Abstract

Objective

Although therapist supportive, rather than directive, strategies have been particularly indicated during client resistance, little systematic research has examined how therapists responsively navigate resistance in different therapy approaches and how this responsiveness is related to outcome.

Method

In the context of disagreement episodes in cognitive–behavioral therapy (CBT) for generalized anxiety disorder (GAD; Westra, H. A., Constantino, M. J., & Antony, M. M. Integrating motivational interviewing with cognitive–behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting and Clinical Psychology, 84(9), 768–782. https://doi.org/10.1037/ccp0000098, 2016), the present study examined (1) the degree to which therapist management of resistance differed between therapists trained in CBT integrated with motivational interviewing (MI-CBT; i.e., training centered on the responsive management of resistance) and therapists trained in CBT-alone, and (2) the impact of specific therapist behaviors during disagreement on client worry outcomes immediately posttreatment and 1-year posttreatment. Episodes of disagreement were rated used the Structural Analysis of Social Behavior (Benjamin, L. S. Structural analysis of social behavior. Psychological Review, 81(5), 392–425. https://doi.org/10.1037/h0037024, 1974).

Results

Therapists trained in MI-CBT were found to exhibit significantly more affiliative and fewer hostile behaviors during disagreement compared to those trained in CBT-alone; both of these, in turn, were found to mediate client 1-year posttreatment outcomes, such that increased affiliation during disagreement was associated with improved outcomes.

Conclusion

This study highlights the value of training therapists in the responsive detection and management of resistance, as well as the systematic integration of MI into CBT.

中文翻译：

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严重广泛性焦虑症的认知行为治疗中的治疗师从属关系和敌意，有和没有动机访谈

摘要

客观的

尽管在来访者抵抗期间特别指出了治疗师的支持性策略，而不是指导性策略，但很少有系统的研究检查治疗师如何在不同的治疗方法中响应性地驾驭抵抗力，以及这种响应性如何与结果相关。

方法

在广泛性焦虑症 (GAD; Westra, HA, Constantino, MJ, & Antony, MM) 的认知行为疗法 (CBT) 出现分歧事件的背景下，将动机性访谈与认知行为疗法相结合以治疗严重的广泛性焦虑症：一项忠诚-随机对照临床试验.咨询与临床心理学杂志, 84(9), 768–782。https://doi.org/10.1037/ccp0000098, 2016），本研究检查了（1）接受 CBT 培训的治疗师与动机性访谈（MI-CBT）相结合的治疗师对阻力的管理差异的程度（MI-CBT；即培训集中在阻力的反应性管理）和单独接受 CBT 培训的治疗师，以及（2）治疗后和治疗后 1 年的分歧期间特定治疗师行为对客户担忧结果的影响。使用社会行为的结构分析 (Benjamin, LS Structural analysis of social behavior. Psychological Review , 81 (5), 392–425. https://doi.org/10.1037/h0037024, 1974) 对分歧事件进行评级。

结果

与单独接受 CBT 培训的治疗师相比，接受过 MI-CBT 培训的治疗师在分歧期间表现出明显更多的亲和和更少的敌对行为；反过来，这两者被发现可以调解客户 1 年的治疗后结果，因此在分歧期间增加的隶属关系与改善的结果相关。

结论

这项研究强调了培训治疗师在反应性检测和管理阻力方面的价值，以及将 MI 系统整合到 CBT 中的价值。