删除或更新信息,请邮件至freekaoyan#163.com(#换成@)

心理治疗中的脱落

本站小编 Free考研考试/2022-01-01

何姣1, 白宝玉2(), 夏勉3
1武汉大学学生工作部大学生心理健康教育中心
2武汉大学哲学学院心理学系, 武汉 430072
3华中师范大学心理学院, 武汉 430079
收稿日期:2019-09-30出版日期:2020-07-15发布日期:2020-05-21
通讯作者:白宝玉E-mail:psy_bby@163.com

基金资助:* “武汉大学人文社会科学青年****学术发展计划”文化与健康研究团队研究成果, 得到“双一流专项资金”资助

Dropout in psychotherapy

HE Jiao1, BAI Baoyu2(), XIA Mian3
1Center for Psychological Health Education of College Students, Department of Student Affairs, Wuhan University, Wuhan 430072, China
2Department of Psychology, School of Philosophy, Wuhan University, Wuhan 430072, China
3School of Psychology, Central China Normal University, Wuhan 430079, China
Received:2019-09-30Online:2020-07-15Published:2020-05-21
Contact:BAI Baoyu E-mail:psy_bby@163.com






摘要/Abstract


摘要: 脱落是指在心理咨询与治疗中, 来访者由于种种原因在导致他前来寻求帮助的心理困扰或问题尚未解决之前就终止治疗的现象。研究者对脱落概念内涵的理解比较一致, 但脱落的操作性定义存在多种且各有利弊。脱落在临床治疗中普遍存在; 脱落率在跨研究间的结果差异很大, 并受到脱落的操作性定义和研究设计类型的重要影响。传统的静态的变量在预测脱落时存在明显局限, 治疗同盟等治疗过程预测变量近年来得到更多重视, 并丰富了我们对来访者脱落的深入理解。为减少脱落, 研究者建议为来访者提供治疗前准备, 对治疗过程中的关键变量进行评估并根据具体情况采用合适的干预策略。未来研究需要完善脱落的操作性定义, 更多地在自然治疗设置下进行研究, 进一步深化脱落的预测变量研究, 并关注治疗外重要事件及文化背景对脱落的影响。


