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：本综述旨在系统化和解释八种期刊中十年来（2009-2019年）心理治疗过程研究的结果。方法：这是一项定量和定性原始研究的混合研究综述。这些研究结果的分析包括描述性定量部分和遵循定性元分析逻辑的定性部分，以自下而上的方式对两类研究的主要结果进行分类，从而生成特定的内容类别，这些类别在更高抽象层次的进一步步骤中进行综合，从而以叙述方式呈现“解释性综合”。结果：综述表明，心理治疗过程研究使用各种定性和定量方法，经常创建新的程序。此外，综述指出，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；而研究最广泛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。宏观层面的结果表明，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；并表明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，变化事件会影响持续变化和结果；对于破裂，关键事实是修复；治疗师的沟通对患者沟通有直接影响。结论：我们对心理治疗相关方面的了解非常零散；可靠且可重复的结果仍然很少。只有少数变量被发现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，清楚地表明这一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化机制的有力工具，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，变化机制需要与持续变化联系起来；这反过来又需要变化模型，希望是跨理论性质的。

【关键词】心理治疗过程研究；过程-结果研究；混合研究综述

[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

（需要英文原文的朋友，请联系微信：iacmsp）