心理治疗关系之作用机制研究述评

综述心理治疗理论中有关治疗关系之治疗机制的理论观点。发现主要存在三种不同的观点。其中社会影响观点认为治疗关系的作用在增强治疗者在当事人心中的可信性,从而强化了治疗者的说服性信息对当事人态度改变的影响力;心理动力学观点主张移情性治疗关系使得当事人早期的依附情况及当事人的内部工作模型得以在治疗中显现,从而为分析治疗提供依据并指示方向;当事人中心观点则认为良好的治疗关系降低了当事人的防卫性,从而使得当事人的感受和体验可以无障碍地进入意识,进而促进了当事人的一致性。作者提出这个领域今后的研究应该考虑以“跨理论”的角度,加强理论模型的提炼和实际检验     

The therapeutic alliance–A conceptual analysis

The role and function of the therapeutic alliance in psychotherapy has increasingly been the focus of clinicians' and researchers' interests over the last decade. Alliance concepts have, however, been criticized for lack of conceptual clarity. The paper presents a generic model as a heuristic means for clarifying the conceptual meaning of the therapeutic alliance. The model distinguishes between the personal relationship aspect, and the collaborative, task-related aspect of the alliance, with therapist, patient, and common contributions to each of these aspects. The model is compared to other alliance conceptualizations, and its implications for alliance theory and research are discussed. A content analysis of four widely used alliance scales in relation to the model shows the scales to represent conceptually different, yet overlapping constructs. It is argued that the componential nature of the therapeutic alliance will render difficult any interpretation of findings regarding the relationship between alliance and outcome in traditional process-outcome research. More complex research strategies guided by theory are called for, if the therapeutic alliance should remain a vital field of research.     

Outsight: Radical Behaviorism and Psychotherapy

Clinical experience suggests that a variety of neurotic and personality disorders are effectively treated by an approach to therapy that is relatively passive in appearance and is directed towards the development of self-knowledge. Behavior theory provides an economical, naturalistic analysis of the therapeutic effects of this approach. Punishment, a common method of controlling forbidden behavior, can result in pathologic avoidance and deficient awareness of one's own behavior and its relation to the environment. Traditional methods of psychoanalysis and behavior therapy provide circumstances that help the patient to observe acts and feelings and their relation to elements of the environment that are otherwise avoided. These procedures may work best when self-observation is (1) not selectively reinforced by the therapist, and (2) supplemented by explicit training in behavior analysis. These elements are combined in a treatment approach for generating observations of one's own behavior and its functional significance in the natural environment.     

Relationship Context,Body-Esteem,Religiosity, and Sexual Experience: Associations with Well-Being and Relationship Status

Abstract

In this study we explored why there are sometimes conflicting findings regarding the influence of past sexual experience on relationships. Consequently, we studied the effects of body-esteem and religiosity on sexual experience in two relational contexts (casual or committed relationships) and how all of these variables were associated with life satisfaction, and the likelihood that a person would be married by their early thirties. With a national sample of 4966 participants, our results indicated that sexual experiences in casual relationships had negative associations with life satisfaction and relationship status, whereas sexual experiences in committed relationships had positive associations.     

The Therapeutic Alliance in Multicultural Practice

Abstract

The therapeutic relationship rests on both an emotional bond with the therapist and a rational, “working” connection. Both dimensions of the alliance have relevance for multicultural clinical work. There have been many contributions to multicultural practice that emphasize either cognitive or emotional levels of the alliance. This paper uses both empirical studies and clinical papers to synthesize both the emotional and the rational perspectives on the multicultural alliance. Examples are drawn from literature, published case examples, and the author's own clinical practice.     

Taking Talk Seriously: Religious Discourse as Social Practice

Talk is easily regarded as having lesser value in studies of social phenomena than action, interaction, and organization. Yet talk is an important way in which humans act, interact, and organize themselves. In this article, I examine how talk has been used in recent decades in the study of religion and in related work on culture and institutions. I argue that careful empirical examination of talk has already significantly increased our understanding of both the micro and macro processes involved in the construction of social life. I discuss four objections to taking talk seriously and show that these objections should not deter investigations in which talk plays a central role. I offer examples of recent work that poses new conceptual and theoretical questions, complements quantitative studies, and provides insights about changing historical and contemporary social conditions.     

Measuring the quality of the sibling relationship during middle childhood: The psychometric properties of the Sibling Relationship Inventory

To address a significant gap in the literature on sibling relationships, the present study examined the psychometric properties of the Sibling Relationship Inventory (SRI) in an Italian sample. The study had three main aims: (i) to investigate the factorial structure of the SRI; (ii) to evaluate the invariance of the SRI's factorial structure across birth order; and (iii) to test the SRI's validity. To this end 385 children, 213 first-borns and 172 second-borns (aged 6 to 12) were recruited. Confirmatory factor analyses showed a three-factor structure identical to that reported by the authors of the SRI. Critically, the SRI structure was stable when first- and second-borns were considered separately. Overall, the Italian version of the SRI showed good psychometric properties.     

Relationship Education for Military Couples: A Pilot Randomized Controlled Trial of the Effects of Couple CARE in Uniform

Military life can place excess strain on couple relationships. The Couple CARE relationship education program was tailored to address the challenges of military couples. Thirty-two Australian military couples participated in a pilot feasibility study assessing the Couple CARE in Uniform adaptation against an active control. Relationship satisfaction and communication improved in both conditions, with no significant difference between the conditions. Couples' high relationship satisfaction on presentation, paired with modest statistical power, might have contributed to the null results. However, Couple CARE in Uniform had significantly higher consumer satisfaction than the comparison condition, suggesting it is a program worthy of further evaluation.     

