十年心理治疗过程研究的经验教训

Lessons from ten years of psychotherapy process research

—原载《心理治疗研究》2024年第34卷第3期—

<Psychotherapy Research>, Volume 34, Issue 3, 2024

【摘要】目的：本综述的目的是对八种期刊十多年来心理治疗过程研究（2009-2019）的结果进行系统化和解释。方法：这是对定量和定性初步研究的混合研究回顾。对这些研究结果的分析包括描述性定量部分和定性部分，遵循定性荟萃分析的逻辑，以自下而上的程序对两类研究的主要结果进行分类，生成特定的内容类别，并在更高层次的抽象的进一步步骤，导致以叙事方式呈现的“解释性综合”。结果：审查表明，心理治疗过程研究使用了各种定性和定量方法，经常创造新的程序。此外，该综述表明，最常评估的宏观过程变量是持续变化、治疗关系（主要是治疗联盟）和治疗干预； 而最广泛研究的微观过程变量是变化事件、困难事件（主要是破裂）和治疗干预。宏观结果表明，持续变化的主要内容是新意义的构建和渐进的心理整合；强调治疗联盟与持续变化和结果的关联；并显示将干预与结果联系起来的复杂性，因为治疗的不同阶段（和问题）需要不同的评估。微观层面的结果表明变革事件对正在进行的变革和结果产生影响；对于破裂来说，关键在于修复；治疗师的沟通对患者的沟通有直接的影响。结论：我们对心理治疗相关方面的了解非常碎片化；稳健且可重复的结果仍然很少。仅发现少数变量可以一致地预测大多数疗法的结果。只有在联盟研究领域，才有可能进行荟萃分析，清楚地证明该因素对最终结果的影响。尽管存在这些局限性，心理治疗过程研究是揭示变革机制的有力工具，目前已得到广泛实施。我们的结论是，为了产生有用的未来知识，变革机制需要与持续的变革相联系；反过来，这需要变革模型，希望具有跨理论性质。

【关键词】心理治疗过程研究； 过程-结果研究； 混合研究回顾

[Abstract] Objective: The aim of this review is to systematize and interpret results produced over one decade of Psychotherapy Process Research (2009–2019) in eight journals. Method: It is a Mixed Studies Review of quantitative as well as qualitative primary studies. The analysis of the results of these studies included a descriptive quantitative part and a qualitative part that followed the logic of Qualitative Meta Analysis, categorizing the main results of both types of studies in a bottom-up procedure that generates specific content categories that are synthesized in further steps of a higher level of abstraction, leading to an “interpretive synthesis” presented in a narrative way. Results: The review shows that psychotherapy process research uses a variety of qualitative and quantitative methods, often creating new procedures. Furthermore, the review indicates that the most commonly assessed macroprocess variables are ongoing change, therapeutic relationship (predominantly therapeutic alliance), and therapeutic intervention; while the most extensively studied microprocess variables are change events, difficult episodes (mainly ruptures), and therapeutic intervention. Macrolevel results reveal that the main contents of ongoing change are the building of new meanings and progressive psychological integration; underscore the association of the therapeutic alliance with ongoing change and outcome; and show the complexity of associating intervention with outcome, because different phases of therapy (and problems) need different assessments. Microlevel results indicate that change events impact on ongoing change and outcome; that for ruptures the key fact is their repair; and that therapist communication has an immediate influence on patient communication. Conclusion: Our knowledge regarding relevant aspects of psychotherapy is very fragmented; robust and replicated results are still scarce. Only a few variables have been found to consistently predict outcome across most therapies. Only in the field of alliance research it has been possible to perform meta-analyses that clearly demonstrate the impact of this factor on final outcomes. Despite these limitations, psychotherapy process research is a powerful tool for uncovering change mechanisms and is at present widely implemented. Our conclusion is that, in order to generate useful future knowledge, change mechanisms need to be linked to ongoing change; this, in turn, requires models of change, hopefully of a transtheoretical nature.

[Key words] Psychotherapy process research; process-outcome research; mixed studies review

论文原文：Mariane Krause (2024). Lessons from ten years of psychotherapy process research. Psychotherapy Research, Volume 34, Issue 3, Pages 261-275.

https://doi.org/10.1080/10503307.2023.2200151

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