心理治疗的过程研究

心理治疗的过程研究是辨识心理治疗的活性成分和改变机制,是心理治疗效果研究的重要领域。心理治疗过程研究的最新进展体现在研究内容的扩展,研究方法的改进及研究结果的新发现等方面。对未来研究的几点建议：活性成分的层次性观点,改变机制的双线研究及与治疗过程模型的结合,借鉴邻近学科的研究成果,改善RCTs时间设计,关注质化研究,临床工作者与研究者的合作,以及开展本土化研究。     

The Development,Process, and Evaluation of Group Psychotherapy With Sexually Abused Preschool Girls

The development, process, and evolution of group psychotherapy specifically designed for sexually abused preschool aged females is presented. Utilization of male and female cotherapists, group structure, individual and family dynamics, the role of children's mothers in treatment, and process of treatment are examined. Issues regarding countertransference phenomena, cotherapy relations, in-depth involvement of the children's mothers, and specifics related to structuring of a time-limited group are beyond the initial intent and scope of this paper, and are not discussed here.

The cotherapists conclude that group psychotherapy for children of this age group is both clearly valuable and highly indicated as an adjunct treatment modality. In future group psychotherapy with sexually abused preschool aged children, based upon clinical experience and evaluation, the cotherapists advocate a time-limited approach whereby each session would focus upon specific issues as illustrated in Table 1, and include structured and purposeful involvement of the girls' caretakers.     

Is the Impact of Psychotherapy Processes on Outcomes Already Quacking and Waddling? Comment “A Primer on Psychotherapy Process Research (Pfeifer & Strunk, 2015)”

The article by Pfeifer and Strunk on psychotherapy process research offers a highly thoughtful review on the state of psychotherapy process research in cognitive therapy for depression, and the inherent challenges in establishing causal relationships between process and outcomes. In this commentary, I argue that the goal of internal validity in psychotherapy process research may be unattainable, and possibly unnecessary. Finally, I suggest that psychotherapy process research should shift from “does it affect change?” to “how does it affect change?”, “when does it affect change?”, and “for whom does it affect change?”     

Process variables in the treatment of sexual offenders: A review of the relevant literature

The present review considers the relevance of process issues for the treatment of sexual offenders. The general literature on psychotherapy indicates that the therapist's style, the client's perceptions of the therapist, and the alliance between client and therapist, all influence treatment effectiveness. From our review of this literature, and the far less voluminous research on these issues by cognitive behavior therapists, we draw implications for enhancing the effectiveness of treatment of sexual offenders. We also make suggestions for research on process variables in the treatment of these offenders.     

Psychotherapy: the humanistic (and effective) treatment

Although it is well established that psychotherapy is remarkably effective, the change process in psychotherapy is not well understood. Psychotherapy is compared with medicine and cultural healing practices to argue that critical aspects of psychotherapy involve human processes that are used in religious, spiritual, and cultural healing practices. A model of psychotherapy is presented that stipulates various aspects that involve uniquely human characteristics. Central to this model is patient acquisition of an adaptive explanation of his or her difficulties. Finally, the research evidence for this model is presented.     

Sailing between Scylla and Charybdis1: Incorporating qualitative approaches into child psychotherapy research

Starting from the acknowledged gap between research and practice in child psychotherapy, this paper offers an historical perspective on the relation between these two activities, and suggests that qualitative approaches to research may offer new ways of bringing them together. After introducing the fundamental concepts of qualitative analysis, three areas where qualitative forms of research may be useful to child psychotherapists are explored: relevant but non-psychotherapy research; accounts of therapy research; and therapy process research. Examples of all of these types of research are presented, and some of the challenges to incorporating qualitative approaches into child psychotherapy research are discussed.     

