【作者】 胡姝婧；

【导师】 江光荣；

【作者基本信息】 华中师范大学 ， 心理咨询与治疗， 2008， 硕士

【摘要】 在泛理论的咨询过程-效果模型中,当事人在会谈中的行为是影响咨询效果的一个重要变量。国外对会谈过程中的其它变量,如咨询师的反应方式、咨询关系与咨询效果的关系做过较多研究,但是对当事人在会谈中的外显行为与咨询效果的关系研究很少。有限的研究表明:当事人的外显行为中,领悟、情感探索、认知.行为探索与会谈效果间存在正相关关系;当事人认为自己的领悟、情感探索、认知-行为探索、治疗性改变这样一些行为十分重要。当事人在会谈中的体验作为一种重要的当事人内隐行为变量,获得了较多研究者的关注。对其与效果关系的研究比较充分,研究结果一致表明:体验水平与效果间存在正相关,无论是整个咨询的平均体验水平、还是咨询早期、中期、晚期的体验水平,均与效果间存在这一相关,而且在不同的理论取向和不同障碍类型的治疗中均发现了这一相关。这些有限的研究结果均针对国外当事人得出,中国当事人的情况如何不得而知。而且当事人的外显行为与内隐体验之间在对效果的影响上是否存在交互作用,前人尚无研究。为了探讨这些问题,该研究拟以中国当事人为样本,考察中国当事人在会谈中的外显行为和内隐体验分别和共同对会谈效果和治疗效果的影响。在某大学心理咨询中心选取了29个咨询个案进行跟踪研究。征得当事人和咨询师的同意后,对这些个案的会谈进行录像,第一次会谈开始前和最后一次会谈结束后,当事人填写《效果问卷》,以考察治疗效果;每一次会谈结束后,当事人填写《会谈评估问卷》,以考察会谈效果。将当事人的每次会谈录像选取四个5分钟长的片断（分别为5-10分钟,15-20分钟,25-30分钟,35-40分钟）转成逐字稿,29个个案的会谈录像共有97个。由3位心理咨询方向一年级的硕士研究生根据会谈录像和逐字稿,按照《当事人行为系统》对当事人在每一个与咨询师的互动回合中最主要的外显行为类型进行评定。另外由3位心理咨询方向二年级的硕士研究生根据会谈录像和逐字稿,按照《体验量表》对当事人在会谈的每个5分钟片断里体验的典型值和峰值进行评定。研究中使用的测评工具,包括《效果问卷》、《当事人行为系统》和《体验量表》,均由本研究者在研究开始前进行翻译和修订。研究结果如下:（1）会谈中出现最多的两类当事人外显行为是描述和认知-行为探索,分别占54.69%和30.44%,其他行为都较少出现。会谈中当事人的体验水平不高,典型值M=2.92,SD=.52;峰值M=3.48,SD=.46,都低于中等水平。认知-行为探索与体验水平间存在正相关,r_{认知-行为探索·典型值}=.62^**,r_{认知-行为探索·峰值}=.62^**;领悟与体验水平的峰值间存在正相关,r_{领悟·峰值}=.34^**;阻抗与体验水平间存在负相关,r_{阻抗·典型值}=-.20^*,r_{阻抗·峰值}=.29^**;描述与体验水平间存在负相关,r_{描述·典型值}=-.63^**,r_{描述·峰值}=-.68^**,其他行为类型与体验水平间无相关。（2）外显行为类型中的治疗性改变与会谈效果的积极性维度以及总分间存在正相关,r_{改变·积极性}=.30^**,r_{改变·总分}=.22^*,其它外显行为类型或体验水平与会谈效果无关。（3）外显行为类型或体验水平与治疗效果无关。但在外显行为类型中的治疗性改变与治疗效果的前测间存在负相关,r=-.37^*。（4）会谈次数与行为类型中的领悟之间存在正相关,r=.50^**。另外,在会谈次数与治疗效果间存在正相关,r=.61^**。（5）治疗效果差不多的不同个案,其行为类型和体验水平随咨询进程的变化形态各不相同。上述结果表明,中国当事人的外显行为中除了治疗性改变与会谈效果间存在正相关外,其它行为均与会谈效果无关,内隐体验也与会谈效果无关。这与国外的研究结论不一致。出现这种不一致的一种可能性是:由于中美的文化差异,“美国文化强调个人尊严和独立,而中国文化重视人与人之间的相互依赖”,因此,对美国当事人来说很重要的一些个人探索行为和体验,对中国当事人可能并没有那么重要,中国当事人可能会更在意与咨询师的交流所获得的东西,当这种东西与自己的咨询需求一致的时候,当事人会觉得会谈效果好。外显行为与治疗效果无关,笔者认为,这可能说明在当事人的会谈外显行为与疗效之间建立关系是不合适的,因为在会谈中的当事人行为与疗效间存在很长的一段距离,中间可能有很多因素会影响到二者的关系,如当事人的人格特点、需要、状态、准备,咨询师的引导和回应方式,等等,可能由于这些因素的共同作用导致二者的关系不明显。而体验水平与治疗效果无关,这可能也说明,中国当事人更注重咨询师所传递的东西与自己咨询需求的一致性,因此咨询的疗效来源于他们对这些内容的吸收和内化,而并不受到他们内心体验强烈程度的影响。更多还原

