心理咨询效果影响因素的研究现状与展望
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摘要
如果心理咨询缺乏效果,那么其便丧失了存在的合理性。影响心理咨询效果的因素既包括咨询过程中的内部要素,也包括咨询过程之外的外部相关要素。不同流派的心理治疗与咨询理论所强调的因素虽然各有不同,但目前综合各流派观点的折中主义已经成为主流观念。本文对各种心理学理论所提出的影响心理咨询效果的因素进行了溯源,着重探讨了影响心理咨询效果的会谈因素和会谈间因素,前者包括咨询师的言语反应、来访者行为、工作同盟,后者则包括会谈间体验、突然获益、咨询期望。并在此基础上,提出了现有研究存在的问题和未来探索的方向:深入探索影响心理咨询效果的更多因素、研究方法有待进一步完善、相关研究的测量工具依然存在缺陷。
Psychological counseling would lose its reasonability of existence if it has no good treatment outcome.Both internal and external factors of counseling sessions can affect the treatment outcome.Although highlighted views on this issue from psychotherapies and counseling theories proposed by different psychological schools vary wildly,the compromise views based on integrating the thoughts of various schools have become the mainstream.This paper traced the origins of influencing factors of psychological counseling suggested by a variety of psychological theories,particularly discussed the influencing factors in session including the counselor' s verbal response,client behavior and working alliance,and intersession covering intersession experience,sudden gain and consultation expectation.Moreover,this paper put forward the problems existing in current research and the direction of future exploration,intensively investigated more factors affecting the treatment outcome,and pointed out that the present research methods need to be improved further,and there are still some defects in the related measurement tools.
Psychological counseling would lose its reasonability of existence if it has no good treatment outcome.Both internal and external factors of counseling sessions can affect the treatment outcome.Although highlighted views on this issue from psychotherapies and counseling theories proposed by different psychological schools vary wildly,the compromise views based on integrating the thoughts of various schools have become the mainstream.This paper traced the origins of influencing factors of psychological counseling suggested by a variety of psychological theories,particularly discussed the influencing factors in session including the counselor' s verbal response,client behavior and working alliance,and intersession covering intersession experience,sudden gain and consultation expectation.Moreover,this paper put forward the problems existing in current research and the direction of future exploration,intensively investigated more factors affecting the treatment outcome,and pointed out that the present research methods need to be improved further,and there are still some defects in the related measurement tools.
引文
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[2]江光荣.心理咨询的理论与实务[M].2版.北京:高等教育出版社,2005:40-42.JIANG G R.The theory and practice of psychological counseling[M].2nd ed.Beijing:Higher Education Press,2005:40-42.
[3]江光荣,胡姝婧.国内心理咨询的过程-效果研究状况及问题[J].心理科学进展,2010,18(8):1277-1282.JIANG G R,HU S J.The status and problems of counseling processoutcome research in China[J].Advances in Psychological Science,2010,18(8):1277-1282.
[4]GELSO C J,CARTER J A.Components of the psychotherapy relationship:their interaction and unfolding during treatment[J].Journal of Counseling Psychology,1994,41(3):296-306.
[5]HILL C E,CORBETT M M.A perspective on the history of process and outcome research in counseling psychology[J].Journal of Counseling Psychology,1993,40(1):3-24.
[6]钱铭怡.心理咨询与心理治疗[M].北京:北京大学出版社,1994:158-174.QIAN M Y.Psychological counseling and psychotherapy[M].Beijing:Peking University Press,1994:158-174.
[7]季建林,徐俊.认知疗法的现状及趋势[J].中国心理卫生杂志,1989,3(3):129-132.JI J L,XU J.The present situation and trend of cognitive therapy[J].Chinese Mental Health Journal,1989,3(3):129-132.
