系统家庭治疗前后精神障碍患者家庭动力学变化及其与疗效的关系

A prospective study of systemic family therapy:the relations between therapeutic outcomes and changes of family dynamics

目的 探讨系统家庭治疗对精神障碍患者的疗效及其与家庭动力学改变的关系。方法对 90例精神障碍患者及其家庭成员实施系统家庭治疗 ,比较治疗前后精神症状、社会功能和家庭动力学变化。结果 与治疗前比较 ,治疗后改善索引患者症状的有效率为 91% ;社会功能均值分[(3.31± 0 .86 )分 ]高于治疗前 [(2 .0 3± 0 .79)分 ;t=12 .6 2 ,P <0 .0 1];家庭动力学指标发生以下变化 ,并与疗效呈正相关 :(1)系统逻辑向多元宽容方向发展 ;(2 )个性化程度增高 ;(3)疾病观念由“患者是受害者”向“患者可以有所作为”转变 ;(4)访谈气氛由沉闷变为轻松。结论 系统家庭治疗的疗效与家庭认知、情感模式及交往行为的改变相关。

Objective (1)To testify the effectiveness of systemic family therapy for Chinese patients and (2)to study the relationship between outcome of systemic family therapy and changes of family dynamics Methods 90 index patients and their families were treated with systemic family therapy Symptoms, social function of the patients and 6 dimensions of family dynamics were evaluated quantitatively before and after treatment Results The rate of effectiveness for symptoms of index patients was 91% The social function of patients and their family dynamic were improved significantly by the treatment The results showed significant correlation between positive outcomes and the following changes in the family dynamic:(1)Systemic logic had moved from “either…or…logic” to “not only…but also…logic” (2)The individuation was promoted (3)The illness concept connoting that “patient is victim” was softened so that the families began to believe that “the patient can do something” (4)The atmosphere of interviews became relaxed Conclusion The effects of systemic family therapy were related to the improvements of cognitive, emotional patterns and communicative behavior in the family