The Impact of Relationship Education on the Couple Relationship: A Grounded Theory of Intentionality and Awareness

Research on relationship education (RE) programs generally shows their effectiveness, but it is important to understand what the mechanisms of change are, how they occur within programs, and what participants experience. The purpose of this study was to explore couples' perceptions of the key components of their experience as participants of a Prep-based RE program. Research questions included: How do couples describe their experience of taking an 8-hour relationship education class? What elements had the biggest impact on their relationship? How has their relationship changed as a result of participation? Interview data from 39 married and cohabitating couples who participated in RE were analyzed using grounded theory methods. Six categories emerged from the analytic process, resulting in a model that provided explanatory detail of a typical RE program experience and its impact on the participants. These categories were: intentionality and awareness, context, relationship, workshop, impact (of RE), and couple interview. Couples described these categories as developing in a relatively chronological order, with Intentionality and Awareness being a central category that cut across the process and helped explain the impact of the program on the couple relationship. Implications for research, program development, and program facilitators providing RE are discussed.     

心理咨询中的突然获益：工作同盟及初始症状的影响

对82位当事人在咨询中的症状改变过程进行纵向研究,检验突然获益模式（Sudden Gain, SG）的发生及其与咨询效果的联系,并探索初始症状水平、工作同盟对SG的影响。结果表明,24.93%的当事人经历了SG,咨询效果显著好于其他当事人;SG组与对照组在初始症状水平和总体工作同盟水平上差异显著。结论：SG出现于本土心理咨询中,经历SG的当事人取得了更好的咨询效果,工作同盟与初始症状水平与SG的发生相关。     

医患关系内涵及模式:基于社会交换理论的研究

梳理了国外医患关系的相关文献,基于社会交换理论视角探析医患关系的内涵,深入剖析了医疗质量和患者信任是构成医患关系的两个重要因子,并进一步构建了简约化的四类医患关系模式,即和谐医患关系模式、改善医患关系模式、不善医患关系模式和紧张医患关系模式。认为医患关系的建立是一个动态的过程,在诊疗过程中医患关系模式之间是可以相互转换的,患者信任是构建和谐医患关系的基础,为我国和谐医患关系的建立进行了理论上的探索。     

Relationality in Kohut's psychology of the self

In this essay, I will posit that Kohut's psychology of the self portrays relationality and that its relationality can be categorized into the explicit aspects. I will also put forth the six aspects of relationality contained in Kohut's psychology of the self as relational, dynamic, wholistic, unilateral, mutual, and doxological and they can be summarized as following: (1) Relational: Narcissism is not self-love but is a particular kind of object relationship; (2) Dynamic: The most central self is dynamic or agentic and not defined in substantival attributes; (3) Wholistic: The whole of the self is important; (4) Unilateral: In order for one's self to develop, one is in need of and at the receptive end of another's empathy; (5) Mutual: Others’ empathy is needed in maintaining the health of the developed selves; and (6) Doxological: Joy and thanksgiving are natural expression of developed selves.     

Reflections of Authority in Psychotherapy

Abstract

This article examines how therapists' expressions of authority affect the psychotherapeutic relationship. The article is based on the proposition that the clinical practitioner is always in a position of authority, regardless of how the role of authority is conceptualized within treatment approaches. The article includes an investigation of power and authority differentials within and across therapeutic approaches that espouse both hierarchical and egalitarian authority relationships. Process material from these approaches is analyzed to identify therapists' exercise of authority within these two approaches. It is suggested that researchers and therapists might use a heuristic research design to study the conveyance of therapeutic authority to identify whether dimensions of authority are overtly or covertly expressed, and whether or how such expression might affect practice and a client's exercise of personal authority.     

Marital Problems Occurring in Midlife: Implications for Couples Therapists

The ability of therapists to adequately address the presenting problems of couples impacts the process and outcome of therapy. Although research has examined the types of problems that couples commonly experience, little is known about problems among midlife couples. Midlife marital problems were examined using data from a national random sample of 632 married people between the ages of 40 and 50. The results indicated that the most common problems were financial matters, ways of dealing with children, and sexual issues. Values, commitment, spiritual matters, and violence were the least common problem areas. There were few differences when gender, remarriage, and length of marriage were considered.     

在心理治疗中审视积极与消极情绪的关系及作用

心理治疗中长期存在两种倾向：力图减少消极情绪、认为这样可以自动增加积极情绪。该文分析并总结了有关积极与消极情绪的关系及作用的实证研究和综述,主要得出三个结论：1）积极与消极情绪有三种关系：负相关、相互独立、部分重合,具体表现出哪种关系要视实际情况而定。2）过多的积极情绪对认知、行为、健康有消极作用。3）适当的消极情绪对认知、行为、健康有积极作用。因此,在进行心理治疗或研究时,应根据实际情况．明确对象并选择正确方法。     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

以心理学共情理论应对困境中的医患关系

和谐的医患关系是构建人性化医疗的基础,面对当今医患关系紧张的困境,探索如何应对困境中的医患关系迫在眉睫.共情是心理学的一个概念,阐述了人际互动过程中的一种心理现象,是一种站在对方立场上的思考方式.临床实践中医务人员存在共情缺陷,如易产生共情疲劳、缺乏倾听、缺少尊重等,通过心理学干预技术提高其临床共情能力有利于减少共情缺陷、避免医疗纠纷、协调医患关系.良好的共情能力有助于推进新的合作型医患关系的建设,尤其适合于临床一线的医务工作者.