医疗行为、指导医疗实践中功不可没。但我们也应当清醒地看到 ,由于一些医疗工作者对循证医学概念的片面理解和应用 ,使得一些疾病的治疗进入了误区。所以 ,在医疗实践中应客观辩证地应用循证医学概念。1　循征医学的历史地位首先 ,循证医学概念的产生有它的历史局限性。循证医…     

具身心理治疗:原理与技术

具身心理治疗是以身体心理治疗、舞动治疗为代表的,理论上契合具身认知观点、实践中注重身体作用的一种当代心理治疗取向。它将“身体”与“躯体”区分开来,赋予身体解剖学的、感觉运动的、认知的与嵌入环境等不同层面的意义。当前,已有不少研究证实身体有助于改善治疗关系,促进来访者认知、情绪的改变,并发展出一系列注重身体内外感知、姿势或运动的非言语治疗技术。具身心理治疗重构了身体在治疗过程中的概念与角色,发展了新的技术,是传统心理治疗的有益补充; 但也存在实证证据不足、理论框架尚未完全整合、容易过分强调身体作用等问题。今后需自觉整合其他治疗流派、开发独特的核心技术,推进循证的具身心理治疗的发展。     

循证医学与心理治疗

随着循证医学在医学领域逐步普及 ,许多医学诊断方法和治疗措施面临科学检验和评价的今天 ,作为具有医学性质的心理治疗 ,笔者认为 ,也应借鉴循证医学的方法。1　以循证医学的方法 ,用现有最好的证据来制定诊断的依据和为每一个患者作出心理治疗方法的选择心理治疗的步骤 ,首先是建立良好的医患关系 ,为取得患者的配合 ,以便进行心理测验 ,使治疗师能根据个人临床经验和心理测验结果对症状作出正确评估和诊断。循证医学不排除个人临床经验 ,心理治疗也不例外。心理治疗中 ,有许多个案病例报道。尽管从学术的立场上讲 ,任何个案报导 ,都不能…     

心理治疗两种范式的对立及其整合

心理治疗有两种不同的范式:科学主义治疗范式和人文主义治疗范式。前者主要由行为疗法和认知—行为疗法的诸种治疗形式所构成;后者则包括当事人中心疗法、存在疗法等。两种范式在人性观、心理诊断、治疗关系、治疗方法和治疗目的等方面存在着明显的对立。对此进行分析,并提出两者整合的构思,以期裨益于心理治疗实践。     

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice.     

积极心理治疗思想概要

积极心理治疗虽然是以积极心理学作为自己的理论基础,但积极心理治疗的实践却早已有之。积极心理治疗作为心理治疗中的一个新生事物．它以反传统医学式心理治疗的面貌出现,运用故事作为治疗者与病人之间的媒介,充分发挥病人的直觉和想象,在与病人的观念不发生直接冲突的情况下提出改变病人观点的建议,这一较符合人性特点的心理疗法正越来越多地受到社会的广泛关注。     

How does evidence-based practice in psychology work? – As an ethical demarcation

Evidence-based practice in psychology (EBPP) is ordinarily understood to demarcate between legitimate and illegitimate psychotherapy practice, based upon the epistemic demarcation distinguishing scientific from non-scientific knowledge. EBPP emphasizes the value of effective and efficient interventions identified through randomized controlled trials and cost-benefit analyses. Basing the template for choice of action or strategy on randomized controlled trials and cost-benefit analyses create a deceptive appearance of ethical neutrality. However, there is an implicit ethical demarcation at work in EBPP, which favors a non-articulated specific position in normative ethics. More particularly, evidence-based practice in psychology is structured according to a utilitarian framework, severely limiting the kinds of ethical perspectives available to assess psychotherapy practice. The latter point is illustrated through a new mode of delivering psychotherapy services called “Internet-based guided self-help” (IBGSH). In EBPP the only relevant ethical question is to what extent any intervention, such as IBGSH, is effective and efficient. Some of the limiting effects of the ethical, utilitarian, demarcation are showcased by presenting three alternative ethical perspectives by which psychotherapy practice in general and IBGSH in particular can be analyzed. The analysis concludes that EBPP is not suited to ethically regulate the practice of psychotherapy.     

Nursing and psychological treatments

Presents a comment on "Psychological Treatments" by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others.     

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Virtual reality in psychotherapy: review.

Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

A call for dialogue: psychotherapists and psychologists specialising in psychotherapy

The development of psychotherapy as an independent discipline in many countries in Europe has stimulated debate within the field of psychology as to what constitutes psychotherapy as a specialism of psychology. The authors, both clinical psychologists who pursued further training in psychotherapy, offer a reflection in this paper on the historical battle between psychiatry and psychology for ‘ownership’ of psychotherapy, describe recent developments in Europe to clarify this specialism within psychology and discuss the distinctive contributions that psychologists offer in developing psychotherapy as a specialism within the discipline. The aim of the paper is to begin a dialogue both within the profession of psychology and outside the profession, with our psychotherapy colleagues, that can develop into an interdisciplinary discourse and a more mutually respectful professional environment.