Improvement of the Working Alliance in One Treatment Session Predicts Improvement of Depressive Symptoms by the Next Session
Improvement of the Working Alliance in One Treatment Session Predicts Improvement of Depressive Symptoms by the Next Session
复制标题
DOI：
10.1037/ccp0000119
复制
发表时间：
2016-08-01
影响因子：
5.9
通讯作者：
Holmqvist, Rolf
中科院分区：
文献类型：
--
作者：
Falkenstrom, Fredrik;Ekeblad, Annika;Holmqvist, Rolf
目的：工作联盟理论的发展假设治疗师在整个治疗过程中对联盟波动的关注是至关重要的。因此，研究人员开始将联盟作为一种时变的变化机制而不是静态的调节机制来研究。然而，迄今为止，由于误差项和预测因子的不独立性（内生性），大多数研究都存在偏差。方法：在一项比较认知行为疗法和人际心理疗法的随机试验中，84名重度抑郁症患者在每次治疗前填写贝克抑郁量表- ii。每次治疗结束后，患者和治疗师都要填写工作联盟清单（Working Alliance Inventory）的简短表格。采用广义矩法对动态面板数据进行分析，这是一种在计量经济学中常用的消除内生性偏差的方法。结果：联盟的改善预示着下一次治疗时抑郁症状的显著减轻（患者评分：b = -4.35, SE = 1.96, p = 0.026, 95%可信区间[CI][-8.19, -0.51]；治疗师评分：b = -4.92, SE = 1.84, p = 0.008, 95% CI[-8.53, -1.31]）。此外，对下一个疗程后的治疗有显著的延迟效应（患者评分：b = -3.25, SE = 1.20, p = 0.007, 95% CI[-5.61, -0.89]；治疗师评分：b = -5.44, SE = 1.92, p = 0.005, 95% CI[-9.20, -1.68]）。结论：如果患者-治疗师联盟的质量在给定的治疗过程中得到改善，抑郁症状可能会在下一次治疗中减少。本研究最重要的局限性是样本量相对较小。
Objective: Developments in working alliance theory posit that the therapist's attention to fluctuations in the alliance throughout treatment is crucial. Accordingly, researchers have begun studying the alliance as a time-varying mechanism of change rather than as a static moderator. However, most studies to date suffer from bias owing to the nonindependence of error term and predictors (endogeneity). Method: Patients with major depressive disorder (N = 84) from a randomized trial comparing cognitive-behavioral therapy with interpersonal psychotherapy filled out the Beck Depression Inventory-II before each session. After each session, patients and therapists filled out the Working Alliance Inventory short forms. Data were analyzed using the generalized method of moments for dynamic panel data, a method commonly applied in econometrics to eliminate endogeneity bias. Results: Improvement of the alliance predicted significant reduction of depressive symptoms by the next session (patient rating: b = -4.35, SE = 1.96, p = .026, 95% confidence interval [CI] [-8.19, -0.51]; therapist rating: b = -4.92, SE = 1.84, p = .008, 95% CI [-8.53, -1.31]). In addition, there was a significant delayed effect on the session after the next (patient rating: b = -3.25, SE = 1.20, p = .007, 95% CI [-5.61, -0.89]; therapist rating: b = -5.44, SE = 1.92, p = .005, 95% CI [-9.20, -1.68]). Conclusion: If the quality of patient-therapist alliance is improved in a given treatment session, depressive symptoms will likely decrease by the next session. The most important limitation of this study is its relatively small sample size.