[8]DEBORAH R L.认知行为疗法[M].李毅飞,译.北京:中国轻工业出版社,2012:9-16.DEBORAH R L.Making cognitive-behavioral therapy work:clinical process for new practitioners[M].LI Y F,Translation.Beijing:China Light Industry Press,2012:9-16.
[9]叶浩生.西方心理学的历史和体系[M].北京:人民教育出版社,1998:576.YE H S.The history of western psychology and the system[M].Beijing:People's Education Press,1998:576.
[10]IRVIN D Y.给心理咨询师的礼物[M].张怡玲,译.北京:中国轻工业出版社,2013:60.IRVIN D Y.The gift of therapy[M].ZHANG Y L,Translation.Beijing:China Light Industry Press,2013:60.
[11]FRANK J D.Therapeutic components of psychotherapy.A 25-year progress report of research[J].J Nerv Ment Dis,1974,159(5):325-342.
[12]STILES W B.Verbal response modes and psychotherapeutic technique[J].Psychiatry,1979,42(1):49-62.
[13]HILL C E,CHARLES C,REED K G.A longitudinal analysis of changes in counseling skills during doctoral training in counseling psychology[J].Journal of Counseling Psychology,1981,28(5):428-436.
[14]ELLIOTT R,HILL C E,STILES W B,et al.Primary therapist response modes:comparison of six rating systems[J].Journal of Consulting and Clinical Psychology,1987,55(2):218-223.
[15]霍丹青.中文心理咨询中咨询者言语反应模型的研究[D].上海:华东师范大学,2013.HUO D Q.Counselor's verbal response models in Chinese counseling process[D].Shanghai:East China Normal University,2013.
[16]贾晓明,师思,周玥.首次咨询中心理咨询师的言语反应类型[J].心理科学,2012,35(5):1261-1266.JIA X M,SHI S,ZHOU Y.Categories of counselors'verbal responses during the first counseling session[J].Journal of Psychological Science,2012,35(5):1261-1266.DOI:10.16719/j.cnki.1671-6981.2012.05.039.
[17]胡姝婧.心理咨询会谈中的当事人行为与咨询效果的关系[D].上海:华中师范大学,2008.HU S J.The relationship between client behavior in sessions and counseling outcome[D].Shanghai:Central China Normal University,2008.
[18]ELLIOTT R,BARKER C B,CASKEY N,et al.Differential helpfulness of counselor verbal response modes[J].Journal of Counseling Psychology,1982,29(4):354.
[19]HILL C E,HELMS J E,TICHENOR V,et al.Effects of therapist response modes in brief psychotherapy[J].Journal of Counseling Psychology,1988,35(3):222.
[20]HILL C E,KNOX S.Self-disclosure[J].Psychotherapy:Theory,Research,Practice,Training,2001,38(4):413.
[21]SHECHTMAN Z.Client behavior and therapist helping skills in individual and group treatment of aggressive boys[J].Journal of Counseling Psychology,2004,51(4):463-472.
[22]HILL C E.An overview of four measures developed to test the hill process model:therapist intentions,therapist response modes,client reactions,and client behaviors[J].Journal of Counseling and Development,1992,70(6):728-739.
[23]HENDRICKS M N.Focusing-oriented/experiential psychotherapy[M]//CAIN D J.Humanistic psychotherapies:handbook of research and practice.Washington,DC:American Psychological Association,2002:221-251.
[24]HILL C E,CORBETT M M,KANITZ B,et al.Client behavior in counseling and therapy sessions:development of a pantheoretical measure[J].Journal of Counseling Psychology,1992,39(4):539-549.
[25]GREENSON R R.The working alliance and the transference neurosis[J].Psychoanalytic Quarterly,2008,77(1):77-102.
[26]BORDIN E S.The generalizability of the psychoanalytic concept of the working alliance[J].Psychotherapy:Theory,Research&Practice,1979,16(3):252.
[27]朱旭,江光荣.工作同盟的概念[J].中国临床心理学杂志,2011,19(2):275-280.ZHU X,JIANG G R.Conceptualization of working alliance[J].Chinese Journal of Clinical Psychology,2011,19(2):275-280.
