个体心理治疗的客户认定结果：定性荟萃分析

IF 30.8 1区医学 Q1 PSYCHIATRY

Lancet Psychiatry Pub Date : 2024-11-26 DOI:10.1016/s2215-0366(24)00356-0

Michaela Ladmanová, Tomáš Řiháček, Ladislav Timulak, Klára Jonášová, Barbora Kubantová, Petr Mikoška, Lucia Polakovská, Robert Elliott

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引用次数: 0

摘要

背景心理治疗的结果通常以症状缓解程度来衡量。然而，这种方法在要求客户报告其重要变化时，可能会忽略客户的观点。以客户为中心的方法可能会让我们更深入地了解心理治疗的结果。我们的目的是评估定性心理治疗研究中由客户确定的结果。方法在 PsycArticles、PsycInfo 和 MEDLINE Complete 数据库中检索了截至 2023 年 11 月 11 日发表的英语研究。此外，还通过主要研究的参考文献和以往的荟萃分析或系统综述确定了其他研究。检索词涉及心理治疗和咨询、客户或患者的经历、心理治疗的结果和变化、治疗后的观点以及定性方法的类型。其中包括有关客户认定的个人心理治疗结果的定性研究。与客户对心理治疗结果的看法有关的研究结果由 ML 提取（TR 和 LT 检查），并采用描述性-解释性元分析方法进行分析（所有作者）。所有作者都曾作为客户亲身经历过心理治疗。本研究已在 PROSPERO 预先注册（CRD42021277330）。研究结果我们在定性荟萃分析中纳入了来自 24 个国家的 177 项研究，包括 2908 名客户的描述。大多数研究的质量都很好；它们涵盖了各种治疗方法和诊断。心理治疗结果的描述被分为 60 个元类别，并分成十个组群。这些类别涉及求助者的关系和社会功能；他们的情绪功能；自我意识、自我理解和更具适应性的认知处理；行为功能；开发他们自己的资源；求助者对自己的态度；普遍拥抱生活；症状和问题的改变；以及更普遍的福祉。第十组是无法明确归因于心理治疗的结果，被认为超出了本研究的范围。"荟萃分析 "结果表明，客户重视的是症状减轻以外的结果，如更深刻的自我理解、更强的自我代理能力和更大的社会参与度。通过对各种诊断和治疗方法的心理治疗结果进行研究，我们强调了传统结果测量方法的局限性，表明需要更全面的、以客户为中心的评估工具，以及将定性方法纳入了解变化维度的价值。

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Client-identified outcomes of individual psychotherapy: a qualitative meta-analysis

Background

Psychotherapy outcomes are typically measured in terms of symptom relief. However, this method might overlook important changes from clients' perspectives when they are asked to report on them. A more client-centred approach might bring a deeper understanding of psychotherapy outcomes. We aimed to evaluate the outcomes identified by clients within qualitative psychotherapy research.

Methods

The PsycArticles, PsycInfo, and MEDLINE Complete databases were searched for English language studies published until Nov 11, 2023. Additional studies were identified through references in the primary studies and previous meta-analyses or systematic reviews. Search terms were related to psychotherapy and counselling, clients' or patients' experiences, psychotherapy outcomes and changes, post-treatment perspectives, and types of qualitative methods. Qualitative studies on client-identified outcomes of individual psychotherapy were included. Findings related to clients' perceptions of psychotherapy outcomes were extracted (by ML and checked by TR and LT) and analysed (by all authors) using the descriptive–interpretative meta-analytic approach. All authors have personally experienced psychotherapy as clients. This study was pre-registered with PROSPERO (CRD42021277330).

Findings

We included 177 studies in the qualitative meta-analysis, from 24 countries, including descriptions from 2908 clients. Most of the studies were of good quality; they covered a wide range of therapeutic approaches and diagnoses. The descriptions of psychotherapy outcomes were classified into 60 meta-categories and grouped into ten clusters. These clusters related to clients' relational and social functioning; their emotional functioning; self-awareness, self-understanding, and more adaptive cognitive processing; behavioural functioning; developing their own resources; clients' attitudes towards themselves; generally embracing life; symptom and problem change; and more general wellbeing. The tenth cluster was outcomes that could not be clearly attributed to psychotherapy, which was considered outside the scope of this study.

Interpretation

The meta-analysis showed that clients value outcome dimensions beyond symptom reduction, such as deeper self-understanding, enhanced self-agency, and greater social engagement. By examining psychotherapy outcomes across various diagnoses and therapeutic approaches, we highlight limitations in traditional outcome measures, showing the need for more comprehensive, client-centred assessment tools and the value of incorporating qualitative methods into understanding dimensions of change.

Funding

European Union.

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来源期刊

Lancet Psychiatry PSYCHIATRY-

CiteScore

58.30

自引率

0.90%

发文量

期刊介绍： The Lancet Psychiatry is a globally renowned and trusted resource for groundbreaking research in the field of psychiatry. We specialize in publishing original studies that contribute to transforming and shedding light on important aspects of psychiatric practice. Our comprehensive coverage extends to diverse topics including psychopharmacology, psychotherapy, and psychosocial approaches that address psychiatric disorders throughout the lifespan. We aim to channel innovative treatments and examine the biological research that forms the foundation of such advancements. Our journal also explores novel service delivery methods and promotes fresh perspectives on mental illness, emphasizing the significant contributions of social psychiatry.