正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展，进而识别缺乏治疗进展的个案，并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段，其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果，也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度，拓展正式反馈的使用价值，建立正式反馈系统的本土化常模。

The Development of Formal Feedback and Its Clinical Application

Formal feedback involves the routine collection of client feedback to track their progress,identify not-on track clients,and facilitate adjustment of therapy to prevent treatment failure.The need for formal feedback is based on previous findings that many clients quit therapy prematurely or have negative outcomes.Unfortunately,therapists usually do poorly in predicting treatment failures.Formal feedback,however,shows a superior ability to identify clients who are not on track in the early stage of psychotherapy,which makes prompt corrective intervention possible in the coming sessions.Historically,the development of formal feedback occurred in two stages.In the first stage(about 1996-2011),researchers developed client feedback systems and examined the effectiveness of formal feedback.So far however,there were only two client feedback systems supported by randomized clinical trials.The first was the Outcome Questionnaire System,and the other was the Partners for Change Outcome Management System.In the second stage(since about 2011),clinical researchers focused on clinical utility,including developing brief questionnaires to track clients’progress and integrating feedback data into clinical processes.Formal feedback is now widely used in various clinical settings,including individual,couples and group therapy.Two recent meta-analyses showed that,in the feedback condition,there was a 50%reduction in the proportion of clients who got worse at the end of therapy,and the rate of significant improvement was several times higher than in the treatment as usual condition.This research introduced the application of formal feedback in different therapy settings and recommended some alternative client feedback systems that have been proved to be effective to enhance treatment outcome in individual,couples and group therapy.In addition,researchers discussed the influence of clients’level of initial distress on feedback effect.The formal feedback provided to therapists is also helpful as part of clinical supervision.Firstly,formal feedback can help evaluate the effect of clinical supervision from the perspective of clients,which may be more objective and accurate.Secondly,novice therapists may use formal feedback from clients to identify what help they need during supervision,and to help them learn from their failures to become more effective.Thirdly,formal feedback can provide indirect information about the effectiveness and direction of clinical supervision.Supervisors can teach targeted techniques and skills to supervisees according to patterns of formal feedback across clients.In future research,it is important to explore therapists’attitudes toward formal feedback,and identify the possible barriers and facilitators of this approach from the perspective of individuals,organizations and practical concerns.This information will then lay the groundwork for promoting positive attitudes towards formal feedback.In addition,it is of significance to extend the application value of formal feedback,such as using feedback to promote the development of therapists’professional skills,and integrating information gained from formal feedback into novice therapists’training.Finally,more localized studies of formal feedback should be conducted,including developing client feedback systems and establishing the norms of client feedback data based on cultural context.