心理治疗中的正式反馈

<正>式反馈是近年来发展出的一项提高临床实践的有效方法,它是指利用标准化的治疗效果测量工具,系统监控当事人评定的治疗进展情况,并将当事人的进展信息提供给治疗师,以供其随后的治疗作参考之用。治疗效果问卷评定系统和合作-改变效果管理系统是目前使用较为广泛的正式反馈测量工具。正式反馈的使用不仅能够改善偏离预期进展当事人(not on track,NOT)的治疗效果,提高当事人治疗进展的速率,同时还能够促进治疗双方更好的合作。正式反馈的作用机制可以使用概念化反馈干预理论和交互作用论进行解释。影响正式反馈作用效果的因素包括反馈本身的特征、当事人初始症状严重程度、治疗师方面因素以及治疗的时长等。未来研究需关注正式反馈的研究方法、作用机制及其跨文化研究的差异。     

如何与当事人的家庭成员沟通?

<正>这是一个一对一的个案督导场景。咨询师正在学习精神分析的咨询技术。她跟督导讨论自己正在做的个案,她的问题是不知道该如何面对当事人的家庭成员。咨询师:"我最近在做一个新的个案,我非常棘手的是不知道与除当事人之外的其他人该建立什么关系。"督导:"能简单介绍一下基本信息吗?"咨询师:"这是一个因情感问题走进咨询室的来访者,女性,23岁,刚刚大学毕业,目前在一家公司里工作,但处于试用阶段。她才来咨询三次,但我已经接到她舅舅和舅妈、爸     

对儿童来访者家庭的观察

<正>这是一个一对一的个案督导场景。咨询师正在学习精神分析的咨询技术。她正在跟督导讨论一个儿童来访者的个案,这个来访者是一个7岁的男孩龙龙,他的父母参与到咨询中。儿童个案中的身体接触咨询师一上来就迫不及待地问:"在儿童咨询个案中,咨询师能否拥抱孩子?"督导:"你能谈一下具体情况吗?"咨询师说:"是这样的:在咨询结束时,我想拥抱一下龙龙,因为他在咨询中表现非常好、非常配合。龙龙是因为多动症来咨询的,爸爸妈     

阅读进度反馈信息对工作同盟和咨询效果的影响

进度反馈指将对当事人的标准化测量结果和解释反馈给咨询师的干预, 其目的在于矫正咨询师对咨询效果主观评估的偏差, 提高咨询效果。考虑到咨询师和当事人“面对面”的标准反馈程序不符合我国社会文化习惯, 采用多层结构方程模型, 分析了自然情境下非“面对面”的进度反馈对工作同盟和咨询效果的影响。结果发现, 在组间水平, 反馈组的工作同盟质量更好; 在组内水平, 工作同盟与症状是相互预测的关系。在结案时, 反馈组在抑郁症状和咨询的有帮助性上效果更好。结论是进度反馈对工作同盟和咨询效果有积极影响。研究从工作同盟和中国人的关系角度拓展了对进度反馈作用机制的认识, 为进度反馈的应用提供了基于实践干预有效的证据。     

“我为来访者做得太多”

<正>以下是对边缘性人格障碍者个案的督导。来访者是一个刚刚走上工作岗位的大学毕业生。对她的咨询是一个长程个案,持续了半年多。督导为一对一的个别督导。这是第四次面接结束后的一次督导。在督导一开始,咨询师就迫不及待地说:"这次咨询可能是一次突破,因为来访者的模式会有改变,但对我来说是一次非典型精神分析的咨询,因为我说得太多。""发生了什么?""这是来访者第四次来咨询。咨     

心理咨询中工作同盟的发展模式与咨询效果

为了探索工作同盟在咨询过程中的发展模式, 采用Stiles等(2004)提出的4个变化特征参数(shape-of-change parameters)对30个个案的工作同盟在咨询过程中的发展变化进行描述。聚类分析的结果显示有3类工作同盟的发展模式, 分别是线性增长、线性下降和二次增长模式。不过, 3种发展模式、4个变化特征参数及同盟的破裂?修复片段对咨询效果均没有影响。比较咨询效果不同的当事人在工作同盟发展模式上的差异, 发现同一个发展模式对于不同的个案可能有着不同的含义, 咨询师在早期对同盟关系的处理与调控对咨询效果有着重要的影响。     

“我是如何被来访者移情为父亲的?”——移情剖析(二)

<正>这是一个一对一的个案督导场景。咨询师正在学习精神分析的咨询技术。她正在跟督导讨论一个刚做了两次的新个案,她重点想讨论其中的移情。咨询师:"我想和您谈一谈我正在做的个案。上次咨询中我感觉到一些奇妙的事情。"督导:"能先简单介绍一下来访者的信息吗?"咨询师:"哦,她是一个在读的大学生,由于在恋爱关系上受挫前来咨询。"督导:"她的咨询目标是什么?"咨询师:"想要知道自己为什么     

