Treatment failure in cognitive-behavioural therapy: therapeutic alliance as a precondition for an adherent and competent implementation of techniques.
Treatment failure in cognitive-behavioural therapy: therapeutic alliance as a precondition for an adherent and competent implementation of techniques.
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认知行为治疗中的治疗失败：治疗联盟是坚持和有效实施技术的先决条件
DOI：
10.1111/bjc.12063
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Stangier
中科院分区：
文献类型：
--
作者：
Grikscheit;Höfling;Stangier
治疗失败是一种常见的现象，但对其原因却知之甚少。治疗联盟、治疗师依从性和治疗师能力被认为是治疗成功的重要方面，并形成了当前调查的焦点。设计三个治疗抑郁症、社交恐惧症和抑郁症的随机对照试验是本研究的基础。其被分类为治疗失败或治疗成功。过程变量进行了评估的基础上的录像带的前三个treatmentsessions.ResultsTherapists的坚持和治疗联盟成功的治疗和那些被归类为失败的显着差异，而治疗师的能力没有独立的评分。在横截面分析中，我们发现了联盟依从性对治疗结局的调节作用，表明治疗联盟越好，依从性对治疗结局的影响越强。此外，较高的治疗师的能力被发现积极影响治疗结果，只有通过治疗联盟介导。高依从性治疗师对治疗结果有正向影响，且仅以能力-联盟关系为中介。在额外的纵向分析中，我们发现的证据表明，在一个会话的治疗联盟影响治疗师的坚持和能力在随后的会话，但不是相反的方式around.ConclusionsTherapeutic联盟被证明是一个重要的变量，预测治疗失败。此外，在我们的纵向分析中，我们发现有证据表明，治疗联盟是坚持和胜任实施治疗技术的先决条件，这对我们的横断面分析和以前的研究结果提出了质疑。从业者指出临床意义治疗失败与认知行为治疗中的治疗联合水平较低有关。治疗联合似乎是依从性和治疗效果的重要先决条件。治疗技术的有效实施。在心理治疗过程中，应监测治疗联合。注意事项或限制结果仅限于认知行为疗法，可能不代表其他治疗方法。过程分析基于高度标准化的随机对照试验，可能无法推广到常规护理。
ObjectivesTreatment failure is a common phenomenon, but little is known about the reasons. Therapeutic alliance, therapist adherence, and therapist competence are considered important aspects of treatment success and formed the focus of the current investigation.DesignThree randomized controlled trials for the treatment of depression, social phobia, and hypochondriasis were the basis of the current study.MethodsThe role of therapeutic alliance, as well as therapist adherence and competence, were investigated in 61 patients, which were classified either as treatment failure or as treatment success. Process variables were evaluated by independent raters on the basis of videotapes of the first three treatment sessions.ResultsTherapists' adherence and therapeutic alliance differed significantly between successful treatments and those classified as failures, whereas therapists' competence did not. In cross‐sectional analysis, we found a moderating effect of adherence with alliance on treatment outcome, indicating that the better the therapeutic alliance, the stronger the effect of adherence on treatment outcome. Moreover, higher therapists' competence was found to affect treatment outcome positively, only mediated by therapeutic alliance. Higher therapists' adherence affected treatment outcome positively, only mediated by the competence–alliance relationship. In additional longitudinal analyses, we found evidence that the therapeutic alliance within one session influences therapists' adherence and competence in the subsequent session, but not the other way around.ConclusionsTherapeutic alliance proved to be an important variable for the prediction of treatment failure. Furthermore, in our longitudinal analyses, we found evidence that the therapeutic alliance is a precondition for the adherent and competent implementation of therapeutic techniques, which questions the results of our cross‐sectional analysis and of previous research.Practitioner pointsClinical implicationsTreatment failure is associated with a lower therapeutic alliance in cognitive‐behavioural treatment.Therapeutic alliance seems to be an important precondition for the adherent and competent implementation of therapeutic techniques.Therapeutic alliance should be monitored during psychotherapeutic treatment.Cautions or limitationsResults are limited to cognitive‐behavioural therapy and may not be representative for other treatment approaches.Process analyses are based on highly standardized randomized controlled trials and may not be generalizable to routine care.
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