Constrained, confounded and confused: why we really know so little about therapists in treatment outcome research.
Constrained, confounded and confused: why we really know so little about therapists in treatment outcome research.
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受限、困惑和困惑：为什么我们对治疗结果研究中的治疗师知之甚少。
DOI：
10.1046/j.1360-0443.2001.9622032.x
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Carroll,KM
中科院分区：
文献类型：
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作者：
Carroll,KM
近年来，在确定药物滥用障碍的有效行为疗法方面取得了非凡的进展（Leshner，1999）。这一进步在很大程度上伴随着临床试验研究方法的日益严格和完善。现在有大量文献涉及治疗结果研究的几乎所有关键组成部分，包括物质使用障碍的疾病分类学、无数评估工具和结果测量的有效性和可靠性、自我报告与物质使用客观测量的有效性、不同治疗结果的预测因素等等。然而，尽管越来越多的治疗被证明是有效的，但关于提供这些治疗的治疗师以及治疗师“重要”程度的信息仍然相对匮乏（Luborsky et al., 1997）；也就是说，个体治疗师是否以及在多大程度上对治疗结果有显着影响（Najavits & Weiss，1994）。对治疗师和治疗师效果的重视不足，部分原因是治疗师效果很难严格研究。例如，参与任何特定试验的治疗师数量通常很少。 “治疗师样本量”只有 10 人左右的研究中很少能得出确切的结论。同样，由于患者很少（如果有的话）被随机分配给治疗师，因此大多数关于治疗师特征与结果关系的报告都是基于探索性的相关分析，因此受到许多替代解释的影响。此外，也许最令人烦恼的问题是理解治疗师对结果的影响。
Extraordinary progress has been made in recent years in the identifi cation of effective behavioral treatments for substance use disorders (Leshner, 1999). This progress has been accompanied, to a large extent, by increasing rigor and refi nement of the methodology of clinical trials research. There are now prodigious literatures on almost all of the key components of treatment outcome research, including the nosology of substance use disorders, the validity and reliability of myriad assessment instruments and outcome measures, the validity of self-report versus objective measures of substance use, predictors of outcome across different treatments, and many more. However, despite a growing number of treatments that have been demonstrated to be effective, there remains a comparative paucity of information on the therapists who deliver those treatments and the extent to which the therapist ‘matters’(Luborsky et al., 1997); that is, whether and to what extent the individual therapist has a signifi cant effect on treatment outcome (Najavits & Weiss, 1994).Under-emphasis on therapists and therapist effects has occurred, in part, because therapist effects are notoriously difficult to study rigorously. For example, the number of therapists participating in any particular trial is typically small. Firm conclusions can seldom be drawn from a study where the ‘therapist sample size’is only 10 or so. Similarly, because patients are very rarely (if ever) randomized to therapists, most reports on the relationship of therapist characteristics to outcome are based on exploratory, correlational analyses and hence sub-ject to a host of alternate explanations. Moreover, perhaps the most vexing problem in understanding the effects of therapists on out-