【Abstract】 In pantheoretical counseling process-outcome model,client behavior in sessions is one of the most important variables which have influence on counseling outcome. Other variables’ relation with outcome,such as therapist response modes,counseling relationship,have been researched much in foreign countries.However,the relation between client’s apparent behavior and outcome has been researched little.Limited researches indicate that:insight,affective exploration and cognitive-behavioral exploration are all positively correlated with session outcome;clients think that their insights,affective exploration,cognitive-behavioral exploration and therapeutic changes are very important behaviors in sessions.Client experience in sessions,as one of the important inner behavior variables, has been paid much attention by researchers.Many researches of its relation with outcome have found that:there is positive correlation between experience level and outcome.No matter the experience level is the average of the whole therapy,or the prophase,metaphase,anaphase of therapy,the correlation is always positive.And the correlation has been found in different theory orientations and treatments of different disorders.These limited results were all found out through foreign clients,and the situation of Chinese clients is not clear.Besides,researchers haven’t explored if there is interaction between client’s apparent behavior and inner experience.To discuss these questions,this research intends to explore the relation between Chinese clients’ behaviors in sessions（including apparent behavior and inner experience）and outcome （including session outcome and treatment outcome）.29 eases were chosen in a counseling center of a university,and their whole counseling processes were followed.After getting clients’ and counselors’ approvements,sessions were recorded by videos.Before the first session and after the last session,clients filled out "Outcome Questionnaire",which was used to measure treatment outcome.After every session,clients filled out "Session Evaluation Questionnaire",which was used to measure session outcome.Four parts of the session videos were transcribed,which were 5-10minutes,15-20 minutes,25-30 minutes,35-40 minutes.29 cases got 97 sessions in total.3 first grade graduate students majored in counseling assessed client’s apparent behavior,basing on the session videos and transcripts.According to "Client Behavior System",they classified main client behavior in every speaking turn.Another 3 second grade graduate students majored in counseling assessed clients’ inner experience level. According to "Experiencing Scale",they assessed mode and peak experience levels in every 5minutes.Measure tools of this research,including "Outcome Questionnaire", "Client Behavior System" and "Experiencing Scale",were all translated into Chinese by our researchers before the research started.Results were as follows:（1）Recounting and cognitive-behavioral exploration were the two kinds most frequently happened client apparent behaviors in sessions,accounted for 54.69%and 30.44%.Other behaviors appeared less.Clients’ experience in sessions were low,mode level M=2.92,SD=.52;peak level M=3.48,SD=.46.Both were lower than middle level. There was positive correlation between cognitive-behavioral exploration and experience,r_{cognitive-behavioral exploration·mode level}=.62^**,r_{cognitive-behavioral exploration·peak level}=.62^**. The correlation between insight and peak level of experience was positive,r_{insight·peak level}=.34^**.There was negative correlation between resistance and experience, r_{resistance·mode level}=-.20^**,r_{resistance·peak level}=-.29^**.The correlation between recounting and experience was negative,r_{recounting·mode level}=-.63^**,r_{recounting·peak level}=-.68^**.Other apparent behaviors were not correlated with experience.（2）There was only one client apparent behavior—therapeutic changespositively correlated with the positivity dimension and total score of session outcome, r_{changes·positivity}=.30^**,r_{changes·total}=.22^*.All other apparent behaviors were not correlated with session outcome.There wasn’t correlation between experience and session outcome,either.（3）Neither apparent behavior nor experience was correlated with treatment outcome.But therapeutic changes was negatively correlated with the former measurement of treatment outcome,r=-.37^*.（4）Session time was positively correlated with insight,r=.50^**.Session time was also positively correlated with treatment outcome,r=.61^**.（5）To different cases of similar treatment outcome,the changing forms of apparent behavior and experience level were different.These results indicate that,Chinese clients’ apparent behaviors are not correlated with session outcome except therapeutic changes,neither is the experience.This result is different with foreign country’s.One possibility is that:because of the culture difference,American culture emphasizes one’s dignity and independence,but Chinese culture emphasizes people’s dependence.So the personal exploration and experience which are important to American clients may be not so important to Chinese clients. What Chinese clients care may be the things that they get through the communication with therapists.And when these things are congruent with their needs,they may think session outcome good.Apparent behaviors are not correlated with treatment outcome.This may indicate that it’s not proper to find the relation between these two variables.Because the distance between these two variables is too long,many factors may affect the relation, such as the characteristics of clients,clients’ needs,states,preparations,therapist’s inductions and responses,etc.Experience is not correlated with treatment outcome. This may indicate that,Chinese clients pay more attention to the congruence of the things that they get from therapists and their needs.So treatment outcome is affected by their assimilation of these matters,but not the experience.更多还原