心理治疗的会谈间体验对治疗效果的影响——来自追踪研究的证据

采用多层线性分析方法,在短程心理咨询的连续会谈中检验来访者的会谈间体验对咨询效果的影响。以36名个案、151次会谈为样本,结果发现,来访者的症状总体呈线性下降趋势;不同来访者症状变化的速率存在个体差异,会谈间体验的情绪因子能解释症状变化速率总变异的40.79%。结论：在短程心理咨询中,来访者想起咨询会谈或/和咨询师时的情绪体验能显著预测咨询效果。     

Reliability and Validity Analyses of the Self-Management Questionnaire

The authors developed a parent-report measure to enhance findings for diagnoses and evaluations, and therefore, improve on the assessments currently being widely used for this purpose. Data were gathered on 322 clients (4–18 years old) seeking treatment at a private practice setting. Factor analysis revealed 18 subscales. Scores were internally consistent and distinct from other subscales. In addition, the questionnaire showed good diagnostic utility for depression, Oppositional Defiant Disorder (ODD), and Pervasive Developmental Disorder (PDD). This study provides sufficient evidence of the reliability and validity of the Self-Management Questionnaire (SMQ) to recommend its use for skills and needs assessment with children and adolescents.     

Ethical Considerations for Clinicians Treating Victims and Perpetrators of Intimate Partner Violence

Intimate partner violence (IPV), a subcategory of domestic abuse, is a prevalent national health concern that many clinicians will face during their careers. It is important that clinicians become aware of the numerous ethical considerations that are relevant to this population. The existing literature has not yet examined the ethical issues faced by clinicians working with IPV clients through the lens of the most recent American Psychological Association ethics code. This article provides a brief overview of the historical context and the current state of the literature pertaining to IPV. Then it examines the unique ethical challenges associated with the treatment of IPV clients through the American Psychological Association ethics code. Recommendations are provided throughout this article to help clinicians make ethical decisions, maximize the benefits their clients receive from therapy, and minimize violence risk.     

Validation of health locus of control patterns in Swedish adolescents

The purpose of the present study was to investigate the relationships between Health Locus of Control (HLOC) questionnaire subscales (Internal, Powerful Others, Chance) and self-esteem in Swedish adolescents (N = 506). Results from traditional correlational analyses were compared with findings using an alternative method of clustering individuals according to their pattern of scores on the three HLOC subscales. One-way analysis of variance, with eight possible groupings of high and/or low scores on the three subscales, indicated that those with a combination of strong belief in internal control of health, high degree of belief that health is determined by powerful others, and low degree of belief that health is a function of chance/luck had better self-esteem than those with a quite opposite pattern, involving high belief in chance and low belief in internal control. The potential benefit to researchers and clinicians of using this method of combining the HLOC subscales, instead of the traditional correlational method, is discussed.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.     

Cognitive errors,coping patterns,and the therapeutic alliance: A pilot study of in‐session process

Aim: This exploratory study examined the association between clients’ assessment of the therapeutic alliance and their cognitive errors (CE) and coping action patterns (CAP). Method: Selected therapy sessions of clients (N = 26) were rated for cognitive errors and coping action patterns using the CERS and CAPRS methods (Drapeau, Perry, & Dunkley, 2008; Perry, Drapeau, & Dunkley, 2005). The therapeutic alliance was assessed using the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989). Results: Following Bonferroni corrections, no significant relationship was found between clients’ CEs and their ratings of the WAI. However, the ‘Negotiation’ CAP was associated with the total alliance score, and with the Task and Goal subscales. Implications: A better understanding of the cognitive processes presented by clients in session can enable clinicians to address these factors early on when the alliance is most critical.     

Influence of stuttering therapy on clinicians'' disfluencies: Effects of client modeling

This study investigated whether student clinicians working with stutterers subsequently produce more disfluencies than student clinicians providing therapy to clients with other speech and language disorders. Seventeen graduate students working in a 6-wk summer camp setting were divided into two groups: eight who provided treatment for stutterers (group 1) and nine who provided therapy for clients with other communication disorders (group 2). All student clinicians were recorded during spontaneous speaking and oral reading tasks prior to camper arrival and following camper departure. An eight-category classification system was used to determine disfluency types. Findings revealed that Group 1 clinicians significantly decreased their total disfluencies between pre- and post-camp recordings on the spontaneous speaking task. Unexpectedly, this same group also substantially increased part-word repetitions and sound prolongations. The possibilities of incidental learning, reverse modeling, and overidentification with stuttering clients are discussed.     

