Robin Anno Wester, Tobias Koch, Fabian Münch, Charles Driver, Wolfgang Lutz, Julian Rubel
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The alliance and symptom burden were assessed each session with the Bernese Session Report and the Hopkins Symptom Checklist-Short-Form, respectively. Different DTM and CTM were estimated using the R-package ctsem and compared in their fit via the Akaike information criterion.</p><p><strong>Results: </strong>CTMs with session as the time unit fitted the data best. Significant negative within-person effects of alliance and symptom burden were found. These effects showed a significant positive correlation, implying that individuals with a stronger effect of the alliance on symptom severity also showed a stronger effect of symptom severity on the alliance.</p><p><strong>Conclusions: </strong>When modeling the relationship of symptom severity and alliance, it seems to be of more importance to capture the fact that a session occurred than to capture the exact time intervals between sessions. Future studies should examine this finding for other psychotherapeutic factors. 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引用次数: 0
摘要
目的：治疗联合度是治疗过程中症状负担最稳定的预测指标之一。到目前为止，这种影响只是在会议的基础上进行了研究。连续时间模型（CTM）允许将这种关系建模为考虑测量之间实际时间间隔的连续过程。本研究的目的是比较不同时间变量（会话与实际时间间隔）下联盟-症状关系的离散时间模型（DTM）与CTM的拟合。方法：对某高校心理治疗门诊1413例患者资料进行分析。每次治疗时分别用伯尔尼会议报告和霍普金斯症状检查表对联盟和症状负担进行评估。使用R-package ctsem估计不同的DTM和CTM，并通过Akaike信息准则比较其拟合性。结果：以会话为时间单位的CTMs拟合效果最好。联盟和症状负担的负性人内效应显著。这些效应呈显著正相关，说明联盟对症状严重程度影响越强的个体，其症状严重程度对联盟的影响也越强。结论：当对症状严重程度和联合的关系进行建模时，捕捉一个会话发生的事实似乎比捕捉会话之间的确切时间间隔更重要。未来的研究应该在其他心理治疗因素中检验这一发现。人际因素可能解释互惠联盟-症状效应的正相关。（PsycInfo Database Record (c) 2025 APA，版权所有）。
In search of lost time: Discrete- versus continuous-time models of working alliance and symptom severity.
Objective: The therapeutic alliance is one of the most stable predictors of symptom burden over the course of therapy. So far, this effect has only been examined on the basis of sessions. Continuous-time models (CTM) allow this relationship to be modeled as a continuous process in which the actual time interval between measurements is considered. The aim of the present study was to compare the fit of discrete-time models (DTM) of the alliance-symptom relationship with CTM using different time variables (sessions vs. actual time interval).
Method: Data from 1,413 patients at a university psychotherapy outpatient clinic were analyzed. The alliance and symptom burden were assessed each session with the Bernese Session Report and the Hopkins Symptom Checklist-Short-Form, respectively. Different DTM and CTM were estimated using the R-package ctsem and compared in their fit via the Akaike information criterion.
Results: CTMs with session as the time unit fitted the data best. Significant negative within-person effects of alliance and symptom burden were found. These effects showed a significant positive correlation, implying that individuals with a stronger effect of the alliance on symptom severity also showed a stronger effect of symptom severity on the alliance.
Conclusions: When modeling the relationship of symptom severity and alliance, it seems to be of more importance to capture the fact that a session occurred than to capture the exact time intervals between sessions. Future studies should examine this finding for other psychotherapeutic factors. Interpersonal factors might explain the positive association of the reciprocal alliance-symptom effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
期刊介绍：
The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.
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