阅读进度反馈信息对工作同盟和咨询效果的影响

doi:10.3724/SP.J.1041.2021.00349

摘要/Abstract

摘要：

进度反馈指将对当事人的标准化测量结果和解释反馈给咨询师的干预, 其目的在于矫正咨询师对咨询效果主观评估的偏差, 提高咨询效果。考虑到咨询师和当事人“面对面”的标准反馈程序不符合我国社会文化习惯, 采用多层结构方程模型, 分析了自然情境下非“面对面”的进度反馈对工作同盟和咨询效果的影响。结果发现, 在组间水平, 反馈组的工作同盟质量更好; 在组内水平, 工作同盟与症状是相互预测的关系。在结案时, 反馈组在抑郁症状和咨询的有帮助性上效果更好。结论是进度反馈对工作同盟和咨询效果有积极影响。研究从工作同盟和中国人的关系角度拓展了对进度反馈作用机制的认识, 为进度反馈的应用提供了基于实践干预有效的证据。

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 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, the theory which explains the effect of progress feedback is very much limited. Before implementing 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 in a university counseling center. Research assistants collected patients’ ratings on working alliance and treatment outcomes and emailed the results with interpretations to the therapists, who were then encouraged to use feedback information to improve treatment outcomes.
The participants included 48 therapists and 445 patients (of which 350 were used for analysis). Post survey indicated that 80% therapists read progress feedback information based on which they were divided into feedback and non-feedback group. 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 three possible mechanisms of progress feedback. Progress feedback may correct the bias of the therapist’s self-evaluation on treatment process, as well as 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, working alliance, treatment outcomes, multi-level SEM

中图分类号:

R395

孙启武, 吴才智, 于丽霞, 王巍欣, 沈国成. (2021). 阅读进度反馈信息对工作同盟和咨询效果的影响. 心理学报, 53(4), 349-361.

SUN Qiwu, WU Caizhi, YU Lixia, WANG Weixin, SHEN Guocheng. (2021). Progress feedback and its effects on working alliance and treatment outcomes. Acta Psychologica Sinica, 53(4), 349-361.

图/表 4

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会谈次数	阅读进度反馈信息组					对照组
	CORE-OM			WAQ		CORE-OM			WAQ
	N	M	SD	M	SD	N	M	SD	M	SD
1	263	16.33	6.28	46.16	7.56	87	17.06	5.81	45.09	8.18
2	218	15.06	6.45	47.59	7.07	76	16.01	6.11	45.68	8.69
3	176	14.53	6.61	49.18	6.99	56	16.29	5.59	45.54	9.53
4	138	14.49	6.64	49.80	6.23	44	17.18	5.98	46.61	8.61
5	113	14.85	7.12	51.15	6.13	40	16.14	5.94	47.88	8.00
6	75	14.71	6.81	51.04	6.06	29	14.78	6.46	50.24	7.70
7	30	17.93	6.49	50.9	6.75	13	17.00	6.99	48.62	10.07
8	23	16.27	8.36	51.69	6.28	12	15.00	6.39	50.00	8.80
9	19	15.74	8.68	52.88	6.03	9	16.33	4.69	48.00	7.31
10	14	14.71	8.55	51.33	6.65	8	16.13	3.09	48.75	8.01
11	7	13.14	9.74	51.43	5.19	8	14.38	4.75	50.86	6.09
12	6	13.20	13.01	52.33	5.65	7	16.00	4.58	51.71	6.47
13	3	29		49.33	4.16	6	15.83	5.34	51.50	5.96
14	1	24		49		6	16.00	6.57	49.83	7.39
15	1	24		51		5	17.00	9.97	48.40	5.59
16	1	31		56		2	22.5	0.71	41.00
17	1	36		53		1	16.00		37.00