The Factor Structure of the COPE Questionnaire in a Sample of Clinically Depressed and Anxious Adults

The Coping Orientation to Problems Experienced is a multidimensional scale designed to assess how people respond to stress. The COPE has been validated in a variety of populations displaying variations in factor structure. However, in terms of mental health populations, it has only been validated in alcohol-dependent samples. This paper investigated the factor structure of the COPE in a sample of adults diagnosed with depression and anxiety. Two hundred and seventy-one patients attending cognitive behaviour therapy for anxiety and depression completed the COPE. Confirmatory factor analysis found a poor fit for both lower order and higher order factors based upon the Lyne and Roger (2000) study. Exploratory factor analyses identified six primary subscales (Active Planning, Social Support, Denial, Acceptance, Disengagement, Restraint) which explained approximately 60% of the variance in coping. These 6 subscales may assist researchers and clinicians to validly measure coping in anxious and depressed adults.     

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。     

Special Series Introduction: Confronting the Challenge of Clinical Decision Making in Evidence-Based Practice

This special series addresses the often ignored problem that many clients seen by practicing clinicians do not benefit from empirically-based practices as neatly as research may suggest. The authors in this series have considered the process of decision making in evidence-based practice, looking from differing viewpoints, and considering treatment setting and ethical issues. They present suggestions for clinicians to adapt treatment to the needs of clients while adhering to the robust research on psychotherapy processes and cognitive behavioral therapy.     

Working With Suicidal Clients: Not Business as Usual

In this introduction to a special series of articles on working with suicidal clients, we note that much of the recent growth in theory and research pertaining to suicidal individuals has been contributed by cognitive-behavioral theorists and researchers. This work has established that suicidal people manifest important cognitive vulnerabilities that can be addressed in therapeutic interventions specifically designed for them. Studies to date have produced outcomes that support this framework. We provide brief previews of the collection of articles that follow, which cover safety planning, protocols for evaluating risk, the utility of health behavior theory for informing treatment, mindfulness-based approaches for suicidality, developmental and family considerations, intensive inpatient CBT for individuals in the military, integrated interventions for substance abuse and suicidal behaviors, and coping with the impact of client suicide. We conclude that clinicians are now in a position to begin moving beyond a “therapy as usual” mindset in working with suicidal clients.     

心理治疗中的脱落

脱落是指在心理咨询与治疗中, 来访者由于种种原因在导致他前来寻求帮助的心理困扰或问题尚未解决之前就终止治疗的现象。研究者对脱落概念内涵的理解比较一致, 但脱落的操作性定义存在多种且各有利弊。脱落在临床治疗中普遍存在; 脱落率在跨研究间的结果差异很大, 并受到脱落的操作性定义和研究设计类型的重要影响。传统的静态的变量在预测脱落时存在明显局限, 治疗同盟等治疗过程预测变量近年来得到更多重视, 并丰富了我们对来访者脱落的深入理解。为减少脱落, 研究者建议为来访者提供治疗前准备, 对治疗过程中的关键变量进行评估并根据具体情况采用合适的干预策略。未来研究需要完善脱落的操作性定义, 更多地在自然治疗设置下进行研究, 进一步深化脱落的预测变量研究, 并关注治疗外重要事件及文化背景对脱落的影响。     

Expanding the Therapy Paradigm with Queer Couples: A Relational Intersectional Lens

North American and global cultures in general—and the field of Couple and Family Therapy in particular—have made significant strides toward recognizing and validating LGBTQ identities and relationships. However, clinical assessment and conceptualization of queer couples still lack the complexity needed to encompass the issues involved in treatment. Existing literature provides clinicians a basic understanding of queer couples and the dynamics that make them unique from nonqueer couples. However, much of this knowledge has been normed on White middle‐class couples and has rarely included couples with transgender or bisexual members. This article invites clinicians and researchers to apply a feminist model of intersectionality to understand queer couples. Our proposed intersectional lens considers multiple axes of identity and power and their interrelationships (Crenshaw, 1989, 1991). We argue that intersectionality is important for understanding all identities, whether privileged or marginalized (Falicov, 2003). This application of the concept of intersectionality is unique in its relational focus, emphasizing how partners’ complex individual identities overlap with and intersect with one another. Additionally, this lens considers how the therapists’ and clients’ multidimensional identities intersect. Three case studies are presented to illustrate application of the intersectional lens. In each case, exploring the partners’ multiple social locations, their influences on one another, and the therapist's intersections of identity all proved critical to the direction of therapy.     