[1] 唐小娟. (2015). 大学生当事人咨询脱落的流行学调查及脱落原因的质性分析 (硕士学位论文). 华中师范大学, 武汉.
[2] 夏勉, 江光荣. (2005). 心理咨询效果的研究进展. 中国心理卫生杂志, 19(3), 217-218.
[3] 杨雪岭, 张培宁, 任家贤, 马晓欣, 谷文静, 张小远. (2017). 基于来访者视角的心理治疗和咨询中的伤害性因素研究. 中国全科医学, 20(1), 114-118.
[4] 赵宏祥, 江光荣, 朱旭. (2014). 精细加工可能性模型对咨询期望的干预研究. 中国心理卫生杂志, 28(12), 902-906.
[5] 周忠英, 夏勉, 江光荣, 孙启武. (2016). 当事人的投入: 概念、测量与影响因素. 心理科学进展, 24(1), 73-82.
[6] Armbruster, P., & Kazdin, A. E. (1994). Attrition in child therapy.In T. H. Ollendick, & T. J. Prinz (Eds.), Advances in clinical child psychology, Vol. 16.(pp. 81-108). New York: Plenum.
[7] Bados, A., Balaguer, G., & Saldana, C. (2007). Outcome of cognitive-behavioural therapy in training practice with anxiety disorder patients. British Journal of Clinical Psychology, 46(4), 429-435.
[8] Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82(5), 738-783.
[9] Berke, D. S., Kline, N. K., Wachen, J. S., McLean, C. P., Yarvis, J. S., Mintz, J., … Litz, B. T. (2019). Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behaviour Research and Therapy, 118, 7-17.
URLpmid: 30933748
[10] Blackshaw, E., Evans, C., & Cooper, M. (2018). When life gets in the way: Systematic review of life events, socioeconomic deprivation, and their impact on counselling and psychotherapy with children and adolescents. Counselling & Psychotherapy. Research, 18(2), 143-153.
[11] Chernus, L. A. (2015). A self psychologist approaches retirement: ‘‘Forced’’ termination with highly vulnerable clients. Clinical Social Work Journal, 44(2), 150-159.
[12] Ciarlo, J. A. (1979). Annual evaluation report for 1975 of the Northwest Denver Mental Health Center. In C. Windle (Ed.), Reporting program evaluations: Two sample community mental health center annual reports. Rockville, MD: U.S. Department of Health, Education and Welfare.
[13] Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23(4), 318-327.
[14] de Haan, A. M., Boon, A. E., de Jong, J. T. V. M., Hoeve, M., & Vermeiren, R. R. J. M . (2013). A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clinical Psychology Review, 33(5), 698-711.
URLpmid: 23742782
[15] DeRubeis, R. J., Gelfand, L. A., German, R. E., Fournier, J. C., & Forand, N. R. (2014). Understanding processes of change: How some patients reveal more than others—and some groups of therapists less—about what matters in psychotherapy. Psychotherapy Research, 24(3), 419-428.
URLpmid: 24219275
[16] Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D. A., Reynolds, L. R., Brown, J., & Johnson, L. D. (2003). The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3(1), 3-12.
[17] Dunn, C. J. (2008). Reducing the premature termination of children from psychotherapy through research based program evaluation (Unpublished doctorial dissertation). Indiana University of Pennsylvania.
[18] Dyer, K., Hooke, G. R., & Page, A. C. (2014). Effects of providing domain specific progress monitoring and feedback to therapists and patients on outcome. Psychotherapy Research, 26(3), 297-306.
[19] Erbes, C. R., Curry, K. T., & Leskela, J. (2009). Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder. Psychological Services, 6(3), 175-183.
doi: 10.1037/a0016662URL
[20] Fernández-Arias, I., García-Fernández, G., Bernaldo-de-Quirós, M., Puig, F. J. E., Encinas, F. J. L., & Labrador-Méndez, M. (2016). Premature termination of psychological treatment for anxiety disorders in a clinical setting. Psicothema, 28(3), 241-246.
[21] Garb, H. N. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1(1), 67-89.
[22] Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change(4th ed., pp. 190-228). Oxford, UK: John Wiley & Sons.
[23] Gearing, R. E., Townsend, L., Elkins, J., El-Bassel, N., & Osterberg, L. (2014). Strategies to predict, measure, and improve psychosocial treatment adherence. Harvard Review of Psychiatry, 22(1), 31-45.
doi: 10.1097/HRP.10.1097/HRP.0000000000000005URLpmid: 24394220
[24] Gonzalez, A., Weersing, V. R., Warnick, E. M., Scahill, L. D., & Woolston, J. L. (2011). Predictors of treatment attrition among an outpatient clinic sample of youths with clinically significant anxiety. Administration and Policy in Mental Health and Mental Health Services Research, 38(5), 356-367.
[25] Greenfield, T. K. (1983). The role of client satisfaction in evaluating university counseling services. Evaluation and Program Planning, 6(3-4), 315-327.
doi: 10.1016/0149-7189(83)90011-3URLpmid: 10267259
[26] Hamberger, L. K., Lohr, J. M., & Gottlieb, M. (2000). Predictors of treatment dropout from a spouse abuse abatement program. Behavior Modification, 24(4), 528-552.