会谈次数	阅读进度反馈信息组					对照组
	CORE-OM			WAQ		CORE-OM			WAQ
	N	M	SD	M	SD	N	M	SD	M	SD
1	263	16.33	6.28	46.16	7.56	87	17.06	5.81	45.09	8.18
2	218	15.06	6.45	47.59	7.07	76	16.01	6.11	45.68	8.69
3	176	14.53	6.61	49.18	6.99	56	16.29	5.59	45.54	9.53
4	138	14.49	6.64	49.80	6.23	44	17.18	5.98	46.61	8.61
5	113	14.85	7.12	51.15	6.13	40	16.14	5.94	47.88	8.00
6	75	14.71	6.81	51.04	6.06	29	14.78	6.46	50.24	7.70
7	30	17.93	6.49	50.9	6.75	13	17.00	6.99	48.62	10.07
8	23	16.27	8.36	51.69	6.28	12	15.00	6.39	50.00	8.80
9	19	15.74	8.68	52.88	6.03	9	16.33	4.69	48.00	7.31
10	14	14.71	8.55	51.33	6.65	8	16.13	3.09	48.75	8.01
11	7	13.14	9.74	51.43	5.19	8	14.38	4.75	50.86	6.09
12	6	13.20	13.01	52.33	5.65	7	16.00	4.58	51.71	6.47
13	3	29		49.33	4.16	6	15.83	5.34	51.50	5.96
14	1	24		49		6	16.00	6.57	49.83	7.39
15	1	24		51		5	17.00	9.97	48.40	5.59
16	1	31		56		2	22.5	0.71	41.00
17	1	36		53		1	16.00		37.00

路径和效用	标准化解	后验SD	单尾p	95%置信区间
阅读进度反馈信息影响模型
		组内水平
症状的自回归效用（core_t-1->core_t）	0.37*	0.04	<0.001	0.36, 0.53
工作同盟的自回归效用（wai_t-1->wai_t）	0.61*	0.04	<0.001	0.49, 0.66
工作同盟预测症状（wai_t-1-> core_t）	-0.14*	0.03	<0.001	-0.19, -0.07
症状预测工作同盟(core_t-1-> wai_t-1）	-0.08*	0.03	0.002	-0.15, -0.03
		组间水平
工作同盟预测症状(wai-> core）	-0.09	0.28	0.357	-0.52, 0.54
反馈预测症状（feedback-> core）	-0.12	0.16	0.221	-0.52, 0.14
反馈预测工作同盟（feedback-> wai）	0.38*	0.16	0.008	0.07, 0.72
缺失值检验模型
		组内水平
症状的自回归效用（core_t-1->core_t）	0.53*	0.06	<0.001	0.42, 0.66
工作同盟的自回归效用（wai_t-1->wai_t）	0.63*	0.04	<0.001	0.55, 0.70
工作同盟预测症状（wai_t-1-> core_t）	-0.12*	0.03	<0.001	-0.17, -0.06
症状预测工作同盟(core_t-1-> wai_t-1）	-0.08*	0.02	<0.001	-0.13, -0.04
		组间水平
工作同盟预测症状(wai-> core）	-0.09	0.22	0.303	-0.49, 0.38
反馈预测症状（feedback-> core）	-0.07	0.14	0.223	-0.44, 0.15
反馈预测工作同盟（feedback-> wai）	0.39*	0.16	0.003	0.12, 0.77

路径和效用	标准化解	后验SD	单尾p	95%置信区间
阅读进度反馈信息影响模型
		组内水平
症状的自回归效用（core_t-1->core_t）	0.37*	0.04	<0.001	0.36, 0.53
工作同盟的自回归效用（wai_t-1->wai_t）	0.61*	0.04	<0.001	0.49, 0.66
工作同盟预测症状（wai_t-1-> core_t）	-0.14*	0.03	<0.001	-0.19, -0.07
症状预测工作同盟(core_t-1-> wai_t-1）	-0.08*	0.03	0.002	-0.15, -0.03
		组间水平
工作同盟预测症状(wai-> core）	-0.09	0.28	0.357	-0.52, 0.54
反馈预测症状（feedback-> core）	-0.12	0.16	0.221	-0.52, 0.14
反馈预测工作同盟（feedback-> wai）	0.38*	0.16	0.008	0.07, 0.72
缺失值检验模型
		组内水平
症状的自回归效用（core_t-1->core_t）	0.53*	0.06	<0.001	0.42, 0.66
工作同盟的自回归效用（wai_t-1->wai_t）	0.63*	0.04	<0.001	0.55, 0.70
工作同盟预测症状（wai_t-1-> core_t）	-0.12*	0.03	<0.001	-0.17, -0.06
症状预测工作同盟(core_t-1-> wai_t-1）	-0.08*	0.02	<0.001	-0.13, -0.04
		组间水平
工作同盟预测症状(wai-> core）	-0.09	0.22	0.303	-0.49, 0.38
反馈预测症状（feedback-> core）	-0.07	0.14	0.223	-0.44, 0.15
反馈预测工作同盟（feedback-> wai）	0.39*	0.16	0.003	0.12, 0.77