A training outline for conducting psychotherapy process ratings: An example using therapist technique

Aims: This study addresses the effects of structured training on the development of coding skills used in psychotherapy process research. Method: Participants included graduate trainees enrolled in an APA approved Clinical PhD programme. A course outline for training is reviewed and examined in relation to ratings of therapist techniques used during psychotherapy sessions. Results: The effects of this structured training protocol for raters resulted in good to excellent levels of interrater reliability. Different groups of raters were compared along multiple factors such as level of graduate training, training received on a particular measure, and psychotherapy experience. Discussion: The implications of these findings for rater training in psychotherapy process research are discussed.     

A Primer on Psychotherapy Process Research: A Review of Cognitive Therapy of Depression

Researchers conducting psychotherapy process research aim to understand the process by which efficacious psychotherapies achieve therapeutic benefits. A key challenge in this research is how to maximise what can be learned from naturalistic longitudinal data. We provide a selective overview of research examining the process of change in cognitive therapy of depression. While the efficacy of this treatment is widely recognised, a consensus regarding how the treatment reduces depressive symptoms and provides protection from relapse and recurrence has yet to be reached. We review the current state of the research addressing the process of change in cognitive therapy, highlighting how specific methodological features can be used to better understand the process by which this treatment achieves its effects. We highlight the importance of two key challenges to making causal inferences from a process–outcome relation: (a) establishing the temporal precedence of predictors to outcome variables, and (b) evaluating whether any relations identified could be spurious. We argue that methodologically rigorous studies tend to support key claims of the model underlying cognitive therapy of depression. We conclude by considering future directions. For example, we highlight the importance of efforts to understand patient characteristics that may moderate process–outcome relations and could ultimately prove useful in tailoring treatment to best suit individual patients.     

Process parallels in related groups

The theoretical basis for the repetition of themes in related groups is addressed by describing similar processes in four systems: inpatient psychiatric ward, inpatient psychotherapy group, supervisory group, and group psychotherapy division. The principles of general system theory help explain process parallels in allied groups and illuminate group process.     

心理治疗的消极后果

心理治疗消极后果是指由于心理治疗本身直接导致的来访者病情恶化。消极后果表现形式多样,对其测量应全面而仔细确证。消极后果的影响因素众多,包括来访者中有人格病理诊断、人际功能障碍、他评病情严重、对治疗期望不正确和动机低下;治疗师缺乏共情、对来访者出现负性反移情、低估来访者病情和错误使用治疗技术;潜在有害疗法。对其预防包括治疗前对治疗师和疗法进行规范和治疗中采用聚焦来访者的研究减少消极后果发生率。最后提出目前研究中存在测量、研究单位选择和伦理等难题,未来研究应全面呈现研究数据、采用RCT研究确定消极后果发生率、用交互作用研究模式寻找消极后果影响因素以及对中介变量的研究探询消极后果发生机制。     

Group Psychotherapy Research Studies That Therapists Might Actually Read: My Top 10 List

Much like a bad marriage, the longstanding split between psychotherapy practitioner and researcher continues, each partner feeling unappreciated by and blaming of the other: Therapists are criticized for not reading research and, in turn, criticize researchers for their pursuit of studies that seem irrelevant to the clinical enterprise. In the present article, the author proposes that a shift in the design of psychotherapy research, away from pure outcome studies to models that focus on process, may serve to bridge the divide. Ten research designs exploring aspects of the process of group psychotherapy are illustrated from the recent literature, with the aim of furthering the dialogue between practitioner and researcher.     

Figuration of the Real as an Intersubjective Process

In this paper, I make use of the term figuration, which relates to the process of giving shape to unconscious contents in the form of meaningful presentations. My interest is in how traumatic experience succeeds or fails to become psychically figured and thereby susceptible to elaboration and absorption through intersubjective process. I argue that the process of figuration always occurs in an actual or implied intersubjective context and involves, thereby, a central feature of an exchange between subject and Other. These concepts are discussed and applied to a case report of an analytic psychotherapy involving a traumatic dream and its sequellae.     

