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。     

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。     

当事人的投入与会谈效果、咨询效果的关系研究

本研究探索了当事人会谈时的投入与即时会谈效果的关系;当事人咨询初期的投入与整体咨询效果的关系。结果发现当事人会谈时的投入与即时会谈效果、在咨询初期的投入与整体咨询效果都呈现显著的正相关。进一步回归分析发现,当事人在咨询初期的投入与整体咨询效果呈现正U型的偏态分布,少数投入水平最低的当事人获得中等水平的咨询效果,中等投入水平的当事人咨询效果最差,投入水平最高的当事人的咨询效果最好。     

当事人眼里的工作同盟：质的分析

为了解中国当事人如何看待咨询中的工作同盟, 对工作同盟做初步的本土概念化, 采用协商一致的质的研究方法对来自1所大学心理咨询中心的20名当事人的访谈结果进行了分析。结果发现, 与工作同盟相关的域有6个, 分别是情感联结、任务、投入、合作模式、发展变化、影响因素。前三个域可以看作是工作同盟的构成要素, 而后三个域则是对其外部特征的描述。对每个域的含义及其与现有理论和研究的关系进行了讨论。     

工作同盟和领悟对咨询效果的影响

为了解短程咨询中工作同盟和领悟对咨询效果的影响,以12个个案94次会谈为对象,考察工作同盟、领悟分别与会谈效果、治疗效果的关系,并考察二者共同作用于效果的方式。结果表明,咨访双方评定的工作同盟都可以正向预测会谈效果,但不能预测治疗效果;领悟与会谈有效性正相关,领悟正向预测治疗效果;咨询师评定的同盟的三个维度以领悟为中介影响其对会谈效果的评价。     

工作同盟的结构：基于两种测量工具的检验

以大学心理咨询中心的当事人为样本,对国外两种广泛使用的工作同盟测量工具WAI-S和WAI-SR的结构和测量学指标进行检验。结果发现,WAI-S和WAI-SR的任务一致与目标一致两个维度的相关较高,分别为0.71和0.74;WAI-S和WAI-SR的一因素、二因素和三因素结构均没有得到充分支持;WAI-SR与咨询效果的相关不显著。WAI-S和WAI-SR的结构不能很好反映其所依据的理论假设,提示在对测量工具进行改进的同时,还需要对工作同盟的理论结构进行思考。     

心理咨询的LIWC语言特征对咨询效果的预测

语言是心理咨询的重要内容。语言探索和词频统计（Language Inquiry and Word Count, LIWC）被广泛用于分析语言使用的心理意义。本研究收集了28名当事人共144次有效咨询录音及每次会谈后当事人的症状自评结果。将录音转录成文本后,抽取当事人的LIWC语言特征,进行主成分降维,结果获得8个因子,解释了总体方差的75.11%。一般线性回归中,躯体感受、功能词、情绪、认知和口语赘词对当事人的症状水平具有显著的预测作用,进一步多层线性模型中,躯体感受和情绪用词显著预测咨询效果。LIWC文本特征能够呈现与当事人症状相关的信息,为未来计算机自动化监控咨询过程和结果提供了新视角。     

心理咨询过程-效果研究现状及展望

心理咨询过程-效果研究考察咨询过程变量对咨询效果的影响。以人为中心流派、认知流派、行为流派、精神分析流派等都为该研究领域提供了理论基础。主要研究内容有咨询师的反应方式、会谈中的当事人行为、工作同盟、会谈中的重要内容等过程变量与效果的关系。该领域积累的成果还不多,这可能与过程-效果关系本身的复杂性有关,同时研究方法尚有许多欠缺,如考察复杂关系时使用的研究设计过于简单、测量工具不统一导致结果难以比较,有些测量工具不成熟信效度不高。未来的研究除了努力克服这些问题外,还应多考虑理论构建、内隐变量的调节和中介作用、当事人变量,在研究方法上应更为综合和多样化     

