分析心理治疗的来访者满意度评价与叙事分析

Client satisfaction and narrative analysis with analytical psychotherapy

目的:探索分析心理治疗的来访者满意度评价与叙事模式,进行过程-疗效研究的初步尝试。方法:2位有20余年从业经验的男性治疗师与1位正在接受治疗师培训的女性学员分别采用积极想象法、联想分析法与综合分析法对3位自愿接受心理治疗的女性来访者进行短程治疗。采用面谈评价问卷对3个治疗过程进行来访者满意度评价,运用叙事过程编码系统进行叙事分析。结果:(1)来访者对联想分析法的面谈深度性评价低于积极想象法和综合分析法[(4.2±0.2)vs.(6.0±1.1)、(6.2±0.3),均P<0.01],积极想象法面谈后来访者的正向性提高[(6.0±0.9)(4.6±1.1),P<0.05]。面谈前正向性与面谈后正向性、面谈深度性呈正相关(r=0.54、0.67,P<0.05或0.01),面谈后正向性与面谈深度性正相关(r=0.76,P<0.01)。(2)联想分析法的内倾型叙事序列少于积极想象法与综合分析法(18.4%vs.38.5%、36.6%,P<0.01),反思型叙事序列则多于积极想象法与综合分析法(37.7%vs.18.1%、20.7%,P<0.01)。(3)在积极想象法治疗中,内倾型叙事与面谈后激动性正相关(r=0.99,P<0.01),反思型叙事与面谈深度性负相关(r=-0.94,P<0.05);在联想分析法治疗中,外倾型叙事与面谈顺畅性正相关(r=0.90,P<0.05);在综合分析法治疗中,反思型叙事与面谈顺畅性负相关(r=-0.85,P<0.05),与面谈后激动性正相关(r=0.82,P<0.05)。结论:在本研究中,积极想象法的来访者满意度评价高于联想分析法与综合分析法,内倾型叙事为积极想象法的叙事特征,反思型叙事为联想分析法的叙事特征,叙事模式与来访者满意度评价之间具有一定的相关性。

Objective： To carry out client satisfaction evaluation and narrative analysis in the process-outcome research of individual analytical psychotherapy in China. Methods： Short-term individual analytical psychotherapy was administrated to 3 female clients by 2 male psychotherapists with more than 20 years professional experiences and 1 female trainee. The method of active imagination, association analysis and integrative analysis were applied respectively. Satisfaction with treatment was evaluated with the Session Evaluation Questionnaire （ SEQ） by the clients during three different processes of individual analytical psychotherapy and the narrative analysis was carried out with the Narrative Processes Coding System （NPCS） on the sessions. Results： （ 1 ） The clients＇depth evaluation of association analysis was lower than that of active imagination and integrative analysis significantly [ （ 4. 2 ± 0. 2 ） vs. （ 6. 0 ± 1, 1 ）, （ 6. 2 ± 0. 3 ） ; P 〈 0. 01 ] . The clients ＇positivity was enhanced significantly in each session [ （ 6.0 ± 0. 9 ） vs. （ 4. 6± 1.1 ）, P 〈 0.05 ] . The clients＇pre-session positivity was correlated with post-session positivity （ r = 0. 54, P 〈 0. 05 ） and depth evaluation （ r = 0. 67, P 〈 0. 01 ） , and post-session Positivity was correlated with Depth evaluation （ r = 0. 76, P 〈 0. 01 ） . （ 2 ） The internal narrative sequence of association analysis was significantly less than that of active imagination and integrative analysis （ 18.4% vs. 38.5%, 36. 6% ; P 〈 0. 01）, and the reflexive narrative sequence was significantly more than that of active imagination and integrative analysis （37.7% vs. 18.1%, 20. 7% ; P 〈0. 01 ） . （3） In the case of active imagination, the internal narrative sequence was positively correlated with the client＇s arousal （ r = 0. 99, P 〈 0. 01 ）, while the reflexive narrative sequence was negatively correlated with the client＇s depth evaluation （ r = -0. 94, P 〈 0. 05） . In the case of association analysis, there was positive correlation between the external narrative sequence and the client＇s smoothness evaluation （ r = 0. 90, P 〈 0.05 ） . In the case of integrative analysis, the reflexive narrative sequence was negatively related with the client＂ s smoothness evaluation （ r = - 0. 85, P 〈 0. 05 ） and positively related with the client＂ s arousal （r =0. 82, P 〈0. 05 ） . Conclusion： According to this research, the client＇s satisfaction evaluations of active imagination are higher than that of association analysis and integrative analysis. The psychotherapy processes of active imagination take on the character of the internal narrative sequences, while the processes of association analysis are characteristic by the reflexive narrative sequences. There are some correlation between narrative modes and client satisfaction with treatment.