Abstract

Objective:

Several studies have shown that the quality of the working alliance predicts symptomatic improvement session-by-session, including in cognitive–behavioral therapy (CBT). We wanted to explore what characterizes CBT sessions with high and low alliances further using qualitative analysis.

Method:

Ten CBT-sessions were selected from eight patients’ therapies in a larger research project on psychotherapy for patients with major depression. Five sessions were chosen from high- and five from low-alliance sessions, based on therapist- and patient-reported Working Alliance Inventory scores. Transcripts of these sessions were analyzed using thematic analysis.

Results:

The analysis yielded four themes, each structured into two sub-themes: Therapist style, Person in focus, Content focus, and Therapeutic direction. In contrast to low-alliance sessions, high-alliance sessions were characterized by a more exploring as opposed to expert therapist style; a focus on the patient’s thoughts, feelings, and behavior, rather than a diffuse focus or a focus on other people’s actions/external events; and a sense of moving forward rather than stagnation.

Conclusion:

Our qualitative analysis showed theoretically and clinically meaningful processes in CBT sessions of high- vs low working alliance. This method is a useful complement to quantitative within-patient analyses, to expand on the meaning of quantitative findings.

中文翻译：

---

“我们应该关注什么？” – 对具有高或低工作联盟质量的认知行为治疗会议的特征进行主题分析

摘要

客观的：

多项研究表明，工作联盟的质量可以预测每次治疗的症状改善，包括在认知行为疗法 (CBT) 中。我们想进一步使用定性分析来探索具有高联盟和低联盟的 CBT 会话的特征。

方法：

在一项针对重度抑郁症患者的心理治疗的大型研究项目中，从八名患者的治疗中选出了十个 CBT 疗程。根据治疗师和患者报告的工作联盟清单分数，从高联盟会议中选择了五个会议，从低联盟会议中选择了五个会议。使用主题分析对这些会议的成绩单进行了分析。

结果：

分析产生了四个主题，每个主题分为两个子主题：治疗师风格、焦点人物、内容焦点和治疗方向。与低联盟会议相比，高联盟会议的特点是更具探索性，而不是专家治疗师风格；关注患者的想法、感受和行为，而不是分散关注或关注其他人的行为/外部事件；以及前进而不是停滞的感觉。

结论：

我们的定性分析显示了在高与低工作联盟的 CBT 会议中具有理论和临床意义的过程。该方法是对患者内定量分析的有用补充，可扩展定量结果的含义。