英国心理咨询的专业化发展及其问题

由于英国咨询与治疗协会及其前身英国咨询协会的不懈努力,英国心理咨询业的专业化发展取得长足进步。表现在：在培训方面,统一课程要求;注重受训者的业务发展;培训对象、时间及费用上有灵活性。在督导方面,实施终身督导;尊重各种流派;坚持授权式和发展式督导,保证督导人员独立行使职责。在资格鉴定或注册方面,严格控制条件和标准。在伦理和投诉方面,出台了内容丰富、独具特色的关于咨询和治疗的伦理规范框架。英国心理咨询所面临的主要问题在于：学校心理咨询的不景气;咨询专业化要求与咨询实际不相吻合;在经济上面临挑战;资格鉴定注册及投诉上存有争议。了解他山之石,对于促进我国心理咨询专业化的健康发展不无裨益。     

来访者提出咨询结束的背后

<正>这是一个儿童多动症的连续个案。目前是在第22次咨询后接受的督导。来访者提出咨询结束咨询师沉默了一下才开口:"我不知道怎样才能说清楚。这个个案结束了,但结束得很突兀,而且是来访者主动提出来的,我的感觉特别复杂。"督导:"能说一下你的感觉吗?"咨询师:"我觉得……"咨询师停顿了一下,想寻找合适的词:"有些失落。好像来访者抛弃了我。"督导:"能够理解,这是很多咨询师都会有的感觉。能说说咨询中发生了什么吗?是怎么结束的?"咨询师:"这个个案已经做了半     

边缘性人格障碍者的极化思维

<正>这是对边缘性人格障碍者个案的督导。来访者是一个刚刚走上工作岗位的大学毕业生。对她的咨询是一个长程个案,持续了半年多。督导为一对一的个别督导。这是第六次咨询结束后的督导。咨询师:"这次咨询结束我充满了惊讶和疑惑。"督导:"为什么?"咨询师:"她一坐下来就说她准备下周一去上班。我就问她接受了哪一份工作,因为上周她还在为四份工作中接受哪一份感到困惑呢。但她居然说她拒绝了上次说过的四份,而接     

Novice therapist,the client and therapy: Integrating the triad

Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio-demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research.     

Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

How the Marvel Cinematic Universe Represents Our Quality World: An Integration of Reality Therapy/Choice Theory and Cinema Therapy

This article presents the integration of cinematherapy with William Glasser’s reality therapy/choice theory. This article also addresses the need to integrate reality therapy/choice theory and the therapeutic intervention known as “cinematherapy” to help students conceptualize the constructs of Glasser’s choice theory and to help novice cinema therapists address Glasser’s themes in their clients’ lives (i.e., fun, survival, power, freedom, love, and belonging). This integration will be helpful to not only students and clients, but also to the community of therapists who will intend to use cinematherapy as a therapeutic and creative intervention.     

Managing Emotional Responses in Therapy: An Adapted EFT Supervision Approach

Therapists often encounter experiences in therapy that elicit emotionality, this could be in the form of self-of-the-therapist issues, compassion fatigue, or professional burnout. Whereas approaches to supervision for self-of-the-therapist issues recognize the need for accessing the supervisee’s emotionality, approaches have not focused on how the clinical and professional system could also be part of the cycle. We propose an adapted emotionally focused supervision approach that employs steps one through six of the EFT model. To display how this approach would work, we provide the example of work with longer-term clients. Working with longer-term clients can be a challenge for many therapists, and both the professional and client system come with factors increasing emotional risk to the therapist. Engaging the therapist’s emotionality through supervision has the potential to improve therapeutic outcomes, as well as reduce loss of good therapists in the field to professional burnout.     

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.     

The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.     

A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client‐centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE‐OM (Clinical Outcomes in Routine Evaluation‐Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the apparatus of service power, positioning therapists as relatively powerless to question their use. Discussion: It is suggested that client‐centred measures like PSYCHLOPS, although partly aligned with a recovery framework, may become part of top‐down state and service power, and there is a need for more research into the different ways in which OMs are used in therapy and the impacts on therapists, clients and their relationships.     

Fostering Client Creativity in Family Therapy: A Process Research Study

Creativity has been shown to enhance problem solving, and to increase flexibility and adaptability—qualities associated with positive therapeutic outcomes. Literature related to therapist and/or client creativity is primarily anecdotal. Empirical literature addressing how therapists can facilitate the creativity of their clients in family therapy is scarce. In this study, the researchers used process methodology to code the behavior of therapists and clients in 31 videotaped family therapy sessions. Results show a significant positive correlation between interventions that induce positive affect and the creative client behaviors of optimism and playfulness.