[27] Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology Science & Practice, 9(3), 329-343.
[28] Hatchett, G. T., & Park, H. L. (2003). Comparison of four operational definitions of premature termination. Psychotherapy: Theory, Research, Practice, Training, 40(3), 226-231.
[29] Jordan, J., McIntosh, V. V. W., Carter, F. A., Joyce, P. R., Frampton, C. M. A., Luty, S. E., … Bulik, C. M. (2017). Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence. International Journal of Eating Disorders, 50(8), 979-983.
URLpmid: 28556022
[30] Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1-27.
[31] Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting & Clinical Psychology, 65(3), 453-463.
[32] Keijsers, G. P. J., Schaap, C. P. D. R., Hoogduin, C. A. L., Hoogsteyns, B., & de Kemp, E. C. M . (1999). Preliminary results of a new instrument to assess patient motivation for treatment in cognitive-behaviour therapy. Behavioural and Cognitive Psychotherapy, 27(2), 165-179.
[33] Klein, E. B., Stone, W. N., Hicks, M. W., & Pritchard, I. L. (2003). Understanding dropouts. Journal of Mental Health Counseling, 26(2), 89-100.
[34] Knox, S., Adrians, N., Everson, E., Hess, S., Hill, C., & Crook-Lyon, R. (2011). Clients’ perspectives on therapy termination. Psychotherapy Research, 21(2), 154-167.
URLpmid: 21229469
[35] Krishnamurthy, P., Khare, A., Klenck, S. C., & Norton, P. J. (2015). Survival modeling of discontinuation from psychotherapy: A consumer decision-making perspective. Journal of Clinical Psychology, 71(3), 199-207.
URLpmid: 25241627
[36] La Greca, A. M., Silverman, W. K., & Lochman, J. E. (2009). Moving beyond efficacy and effectiveness in child and adolescent intervention research. Journal of Consulting and Clinical Psychology, 77(3), 373-382.
[37] Lambert, M. J. (2013). Outcome in psychotherapy: The past and important advances. Psychotherapy, 50(1), 42-51.
doi: 10.1037/a0030682URLpmid: 23505980
[38] Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change(5th ed. pp.139-193). New York: John Wiley & Sons.
[39] Lamers, F., Hoogendoorn, A. W., Smit, J. H., van Dyck, R., Zitman, F. G., Nolen, W. A., & Penninx, B. W. (2012). Sociodemographic and psychiatric determinants of attrition in the Netherlands Study of Depression and Anxiety (NESDA). Comprehensive Psychiatry, 53(1), 63-70.
URLpmid: 21397218
[40] Lee, D. B. (2015). Treatment dropout at the Berkeley CBT Clinic: An outcome study (Unpublished doctorial dissertation). The Wright Institute Graduate School, Berkeley.
[41] Lowry, J., & Ross, M. (1997). Expectations of psychotherapy duration: How long should psychotherapy last? Psychotherapy: Theory, Research, Practice, Training, 34(3), 272-277.
[42] Malan, D. H. (1979). Individual psychotherapy and the science of psychodynamics. London: Routledge.
[43] Maniaci, G., La Cascia, C., Picone, F., Lipari, A., Cannizzaro, C., & La Barbera, D. (2017). Predictors of early dropout in treatment for gambling disorder: The role of personality disorders and clinical syndromes. Psychiatry Research, 257, 540-545.
URLpmid: 28886591
[44] Meier, P. S., Donmall, M. C., Mcelduff, P., Barrowclough, C., & Heller, R. F. (2006). The role of the early therapeutic alliance in predicting drug treatment dropout. Drug Alcohol Depend, 83(1), 57-64.
URLpmid: 16298088
[45] Mennicake, S. A., Lent, R. W., & Burgoyne, K. L. (1988). Premature termination from university counseling centers: A review. Journal of Counseling & Development, 66(10), 458-465.
[46] Ogrodniczuk, J. S., Joyce, A. S., & Piper, W. E. (2005). Strategies for reducing patient-initiated premature termination of psychotherapy. Harvard Review of Psychiatry, 13(2), 57-70.
URLpmid: 16020021
[47] O’Keeffe, S., Martin, P., Target, M., & Midgley, N. (2019). ‘I just stopped going’: A mixed methods investigation into types of therapy dropout in adolescents with depression. Frontiers in Psychology, 10, 75. doi. org/10.3389/fpsyg. 2019.00075.
URLpmid: 30804827
[48] Olver, M. E., Stockdale, K. C., & Wormith, J. S. (2011). A meta-analysis of predictors of offender treatment attrition and its relationship to recidivism. Journal of Consulting and Clinical Psychology, 79(1), 6-21.
URLpmid: 21261430
[49] Pekarik, G. (1985). The effects of employing different termination classification criteria in dropout research. Psychotherapy, 22(1), 86-91.