Measuring drinking patterns among college students.

Alcohol use among college students is of interest to clinicians and researchers. The results of such studies depend on the quality and nature of the measures used. The literature includes a wide variety of operational definitions of drinking patterns, making difficult comparisons across studies. For 109 men and 83 women attending college this paper provides data on the Drinking Practices Questionnaire, a self-report measure of drinking patterns designed specifically for use with college students. The three subscales, Negative Affect, Positive Expectancies, and Negative Consequences, have good internal consistency reliabilities, and scores correlate significantly with measures of problems associated with alcohol use. Appropriate uses of the measure are discussed.     

Confirming,Validating, and Norming the Factor Structure of Systemic Therapy Inventory of Change Initial and Intersession

Progress or feedback research tracks and feeds back client progress data throughout the course of psychotherapy. In the effort to empirically ground psychotherapeutic practice, feedback research is both a complement and alternative to empirically supported manualized treatments. Evidence suggests that tracking and feeding back progress data with individual or nonsystemic feedback systems improves outcomes in individual and couple therapy. The research reported in this article pertains to the STIC^® (Systemic Therapy Inventory of Change)—the first client‐report feedback system designed to empirically assess and track change within client systems from multisystemic and multidimensional perspectives in individual, couple, and family therapy. Clients complete the STIC Initial before the first session and the shorter STIC Intersession before every subsequent session. This study tested and its results supported the hypothesized factor structure of the six scales that comprise both STIC forms in a clinical outpatient sample and in a normal, random representative sample of the U.S. population. This study also tested the STIC's concurrent validity and found that its 6 scales and 40 of its 41 subscales differentiated the clinical and normal samples. Lastly, the study derived clinical cut‐offs for each scale and subscale to determine whether and how much a client's score falls in the normal or clinical range. Beyond supporting the factorial and concurrent validity of both STIC forms, this research supported the reliabilities of the six scales (Omega_hierarchical) as well as the reliabilities of most subscales (alpha and rate–rerate). This article delineates clinical implications and directions for future research.     

Expectations About Couple Therapy Over Time

One common factor of therapy, expectations, has been demonstrated to be a significant contributor to outcome in individual therapy. Despite this, little is known about expectations about couple therapy. This paper presents the qualitative results of a study exploring clients’ expectations before beginning couple therapy and after six sessions. Results indicate that clients form pre-therapy expectations about their therapist, the process of therapy, and their partner. Results also showed that after six sessions, clients’ expectations about therapy were often met or modified in ways that were positive. Implications for therapists and researchers are included.     

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。     

当事人对领悟的看法：质化分析

为了从当事人的视角理解领悟, 采用协商一致的质化研究方法对15位当事人的访谈结果进行分析。结果发现7个与领悟有关的域：领悟的内容, 领悟的效果, 影响领悟产生的因素, 评估领悟质量的依据, 领悟出现时的反应, 领悟的来源和阻碍领悟发挥作用的因素。形成了领悟的概念界定：领悟是对自己和他人(主要是自己)的新认识, 对自己的认识内容包括, 自己的问题模式, 心理困扰或问题模式的原因、影响和解决办法, 以及自己内在的心理状态。     

The therapeutic relationship in Rational-Emotive Therapy: Some preliminary data

This study assessed the therapeutic relationship between psychotherapy clients and Albert Ellis and other Rational-Emotive Therapists. Clients at the Institute for Rational-Emotive Therapy completed the relationship questionnaire (Truax, & Carkhuff, 1967). The results suggest that RET therapists do develop positive therapeutic relationships. Clients receiving RET endorsed significantly higher scores on most therapeutic relationship subscales compared to subjects in the initial articles introducing the therapeutic relationship scale. There were no differences in therapeutic relationship scores by gender of the therapist. Also, there was no correlation between the relationship scores and the number of sessions completed, which suggests the therapuetic relationship develops early. Both clients of senior and junior therapists received higher relationship scores than did clients of Dr. Ellis. This disconfirms the argument that RET practices cannot lead to a therapuetic relationship and Ellis' therapeutic relationship is a result of his fame and could not be duplicated by other therapists using RET.The authors wish to thank the Board of Trustees of Institute for Rational-Emotive Therapy for their financial support of this study.