视频咨询不会削弱咨询效果：来自与线下面询比较的证据

doi:10.3724/SP.J.1041.2023.01845

摘要/Abstract

摘要：

在新冠疫情背景下, 许多心理咨询从线下面询转向了视频咨询, 由此引发的问题是：与线下面询相比, 视频咨询是否会削弱咨询效果?在高校咨询中心的自然情境下, 使用随机截距交叉滞后模型, 比较了视频咨询和线下面询条件下, 工作同盟与咨询效果的相互影响及其差异。结果发现, 在组内水平, 两种条件下工作同盟与咨询效果的相互预测关系无显著性差异。前六次会谈中, 仅第一次和第四次会谈结束后, 视频咨询组工作同盟水平显著低于线下面询组; 其余会谈结束后, 两组工作同盟水平无显著性差异。结案时, 两组在咨询效果上无显著性差异。结论是视频咨询和线下面询类似, 能建立相对稳固的工作同盟, 从而降低症状水平。这为后疫情时代应用视频咨询的有效性提供了新的证据。

关键词: 视频咨询, 线下面询, 工作同盟, 咨询效果, 随机截距交叉滞后模型

Abstract:

The COVID-19 pandemic has led to a shift from in-person face-to-face counseling (F2F) to online videoconferencing counseling (VCP), which poses the question: how does VCP affect treatment outcomes compared to F2F? Existing research has demonstrated the equivalence of VCP and F2F in terms of effectiveness. However, the working alliance, a key common factor in F2F, has been found to be lower in quality in VCP than in F2F in a recent meta-analysis. Moreover, only one study has examined the reciprocal relationship between working alliance and treatment outcomes in VCP at the within-patient level. The present study aims to (a) compare the treatment outcomes between VCP and F2F using longitudinal data from a naturalistic setting; and (b) explore the mutual influence of working alliance and treatment outcomes in VCP and F2F at the within-patient level.
This study was conducted in a counseling center of a university in central China, and participants were arranged to receive VCP or F2F. The final sample consisted of 525 college students, of whom 117 received VCP and 408 received F2F. The only difference between the two conditions was the mode of delivery (VCP vs. F2F). Participants completed the CORE-OM-10 before each session and the Session Alliance Inventory (SAI) after each session. They also completed the PHQ-9, GAD-7, and CORE-OM-34 at pre- and post-treatment. The data from sessions 1 to 6 were analyzed using the Random Intercept Cross-Lagged Panel Model (RI-CLPM). A multi-group RI-CLPM comparison was conducted to examine the alliance-outcome relationship in VCP and F2F at the within-patient level.
The within-patient analysis revealed that SAI was a significant predictor of CORE-OM in the subsequent session, and CORE-OM was a significant predictor of SAI in the same session. The multi-group comparison indicated that the predictive effect of SAI on CORE-OM did not differ significantly between VCP and F2F. However, the working alliance quality in VCP was significantly lower than that in F2F after the first and the fourth sessions, but not after the other sessions. The post-treatment analysis, using Propensity Score Matching with pretest CORE-OM34, PHQ-9 and GAD-7 as predictor variables, showed no significant difference in PHQ-9, GAD-7, and CORE-OM34 between VCP (N = 89) and F2F (N = 336).
These findings indicate that VCP is as effective as F2F in reducing psychological distress, and that clients can establish a stable working alliance in VCP over time, even if they initially experience difficulties in adapting to the online mode. Moreover, the reciprocal influence of working alliance and treatment outcomes in VCP is similar to that in F2F. This study offers empirical support for the use of VCP, especially in the context of the COVID-19 pandemic.

Key words: online videoconferencing counseling (VCP), in-person face-to-face counseling (F2F), working alliance, treatment outcomes, Random Intercept Cross-Lagged Panel Model (RI-CLPM)

中图分类号:

R395

孙启武, 王之焕, 任志洪, 于丽霞, 吴才智. (2023). 视频咨询不会削弱咨询效果：来自与线下面询比较的证据. 心理学报, 55(11), 1845-1858.

SUN Qiwu, WANG Zhihuan, REN Zhihong, YU Lixia, WU Caizhi. (2023). Videoconferencing counseling online will not weaken treatment outcomes: Evidence from comparison with face-to-face counseling in-person. Acta Psychologica Sinica, 55(11), 1845-1858.

图/表 5

图1 研究参与者入组和分析数据流程图

图2 工作同盟与症状的随机截距交叉滞后模型注：矩形框表示观测变量, 以SA、OM分别表示工作同盟、症状; 椭圆表示去中心化的变量, 以c_wai、c_core分别表示工作同盟、症状; intercept_SA表示工作同盟的随机截距项; intercept_OM表示症状的随机截距项; ε表示残差项。

图4 基于工作同盟与症状随机截距交叉滞后模型的Diggle-Kenward选择模型注：矩形框表示观测变量, 以SA、OM分别表示工作同盟、症状; 椭圆表示去中心化的变量, 以c_wai、c_core分别表示工作同盟、症状; intercept_SA表示工作同盟的随机截距项; intercept_OM表示症状的随机截距项; ε表示残差项; Missing_4-Missing_6是缺失数据编码而成的虚拟变量(陈楠, 刘红云, 2015)。图中包含了从c_SA3-c_SA6到Missing_4-Missing_6的路径, 但没有显示出来, 以避免造成混乱。

表1 视频咨询组与线下面询组的描述性统计

会谈次数	线下面询组					视频咨询组
	N	CORE-OM		SAI		N	CORE-OM		SAI
	N	M	SD	M	SD	N	M	SD	M	SD
1	408	17.69	6.62	20.77	3.27	117	16.34	6.63	20.01	3.63
2	408	15.80	6.35	20.87	3.18	117	14.84	6.46	20.28	3.03
3	408	14.61	6.66	21.18	3.03	117	14.18	6.52	20.74	3.45
4	359	14.57	7.01	21.44	3.03	106	13.58	5.81	20.70	3.80
5	290	14.21	6.77	21.62	3.06	81	13.47	6.43	21.27	3.56
6	233	14.11	7.14	22.06	2.74	58	12.38	6.18	21.78	3.49
7	111	15.61	6.62	21.75	3.11	23	12.55	5.58	21.9	3.39
8	72	15.86	6.38	22.01	2.86	16	15.93	8.93	20.58	5.04
9	54	16.88	6.61	21.80	3.41	9	14.25	7.38	21.00	4.04
10	43	17.17	6.92	21.93	3.20	6	17.60	9.71	21.33	4.62
11	29	16.29	6.74	21.12	3.91	4	21.00		22.67	2.31
12	23	16.56	9.41	21.45	3.46	0
13	16	16.57	7.31	20.77	3.86	0
14	10	17.78	7.48	20.30	3.92	0
15	7	20.17	7.06	18.57	4.69	0
16	4	21.00	10.68	18.00	6.00	0
17	1	13.00		14.00		0

图3 视频咨询组与线下面询组的多组随机截距交叉滞后模型注：矩形框表示观测变量, 以SA、OM分别表示工作同盟、症状; 椭圆表示去中心化的变量, 以c_wai、c_core分别表示工作同盟、症状; intercept_SA表示工作同盟的随机截距项; intercept_OM表示症状的随机截距项; ε表示残差项。

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