How Central Is the Alliance in Psychotherapy? A Multilevel Longitudinal Meta-Analysis
How Central Is the Alliance in Psychotherapy? A Multilevel Longitudinal Meta-Analysis
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DOI：
10.1037/a0025749
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发表时间：
2012-01-01
影响因子：
3.9
通讯作者：
Horvath, Adam O.
中科院分区：
文献类型：
--
作者：
Flueckiger, Christoph;Del Re, A. C.;Horvath, Adam O.
先前的荟萃分析发现，在广泛的治疗中，联盟与结果之间存在适度但强大的关系，包括关注的问题、背景和测量。然而，关于联盟的治疗作用仍然存在激烈的争论，特别是在使用随机临床试验（RCT）设计进行测试的治疗中。本研究的目的是检验研究设计、治疗类型或作者忠诚变量是否单独或联合调节联盟与结果之间的关系。使用多水平纵向分析来调查联盟-结果相关性的以下调节因素：(a)研究设计（RCT或其他），(b)疾病特异性手册的使用，(c)结果的特异性，(d)认知和/或行为治疗（CBT）或其他类型的治疗，(e)研究人员的忠诚，(f)联盟评估的时间。随机对照试验、疾病特异性手工使用、主要和次要结局的特异性以及CBT并没有调节联盟-结局的相关性。在对联盟有特殊兴趣的研究者进行的研究中，早期联盟-结果的相关性略高于那些没有这种忠诚的研究者进行的研究。在治疗过程中，这些最初的差异消失了。除了这种趋势之外，之前提出的作为联盟-结果关系的潜在调节因子或中介因子的变量，无论是单独还是组合，都没有被发现具有中介影响。
Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance-outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance-outcome correlation. Early alliance-outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance-outcome relation, alone or in combination, were found to have a mediating impact.