Ulrike Maaß, Michael Witthöft, Yvonne Marie Junga, Daniela Hahn, Florian Weck
{"title":"认知行为治疗中患者人际行为、治疗师能力和治疗联盟的关系：一个交叉滞后的面板分析。","authors":"Ulrike Maaß, Michael Witthöft, Yvonne Marie Junga, Daniela Hahn, Florian Weck","doi":"10.1002/jclp.70040","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate the reciprocal relationships between patient interpersonal behavior (IB), therapist competence, and the alliance within- and between-persons.</p><p><strong>Methods: </strong>A secondary analysis was conducted of a randomized controlled trial with 67 cognitive behavior therapists and 114 patients with depression. The therapists evaluated their patients' IB, and they both judged the alliance. Pre- and post-treatment, the patients indicated their general levels of interpersonal problems. Every fourth session, independent raters judged the patients' IB and therapists' competence. Random-intercept cross-lagged panel analyses were calculated.</p><p><strong>Results: </strong>First, intraindividual deviations in patient IB were associated with deviations in therapist competence or the alliance (within-person); and patients with generally more positive IB experienced not only better alliances but also more competent therapists (between-person). Second, the perspective of the evaluating person and the time interval were decisive, as significant cross-lagged effects between patients' IB in one session and the alliance in subsequent sessions (and vice versa) only occurred from the therapist perspective, but not when the patient perspective was considered. Third, patients with more interpersonal problems before treatment did not show more negative IB, nor did they experience poorer alliances or less competent therapists.</p><p><strong>Conclusion: </strong>The study supports the idea that patient IB is as an important part of both therapeutic competence and the alliance. However, therapists and raters may be prone to evaluation bias, interpreting negative patient IB as a sign of poor alliance or competence (and vice versa). Finally, the extent of interpersonal problems before treatment does not substantially influence the three process variables.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/study/NCT02479594.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Relationships Among Patients' Interpersonal Behaviors in Sessions, Therapist Competence, and the Therapeutic Alliance in Cognitive Behavior Therapy: A Cross-Lagged Panel Analysis.\",\"authors\":\"Ulrike Maaß, Michael Witthöft, Yvonne Marie Junga, Daniela Hahn, Florian Weck\",\"doi\":\"10.1002/jclp.70040\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate the reciprocal relationships between patient interpersonal behavior (IB), therapist competence, and the alliance within- and between-persons.</p><p><strong>Methods: </strong>A secondary analysis was conducted of a randomized controlled trial with 67 cognitive behavior therapists and 114 patients with depression. The therapists evaluated their patients' IB, and they both judged the alliance. Pre- and post-treatment, the patients indicated their general levels of interpersonal problems. Every fourth session, independent raters judged the patients' IB and therapists' competence. Random-intercept cross-lagged panel analyses were calculated.</p><p><strong>Results: </strong>First, intraindividual deviations in patient IB were associated with deviations in therapist competence or the alliance (within-person); and patients with generally more positive IB experienced not only better alliances but also more competent therapists (between-person). Second, the perspective of the evaluating person and the time interval were decisive, as significant cross-lagged effects between patients' IB in one session and the alliance in subsequent sessions (and vice versa) only occurred from the therapist perspective, but not when the patient perspective was considered. Third, patients with more interpersonal problems before treatment did not show more negative IB, nor did they experience poorer alliances or less competent therapists.</p><p><strong>Conclusion: </strong>The study supports the idea that patient IB is as an important part of both therapeutic competence and the alliance. However, therapists and raters may be prone to evaluation bias, interpreting negative patient IB as a sign of poor alliance or competence (and vice versa). Finally, the extent of interpersonal problems before treatment does not substantially influence the three process variables.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/study/NCT02479594.</p>\",\"PeriodicalId\":15395,\"journal\":{\"name\":\"Journal of Clinical Psychology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-08-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Psychology\",\"FirstCategoryId\":\"102\",\"ListUrlMain\":\"https://doi.org/10.1002/jclp.70040\",\"RegionNum\":3,\"RegionCategory\":\"心理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Psychology","FirstCategoryId":"102","ListUrlMain":"https://doi.org/10.1002/jclp.70040","RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
Relationships Among Patients' Interpersonal Behaviors in Sessions, Therapist Competence, and the Therapeutic Alliance in Cognitive Behavior Therapy: A Cross-Lagged Panel Analysis.
Objective: To investigate the reciprocal relationships between patient interpersonal behavior (IB), therapist competence, and the alliance within- and between-persons.
Methods: A secondary analysis was conducted of a randomized controlled trial with 67 cognitive behavior therapists and 114 patients with depression. The therapists evaluated their patients' IB, and they both judged the alliance. Pre- and post-treatment, the patients indicated their general levels of interpersonal problems. Every fourth session, independent raters judged the patients' IB and therapists' competence. Random-intercept cross-lagged panel analyses were calculated.
Results: First, intraindividual deviations in patient IB were associated with deviations in therapist competence or the alliance (within-person); and patients with generally more positive IB experienced not only better alliances but also more competent therapists (between-person). Second, the perspective of the evaluating person and the time interval were decisive, as significant cross-lagged effects between patients' IB in one session and the alliance in subsequent sessions (and vice versa) only occurred from the therapist perspective, but not when the patient perspective was considered. Third, patients with more interpersonal problems before treatment did not show more negative IB, nor did they experience poorer alliances or less competent therapists.
Conclusion: The study supports the idea that patient IB is as an important part of both therapeutic competence and the alliance. However, therapists and raters may be prone to evaluation bias, interpreting negative patient IB as a sign of poor alliance or competence (and vice versa). Finally, the extent of interpersonal problems before treatment does not substantially influence the three process variables.
期刊介绍：
Founded in 1945, the Journal of Clinical Psychology is a peer-reviewed forum devoted to research, assessment, and practice. Published eight times a year, the Journal includes research studies; articles on contemporary professional issues, single case research; brief reports (including dissertations in brief); notes from the field; and news and notes. In addition to papers on psychopathology, psychodiagnostics, and the psychotherapeutic process, the journal welcomes articles focusing on psychotherapy effectiveness research, psychological assessment and treatment matching, clinical outcomes, clinical health psychology, and behavioral medicine.
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