关键词: 进度反馈, 工作同盟, 咨询效果, 多层结构方程模型

Abstract: Progress feedback involves collecting patients’ ratings on treatment outcome session by session and providing feedback to therapists on patient progress. Research has indicated that the positive effect of progress feedback on psychotherapy outcome is a promising advancement. However, a recent meta-analysis showed that progress feedback may only have a small to medium effect for non-severe patients. Also, there is a limited theory in explaining the effect of progress feedback. Before implementing the progress feedback in China, it is necessary to test its effect on working alliance and treatment outcomes in a natural setting. It is believed that Chinese are taught to obey their parents, respect elders, and restrain themselves to keep family harmony. Such schemas are subsequently transferred to their social life in the forms of respecting authority/superior, maintaining interpersonal harmony, which will lead to an indirect style of communication. Progress feedback from patients’ weekly reports can be used as a correction method for incongruences between therapists and patients without discussing it immediately and face-to-face, and thus can improve the quality of working alliance and treatment outcomes. The current study used a culturally-adapted version of progress feedback procedure in a university counseling center. Research assistants collected patients’ ratings on working alliance and treatment outcomes and sent the results with interpretations to therapists’ email address. Therapists were encouraged to use feedback information to improve treatment outcomes. The participants included 48 therapists and 445 patients (350 were used for analysis). Post survey indicated that 80% therapists read progress feedback information based on which feedback group was determined. CORE-OM10 was used to evaluate symptoms before each session and WAQ was used to evaluate the working alliance after each session. PHQ-9, GAD-7, and CORE-OM-34 were used before and after treatment. Multi-level structural equation models were used to analyze the data. Results showed that progress feedback had a medium effect on working alliance but no effect on treatment outcomes (measured by CORE-OM) at the between-person level. At the within-person level, the results affirmed the reciprocal model of alliance-outcome which indicated that the model is consistent and steady across cultures. In addition, the feedback group had better treatment outcomes measured by PHQ-9 and self-rated helpfulness measured after treatment. The results were discussed under the possible three mechanisms of progress feedback. Progress feedback may correct the blindness of the therapist’s self-evaluation on treatment process, can correct the incongruence and alliance ruptures between therapists and patients. The cultural-specific factors may also contribute to the effect of progress feedback (e.g., indirect communication style). The support from regular supervision for therapists under progress feedback was emphasized as well. Overall, the present study suggested the positive effect of progress feedback on the working alliance and treatment outcomes in a Chinese counseling center based on practical evidence.

Key words: Progress feedback, the working alliance, treatment outcomes, multi-level SEM