Die Bindungstheorie und ihre Relevanz für die Psychotherapie

Ten years ago, two reviews of clinical attachment research were published in this journal (Schmidt and Strauß 1996; Strauß and Schmidt 1997) dealing with the question whether this theory might be of relevance for psychotherapy. Since that time, numerous theoretical and empirical papers related to this issue have been published, thus, justifying an update. The prediction that attachment theory would gain importance within psychotherapy and psychosomatics has been clearly confirmed. Elements of attachment theory have been incorporated into non-specific and specific psychotherapeutic approaches. Recently, also including neurobiological evidence, clinical attachment research continues to deal with the question whether clinical diagnoses or constructs can be differentiated on the basis of attachment characteristics. Related to this question, problems in assessing attachment characteristics are still of relevance. Within psychotherapy research, attachment-related characteristics are primarily investigated in relation to a) their value to predict treatment outcome, b) their significance for the psychotherapeutic process and c) their change during treatment.     

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.     

The validity of psychotherapy 1

How good is psychotherapy as a tool of research into human nature? There is an orthodox defence of it as a research tool, which relies on showing that interpretations are true of the patient when they satisfy certain criteria. This defence is examined and rejected. The reply is considered that an interpretation which ‘keeps things moving’ is true, or an approximation to the truth. This reply is rejected by comparing and contrasting an interpretation in psychotherapy with one from brainwashing sessions. Two suppositions about psychotherapy (which weaken its discovery powers) are deliberately adopted — the suppositions that the material produced is ‘perspective’ and ‘method’ dependent. An unorthodox defence of psychotherapy is then offered — by means of a watery sense of ‘discover’. This enables us to outline a weak sense in which psychotherapy is a valid enterprise, but one which is still strong enough for research purposes.     

反社会型人格障碍的心理治疗

该文从认知一行为治疗、个别治疗和团体治疗等方面,介绍了反社会型人格障碍心理治疗的研究进展情况,旨在促进国内有关反社会型人格障碍心理治疗的研究。     

The Closing of a Ward: A Group Experience

The potential for psychotherapy in a large-group format has been discussed since the 1960s. Day treatment programs provide optimal support for such groups. One program type, which has maintained large-group psychotherapy as a central feature for over twenty years, is described. Essential features include an integrated therapeutic team, with clearly defined leadership, that is open to examination of its own process. Such groups may not only provide effective therapy, but are also readily amenable for teaching and research in psychotherapy.     

Psychotherapy is an Emergent Process: In Favor of Acknowledging Hermeneutics and Against the Privileging of Systematic Empirical Research

I argue that because psychoanalysis and psychotherapy are emergent processes and the expression of values, a hermeneutic perspective is necessary to study them. I present some basic aspects of one significant perspective of this kind, that of Hans-Georg Gadamer. We have no choice but to recognize that objectivism is the dominant mode of thought in our culture and the means by which the public is liable to judge our claims for psychoanalysis and psychotherapy. Nevertheless, it is crucial for us not to privilege quantitative empirical research in the study, and especially in the formulation, of these activities.     

Hidden in Plain Sight: The Active Ingredients of Executive Coaching

We propose that I/O psychologists who coach executives have overlooked psychotherapy outcome research as a source of information and ideas that can be used to improve our executive coaching practices. This research, based on thousands of studies and many meta-analyses, has converged on the conclusion that four "active ingredients" account for most of the variance in psychotherapy outcomes. We describe how this literature has identified four primary "active ingredients" that account for most of the variance in psychotherapy outcomes: 1) Client/extratherapeutic factors (40%), 2) The relationship or alliance (30%), 3) Placebo or hope (15%), and 4) Theory and technique (15%). Working on the assumption that psychotherapy and executive coaching are sufficiently similar to justify generalization from one domain to the other, we describe these four active ingredients at length and explore how they may be at work in the executive coaching process. We also suggest that I/O psychologists have training and experience that allows us to leverage some of these active ingredients in our executive coaching (e.g., understanding of client individual differences related to coaching outcomes). But we also have areas of weakness (e.g., building a strong working relationship with an individual client) that may need to be bolstered with additional training and development experiences.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.