[28]HORVATH A O,GREENBERG L S.Development and validation of the working alliance inventory[J].Journal of Counseling Psychology,1989,36(2):223-233.
[29]孙启武,江光荣,冯玉.工作同盟:概念、测量及实证研究[J].中国临床心理学杂志,2009,17(3):383-386.SUN Q W,JIANG G R,FENG Y.Working alliance:conceptualization,measurement and review on empirical researches[J].Chinese Journal of Clinical Psychology,2009,17(3):383-386.
[30]牛宏伟,江光荣,郝嘉佳.心理咨询中当事人工作同盟的发展及与依恋的关系[J].中国心理卫生杂志,2013,27(7):513-517.NIU H W,JIANG G R,HAO J J.Development pattern of working alliance and impact of client attachment in psychological counseling[J].Chinese Mental Health Journal,2013,27(7):513-517.
[31]朱旭,江光荣.当事人眼里的工作同盟:质的分析[J].心理学报,2011,43(4):420-431.ZHU X,JIANG G R.The working alliance in clients'eyes:a qualitative analysis[J].Acta Psychologica Sinica,2011,43(4):420-431.
[32]HORVATH A O,SYMONDS B D.Relation between working alliance and outcome in psychotherapy:a meta-analysis[J].Journal of Counseling Psychology,1991,38(2):139-149.
[33]孙启武.工作同盟研究述评[C]//中国心理卫生协会大学生心理咨询专业委员会.高校心理健康教育新进展---全国第十届高校心理健康教育与心理咨询学术交流会论文集,2007:4.SUN Q W.Working alliance research review[C]//The Committee of Psychological Consultation for College Students in Chinese Association for Mental Health.New progress in college mental health education---the paper collection of 10th national symposion on college mental health education and mental consultation,2007:4.
[34]MARTIN D J,GARSKE J P,DAVIS M K.Relation of the therapeutic alliance with outcome and other variables:a metaanalytic review[J].Journal of Consulting&Clinical Psychology,2000,68(3):438-450.
[35]ORLINSKY D E,GELLER J D.Patients'representations of their therapists and therapy:new measures[M]//MILLER N E,LUBORSHY L,BARBER J P,et al.Psychodynamic treatment research:a handbook for clinical practice.New York:Basic Books,1993:423-466.
[36]WZONTEK N,GELLER J D,FARBER B A.Patients'posttermination representations of their psychotherapists[J].Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry,1995,23(3):395-410.
[37]于丽霞,郑晓边,夏勉,等.短程心理咨询的会谈间体验对咨询效果的影响---来自纵向测量的证据[J].心理科学,2013,36(5):1216-1222.YU L X,ZHENG X B,XIA M,et al.Intersession experiences and treatment outcome in short-term psychotherapy:evidence from longitudinal data[J].Journal of Psychological Science,2013,36(5):1216-1222.DOI:10.16719/j.cnki.1671-6981.2013.05.034.
[38]HARTMANN A,ORLINSKY D,WEBER S,et al.Session and intersession experience related to treatment outcome in bulimia nervosa[J].Psychotherapy:Theory,Research,Practice,Training,2010,47(3):355-370.
[39]TANG T Z,DERUBEIS R J.Sudden gains and critical sessions in cognitive-behavioral therapy for depression[J].Journal of Consulting&Clinical Psychology,1999,67(6):894-904.
[40]BUSCH A M,KANTER J W,LANDES S J,et al.Sudden gains and outcome:a broader temporal analysis of cognitive therapy for depression[J].Behavior Therapy,2006,37(1):61-68.
[41]KELLY M A R,CYRANOWSKI J M,FRANK E.Sudden gains in interpersonal psychotherapy for depression[J].Behaviour Research&Therapy,2007,45(11):2563-2572.
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