心理咨询中好坏效果案例的同化水平对比：基于同化模型的视角

A Comparison of Assimilation in Good- and Poor-outcome Cases of Counseling: From the Perspective of Assimilation Model

目的：通过对比心理咨询中4例好效果案例和4例坏效果案例同化水平的差异,对同化模型有关成功治疗改变过程的理论构想进行检验,并寻找区分好坏案例的关键点。方法：选用7位经过培训的评定者组成三个研究小组,采用同化分析这一用来追踪当事人问题经验发展进程的研究方法,对8个当事人完整的咨询逐字稿资料进行分析,并对涉及当事人问题经验的段落进行摘录。依据同化问题经验量表和同化标识手册对摘录的段落进行同化评定。结果：8个案例的核心问题得到一致确定,三组评定者评分的组内相关系数ICC（1,1）在.64~.86之间,ICC（1,K）在.84~.96之间。好效果案例结束时的同化水平均分（M=5.50）和同化进展均分（M=4.25）高于坏效果案例（2.13和-.13）。好坏效果案例的同化进程均出现前进中倒退的情形,但好效果案例能够在倒退中保持上升,而坏效果案例未能完成上升。好效果案例最终的同化水平均达到了4（理解/领悟）及以上,坏效果案例最终的同化水平均未达到4。结论：研究结果基本支持同化模型的理论设想,即症状强度的减少同更高的同化水平相联系;并初步确定区分好坏效果的关键点是同化水平4;但从同化进程来看,可考虑对模型的发展序列进行修改完善。

Objective： The assimilation model is a theoretical model concerning the change process of psychotherapy, which was put forward by William B. Stiles and his colleagues. The model suggested that, in a successful psychotherapy, clients followed a regular developmental sequence of resolving the problematic experiences that they brought into the treatment. The aim of this study was to verify the theoretical construct of the assimilation model on the change process of successful psychotherapy, and to find the key points which might distinguish the cases of good and poor outcomes, by increasing the sample size to four cases with good outcome and four cases with poor outcome, and to compare the assimilation levels of these cases. Methods： Three research teams consisted of seven trained raters were engaged in the rating work. They used a qualitative research method of assimilation analysis to analyze the clients＇ transcripts. Assimilation analysis has been used to track the change process of clients＇ problematic experiences in psychotherapy. Every investigator of the three research teams read and reread the transcripts of eight clients, tracked the major themes and described the voices, excerpted the relevant passages related to the voices as the rating materials, then rated each passage according to the Assimilation of Problematic Experiences Scale （APES） and the Markers of Assimilation Manual. Finally, every team reached consensus in their ratings of the excerpted passages. Results： The essential problems in those cases were discussed and consensus was reached. The internal coefficient consistency, ICC, of the three teams ranged from .64 to .86; the ICC ranged from .84 to .96. After the termination sessions, the mean score of the final assimilation （M = 5.50） and the mean score of the progress assimilation level （M = 4.25） for good outcome cases were higher than the poor outcome cases （with the mean score of 2.13 and -. 13）. The good outcome cases, along with the poor outcome cases, presented that therapeutic advances was a process in which progresses alternated with setbacks. However, the good outcome cases were able to maintain progress despite setbacks, while the poor outcome cases failed to progress. All of the good outcome cases reached the Assimilation level 4 （understanding/insight）, whereas the poor outcome cases failed to reach the level 4. Conclusions： Consistent with the forfiaer researches＇ results, the findings supported the theoretical expectation that the reduction of sympto0a intensity were associated with higher levels of assimilation. All of the good outcome cases reached Assimilation Level 4, whereas none of the poor outcome cases did so. So the Assimilation Level 4 was the key point that distinguished the good from the poor outcome cases. However, in the view of all cases＇ assimilation process, the therapeutic advances alternated with some setbacks, from the latter we may suggest that maybe some improvements on the model＇s developmental sequence were needed. For example, the former linear developmental sequence could be revised as a cycling up sequence.