The Alliance in Adult Psychotherapy: A Meta-Analytic Synthesis
The Alliance in Adult Psychotherapy: A Meta-Analytic Synthesis
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DOI：
10.1037/pst0000172
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发表时间：
2018-12-01
期刊：
影响因子：
2.5
通讯作者：
Horvath, Adam O.
中科院分区：
文献类型：
--
作者：
Fluckiger, Christoph;Del Re, A. C.;Horvath, Adam O.
无论理论取向如何，该联盟仍然是与心理治疗成功相关的最受研究的变量之一。我们定义并说明了联盟（也被概念化为治疗联盟、帮助联盟或工作联盟），然后对295项独立研究进行了荟萃分析，这些研究涵盖了30,000多名患者（发表于1978年至2017年之间），用于面对面和基于互联网的心理治疗。使用随机效应限制最大似然估计器的三水平荟萃分析来调查联盟与治疗结果的关系。面对面心理治疗的整体联盟-结果相关性为r = 0.278（95%可信区间）。256年,。299], p < 0.0001；相当于d = .579)。效应量之间存在异质性，295个效应量中有2%呈负相关。基于网络的心理治疗的相关性大致相同（即，r = 0.275, k = 23）。这些结果证实了联盟与结果之间正相关的稳健性。这种关系在评估者的观点、联盟和结果测量、治疗方法、患者特征和国家之间保持一致。文章总结了因果关系考虑、研究局限性、多样性考虑和治疗实践。
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.