会谈中的当事人阻抗及工作同盟的影响因素:一项过程研究

从心理咨询过程研究视角,以38个会谈为对象,考察咨询师指导和当事人特质逆反对当事人阻抗的影响,并检验三者对工作同盟的影响。结果:指导正向预测阻抗,特质逆反则不能,二者的交互作用也不显著;阻抗负向预测工作同盟,指导则不能,二者的交互作用和中介作用都不显著,但阻抗的中介效应相对更大。结论:咨询师指导增加当事人阻抗;当事人阻抗破坏工作同盟,并在咨询师指导对工作同盟的影响过程中可能起中介作用。     

咨询会谈中的人际互补及其与工作同盟、咨询效果的关系

Leary的人际理论将人际互动行为划分为“情感”和“控制”两个维度, 互动双方在情感维度的一致性和控制维度的互补性统称为人际互补。为探究心理咨询过程中人际互补的发展趋势及其与工作同盟、咨询效果的关系, 采用电脑操纵杆方法, 编制《咨询会谈人际互补行为评分手册》, 对16个个案的48个心理咨询会谈录像进行评估。结果表明：有经验的咨询师在咨询前期的情感轴一致性高于中期和后期, 在咨询后期的控制轴互补性高于前期和中期, 新手咨询师的情感轴一致性和控制轴互补性均无阶段性差异; 咨询中期的情感轴一致性负向预测工作同盟和会谈深度; 情感轴一致性呈高-低-高发展趋势的个案咨询效果更好。结论: 心理咨询的人际互补三阶段模型得到一定程度的支持, 其作用机制有待进一步验证。     

Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder

Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18-65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).     

Sudden Gains in Two Trauma-Focused Treatments for Posttraumatic Stress Disorder

In the current study, we examined the degree to which sudden gains (large, rapid, and stable symptom reduction in a one-session interval) predicted treatment outcome in adults randomized to two different trauma-focused treatments. Adults diagnosed with PTSD were randomized to either written exposure therapy (WET; n = 63), a brief, exposure-based treatment for posttraumatic stress disorder (PTSD), or the more time-intensive Cognitive Processing Therapy (CPT; n = 63). Findings showed that 20.6% of participants who received WET and 17.5% of participants who received CPT experienced sudden gains. Sudden gains occurred earlier in WET (M session = 2.69, SD = 0.75) than in CPT (M session = 5.64, SD = 3.01). However, there were no treatment condition differences in the magnitude of the sudden gains. Treatment outcomes were significantly better for those who experienced sudden gains compared with those who did not, regardless of treatment assignment. Exploratory analyses of participants’ trauma narratives revealed that expressing more negative emotion predicted the occurrence of sudden gains in both treatment conditions. Negative beliefs about the self and others did not predict sudden gains. The findings are discussed in terms of how they may help identify individual early response patterns that predict outcomes in trauma-focused treatments.     

Sudden gains in group cognitive-behavioral therapy for panic disorder

The current study investigates sudden gains (rapid symptom reduction) in group cognitive-behavioral therapy for panic disorder. Sudden gains occurring after session 2 of treatment predicted overall symptom reduction at treatment termination and some changes in cognitive biases. Meanwhile, sudden gains occurring immediately following session 1 were not associated with symptom reduction or cognitive change. Together, this research points to the importance of examining sudden gains across the entire span of treatment, as well as the potential role of sudden gains in recovery from panic disorder.     

Sudden Gains in Depressed Cancer Patients Treated With Behavioral Activation Therapy

Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M = 11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.     

Sudden gains in cognitive behavioral treatment for depression: when do they occur and do they matter?

Despite the use of efficacious treatments for depression, individuals differ in both the degree to which they recover and the rate at which recovery occurs. Tang and colleagues found that depressed patients who had sudden improvements in their symptomatology not only maintained these gains, but also enjoyed more improvement and higher rates of recovery than those without sudden gains (J. Consulting Clin. Psychol. 67(6) (1999) 894; J. Consulting Clin. Psychol. 70(2) (2002) 444). Our study examined the role of sudden gains in a cognitive-behavioral group treatment for depression. Results indicated that 41.9% of patients experienced sudden gains. Furthermore, sudden gains occurring in the first third of treatment appear to have special importance. Participants enjoying early sudden gains had significantly larger changes in depressive symptom scores over the course of treatment than those without sudden gains and were marginally more likely to be treatment responders compared to those without early sudden gains. In contrast to Tang and DeRubeis (J. Consulting Clin. Psychol. 67(6) (1999) 894), however, sudden gains were not associated with cognitive changes.     

Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?

Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.     

Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder

Sudden gains have been associated with better short- and long-term treatment outcomes in a number of psychiatric disorders. However, no studies to date have evaluated sudden gains in body dysmorphic disorder (BDD). We used data from a previous randomized controlled trial evaluating the efficacy of an Internet-based cognitive-behavior treatment (CBT) for BDD. The sample consisted of 47 adults diagnosed with BDD. We compared the treatment outcomes of sudden gainers vs. gradual gainers (i.e., treatment responders with no sudden gains) and non-sudden gainers (i.e., gradual gainers plus nonresponders) at posttreatment and 3, 12, and 24 months after the end of the treatment. Twelve (25.5%) participants experienced a sudden gain. Compared to non-sudden gainers and to gradual gainers, sudden gainers showed significantly larger improvements on the Yale-Brown Obsessive-Compulsive Scale modified for BDD at posttreatment (g = 1.23 and g = .91, respectively), and at 3-month (g = 1.23 and g = 1.00, respectively), 12-month (g = 1.12 and g = .91, respectively), and 24-month follow-up (g = 1.11 and g = .97, respectively). This translated into higher rates of treatment responders and remitters in the sudden gainers across all time points. The occurrence of sudden gains in Internet-based CBT for BDD is associated with favorable short- and long-term treatment outcomes. This suggests that a sudden improvement during the treatment could be a marker of good prognosis, while non-sudden—including gradual—gainers are more likely to need continued support or booster sessions. Early identification of patients who are not progressing as expected and subsequent tailoring of the delivered intervention has the potential to improve treatment outcomes in this group.     

Non-treatment-related sudden gains in depression: the role of self-evaluation

A number of studies have demonstrated that recovery from depression is often marked by precipitous improvements during the course of treatment. The present research examined sudden gains occurring outside of the context of treatment in a sample of college students with current major depressive disorder (n=60), and tested whether variables pertaining to cognitive style, hope, self-evaluation, and life events would be associated with these gains. Results indicated that 60% of the sample experienced sudden gains, with over half of those sudden gains reversing before the end of the 9-week observation period. Sudden gainers were significantly less depressed at the end of the observation period but were no more likely to have achieved remission compared to non-sudden gainers. Although changes in cognitive style did not precede sudden gains, individuals with sudden gains had significantly higher self-esteem at baseline compared to non-sudden gainers. Furthermore, decreases in the frequency of social comparison occurred in the week prior to sudden gains. These results suggest that sudden gains do occur outside of the context of treatment and that self-evaluation processes may play an important role in recovery from depression.     

Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations

ObjectiveSudden gains have been described as rapid, sizeable changes observed between treatment sessions and have been associated with improved treatment outcome in adults. The current study examined weekly sudden gains among children seeking treatment in the community mental health setting.MethodParticipants were 161 children (age M = 10.58, SD = 1.73; 69.6% male; 47.8% Caucasian) and their parents who were randomized to one of three treatment modalities and were administered weekly and quarterly assessments throughout treatment.ResultsWhen idiographic (youth- and parent-identified “top problems”) and nomothetic measures (standardized checklists) were used to calculate sudden gains (i.e., gain must be large: in absolute terms, relative to prior session, and relative to changes in prior and subsequent sessions), 20–42% of participants experienced at least one sudden gain during treatment. Most sudden gains occurred early in treatment, and session content of relaxation was associated with sudden gain presence. Using a modified Bonferonni correction, sudden gains predicted overall symptom levels at final assessment (i.e., last assessment obtained following post-treatment) even after controlling for pre-treatment symptom levels and magnitude of the overall gain from pre- to post-treatment.ConclusionsSuddenness of gains may have a direct effect on long-term treatment outcome among children in the community.