Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good-outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time-backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university-based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time-backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R²_adj = .29). Specifically, good-outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor-outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β₁₁ = .64, p = .014). Additionally, poor-outcome dropouts presented higher levels of ambivalence (β₀₁ = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed.

中文翻译：

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过早终止对情绪障碍进行跨诊断治疗的统一方案：矛盾心理对变革的作用

对变化的矛盾心理是心理变化中预期的、反复出现的过程。然而，心理治疗中长期的矛盾心理会导致来访者脱离接触，这可能导致治疗中途退出。考虑到过早终止治疗的负面影响以及在获得良好结果之前识别有退出风险的客户的便利性，本研究使用多级时间倒推模型探讨了矛盾心理对过早终止治疗的预测能力（即，将 dropout 的会话视为会话零，然后对从 dropout 到会话 1 发生的情况进行建模）。参与者包括总共 96 名心理治疗客户（38 名辍学者），他们按照《情绪障碍跨诊断治疗统一协议》在大学诊所接受治疗。使用时间倒推模型分析辍学数据的多级建模提供了证据，证明在整个治疗过程中矛盾情绪演变对提前停止治疗的决定具有预测能力。p  < .0001；R ²调整 = .29) _。具体来说，结果良好的辍学者在整个治疗过程中表现出矛盾心理下降的趋势，而结果不佳的辍学者在决定退出之前往往会经历相同程度的矛盾心理（时间 × 辍学；β ₁₁  = .64，p  = .014）。此外，结果不佳的辍学者在最后一次会议上表现出更高水平的矛盾心理 ( β ₀₁  = 9.92, p  < .0001)。结果表明，客户对改变的矛盾心理模式是提前终止治疗的预测因素。讨论了对临床和研究背景的影响。