团体正念认知疗法治疗强迫症中的治疗关系

Psychotherapy relationship in group mindfulness-based cognitive therapy for obsessive-compulsive disorder

目的·探讨运用团体正念认知疗法治疗强迫症患者时,心理治疗师和强迫症患者之间治疗关系的表现特征及促进疗效的策略。方法·选取上海交通大学医学院附属精神卫生中心3位心理治疗师和其所带领的2组强迫症正念认知治疗团体(共11人完成治疗,2人脱落)。团体成员皆为轻至中度强迫症患者。运用质性研究方法对治疗师和来访者进行半结构式访谈,对逐字转录所获得的访谈资料进行编码,运用类属分析的方法进行分析。结果·强迫症患者眼中的治疗关系表现为温暖的情感支持、专业权威性、个性化需求。治疗师眼中的治疗关系表现为平等的陪伴、相对温和、模糊而有距离。从治疗关系角度促进疗效的策略包括专业性带来信任(特别是举例讲解)、促进情感体验、接纳失望和负面情绪。结论·增加有效策略的运用,可促进正念认知疗法治疗强迫症患者时治疗关系的建立和积极发展,提高治疗的有效性。

Objective To explore the performance characteristics of the psychotherapy relationship in mindfulness-based cognitive therapy between the psychotherapists and patients with obsessive-compulsive disorder （OCD）, and the strategies to promote the curative effect in mindfulness-based cognitive therapy. Methods Three psychotherapists in Shanghai Mental Health Center and two groups of mindfulness-based cognitive therapy for OCD groups （a total of 11 people who completed treatment and 2 people dropped off） were selected. All the patients had mild to moderate OCD. The transcripts were transcribed into verbatim and coded using interpretative phenomenological analysis. Results The psychotherapy relationship in subjective experience of patients with OCD showed warm emotional support, professional authority and individual requirements. The psychotherapy relationship in subjective experience of the therapist was manifested as equal companion, relatively mild and fuzzy distance. Strategies to promote efficacy from a therapeutic relationship perspective was profession to trust （especially for example）, to promote emotional experience and to accept disappointment and negative emotions. Conclusion Increasing the use of effective strategies can promote the establishment and positive development of therapeutic relationship in mindfulness-based cognitive therapy for OCD and promote the effectiveness of treatment.