ISSN 1671-3710
CN 11-4766/R
主办:中国科学院心理研究所
出版:科学出版社

心理科学进展 ›› 2009, Vol. 17 ›› Issue (6): 1316-1326.

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心理治疗的消极后果

秦旻;郑涌   

  1. 西南大学心理学院,重庆 400715
  • 收稿日期:2009-02-20 修回日期:1900-01-01 出版日期:2009-11-15 发布日期:2009-11-15
  • 通讯作者: 郑涌

The Negative Outcome of Psychotherapy

QIN Min; ZHENG Yong   

  1. School of Psychology, Southwest University, Chongqing 400715, China
  • Received:2009-02-20 Revised:1900-01-01 Online:2009-11-15 Published:2009-11-15
  • Contact: ZHENG Yong

摘要: 心理治疗消极后果是指由于心理治疗本身直接导致的来访者病情恶化。消极后果表现形式多样,对其测量应全面而仔细确证。消极后果的影响因素众多,包括来访者中有人格病理诊断、人际功能障碍、他评病情严重、对治疗期望不正确和动机低下;治疗师缺乏共情、对来访者出现负性反移情、低估来访者病情和错误使用治疗技术;潜在有害疗法。对其预防包括治疗前对治疗师和疗法进行规范和治疗中采用聚焦来访者的研究减少消极后果发生率。最后提出目前研究中存在测量、研究单位选择和伦理等难题,未来研究应全面呈现研究数据、采用RCT研究确定消极后果发生率、用交互作用研究模式寻找消极后果影响因素以及对中介变量的研究探询消极后果发生机制。

关键词: 心理治疗, 消极后果, 潜在有害疗法, 聚焦来访者的研究

Abstract: Psychotherapy negative outcome is defined as the process of worsening in psychotherapy, and implies an impairment of vigor, resilience, or usefulness from a previously higher state of functioning. The constitutions of negative outcome varied much and the identification should be carried carefully. Patient, therapist, and therapy variables are examined, and tentative conclusions are drawn from the existing data. Patients who are diagnosed personality disorders, have severe interpersonal difficulties, are judged more severe, have unrealistic expectation about psychotherapy, and who are poorly motivated, have been found at risk for negative outcome. On the part of therapist, lack of empathy, negative countertransference, underestimation of the severity of the patient’s problems, and poor technique all have been associated with negative outcome. Potentially harmful therapies are thought to produce higher rates of negative outcome than others. The approaches that may help prevent or decrease the incidence of negative outcome in psychotherapy include supervision of therapists and therapies before a treatment and client-focused research in treatment. Issues in research are discussed, including negative outcome measurement, unit of investigation and the ethical dilemmas. The future research directions should include full presentation of research data, obtaining the actual incidence by RCTs, learning risk factors by an interactional model, and studying mediators to discover the mechanisms.

Key words: psychotherapy, negative outcome, potentially harmful therapies, client-focused research