[50] Piselli, A., Halgin, R. P., & MacEwan, G. H. (2011). What went wrong? Therapists’ reflections on their role in premature termination. Psychotherapy Research, 21(4), 400-415.
[51] Raytek, H. S., McCrady, B. S., Epstein, E. E., & Hirsch, L. S. (1999). Therapeutic alliance and the retention of couples in conjoint alcoholism treatment. Addictive Behaviors, 24(3), 317-330.
URLpmid: 10400272
[52] Reis, B. F., & Brown, L. G. (1999). Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy, 36(2), 123-136.
doi: 10.1037/h0087822URL
[53] Richmond, R. (1992). Discriminating variables among psychotherapy dropouts from a psychological training clinic. Professional psychology: Research and Practice, 23(2), 123-130.
[54] Rodolfa, E. R., Rapaport, R., & Lee, V. E. (1983). Variables related to premature termination in a university counseling service. Journal of Consulting Psychology, 30(1), 87-90.
[55] Rooney, J., & Hanson, R. K. (2001). Predicting attrition from treatment programs for abusive men. Journal of Family Violence, 16, 131-149.
[56] Schneibel, R., Wilbertz, G., Scholz, C., Becker, M., Brakemeier, E.-L., Bschor, T., & Schmoll, D. (2017). Adverse events of group psychotherapy in the in-patient setting - Results of a naturalistic trial. Acta Psychiatr Scand, 136(3), 247-258.
doi: 10.1111/acps.12747URLpmid: 28561929
[57] Sly, R. (2009). What’s in a name? Classifying ‘the dropout’ from treatment for anorexia nervosa. European Eating Disorders Review, 17(6), 405-407.
doi: 10.1002/erv.964URLpmid: 19851991
[58] Sly, R., Morgan, J. F., Mountford, V. A., & Lacey, J. H. (2013). Predicting premature termination of hospitalised treatment for anorexia nervosa: The roles of therapeutic alliance, motivation, and behavior change. Eating Behavior, 14(2), 119-123.
doi: 10.1016/j.eatbeh.2013.01.007URL
[59] Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2003). Youth with anxiety disorders in research and service clinics: Examining client differences and similarities. Journal of Clinical Child and Adolescent Psychology, 32(3), 375-385.
doi: 10.1207/S15374424JCCP3203_06URLpmid: 12881026
[60] Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547-559.
doi: 10.1037/a0028226URL
[61] Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. (2012). Practice recommendations for reducing premature termination in therapy. Professional Psychology: Research and Practice, 43(4), 379-387.
doi: 10.1037/a0028291URL
[62] Szafranski, D. D., Smith, B. N., Gros, D. F., & Resick, P. A. (2017). High rates of PTSD treatment dropout: A possible red herring? Journal of Anxiety Disorders, 47, 91-98.
doi: 10.1016/j.janxdis.2017.01.002URLpmid: 28117192
[63] ter Huurne, E. D., Postel, M. G., de Haan, H. A., van der Palen, J., & DeJong, C. A. (2017). Treatment dropout in web-based cognitive behavioral therapy for patients with eating disorders. Psychiatric Research, 247, 182-193.
doi: 10.1016/j.psychres.2016.11.034URL
[64] Thylstrup, B., & Hesse, M. (2016). Impulsive lifestyle counseling to prevent dropout from treatment for substance use disorders in people with antisocial personality disorder: A randomized study. Addictive Behaviors, 57, 48-54.
doi: 10.1016/j.addbeh.2016.02.001URLpmid: 26882500
[65] Warnick, E. M., Gonzalez, A., Weersing, V. R., Scahill, L. D., & Woolston, J. L. (2012). Defining dropout from youth psychotherapy: How definitions shape the prevalence and predictors of attrition. Child and Adolescent Mental Health, 17(2), 76-85.
doi: 10.1111/j.1475-3588.2011.00606.xURL
[66] Wergeland, G. J. H., Fjermestad, K. W., Marin, C. E., Haugland, S. M., Silverman, W. K., ?st, L. G., … Heiervang, E. K. (2015). Predictors of dropout from community clinic child CBT for anxiety disorders. Journal of Anxiety Disorders, 31, 1-10.
URLpmid: 25637909
[67] Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190-195.
doi: 10.1037/0735-7028.24.2.190URL
[68] Yoo, H., Bartle-Haring, S., & Gangamma, R. (2016). Predicting premature termination with alliance at sessions 1 and 3: An exploratory study. Journal of Family Therapy, 38(1), 5-17.
doi: 10.1111/1467-6427.12031URL
[69] Zaitsoff, S., Pullmer, R., Cyr, M., & Aime, H. (2015). The role of the therapeutic alliance in eating disorder treatment outcomes: A systematic review. Eating Disorders, 23(2), 99-114.
URLpmid: 25330409
[70] Zimmermann, D., Rubel, J., Page, A. C., & Lutz, W. (2017). Therapist effects on and predictors of non-consensual dropout in psychotherapy. Clinical Psychology & Psychotherapy, 24(2), 312-321.
doi: 10.1002/cpp.2022URLpmid: 27160543




[1]陈子晨, 姜鹤. 心理健康服务的文化胜任力:理论取向与实践策略[J]. 心理科学进展, 2020, 28(4): 661-672.
[2]林弋琪, 王希, 彭凯平, 倪士光. 虚拟现实技术与自闭症谱系障碍治疗:科技新希望[J]. 心理科学进展, 2018, 26(3): 518-526.
[3]周社刚, 张小远. 选择最佳治疗:来访者−治疗方法的匹配[J]. 心理科学进展, 2018, 26(2): 294-305.
[4]佘壮, 孙启武, 江光荣, 史燕伟. 心理治疗中的正式反馈[J]. 心理科学进展, 2017, 25(7): 1197-1207.
[5]杨文登;张小远. 心理治疗中的共同要素理论与特殊成分说:争议与整合[J]. 心理科学进展, 2017, 25(2): 253-264.
[6]李北容;宋斌;申荷永. 积极想象的理解与应用[J]. 心理科学进展, 2012, 20(4): 608-615.
[7]张田;孙卉;傅安球. 集体主义背景下的宽恕研究及其对心理治疗的启示[J]. 心理科学进展, 2012, 20(2): 265-273.
[8]周雅; 刘翔平; 苏洋; 冉俐雯. 消极偏差还是积极缺乏:抑郁的积极心理学解释[J]. 心理科学进展, 2010, 18(4): 590-597.
[9]秦旻;郑涌. 心理治疗的消极后果[J]. 心理科学进展, 2009, 17(6): 1316-1326.
[10]尹可丽;秦旻;黄希庭. 心理治疗的循证实践与循效施治[J]. 心理科学进展, 2009, 17(6): 1327-1335.
[11]周婧;郑涌. 心理治疗结果的临床显著性分析方法[J]. 心理科学进展, 2009, 17(5): 1002-1009.
[12]张倩;郑涌. 心理治疗的过程研究
[J]. 心理科学进展, 2009, 17(4): 766-773.
[13]许海燕;黄希庭. 人际心理治疗的发展[J]. 心理科学进展, 2007, 15(6): 923-929.
[14]高文斌;陈祉妍. 网络成瘾病理心理机制及综合心理干预研究[J]. 心理科学进展, 2006, 14(4): 596-603.
[15]吴明霞;郑涌;汤万文. 心理治疗效果研究的进展[J]. 心理科学进展, 2001, 9(2): 151-156.





PDF全文下载地址:

http://journal.psych.ac.cn/xlkxjz/CN/article/downloadArticleFile.do?attachType=PDF&id=5112
相关话题/心理 科学 武汉大学 咨询 过程