发表评论-心理与性-万维博客-万维读者网（电脑版）

【摘要】目的：工作联盟是心理治疗结果的有力预测指标，近期理论提出，心理治疗师与患者对联盟的感知一致性可能进一步改善治疗效果。本研究考察了“情感联结”评分在逐次治疗中的一致性是否能预测下一次治疗时的症状改善情况。方法：数据来自某大学门诊部，涉及194名实习心理治疗师为2,575名患者提供的“基于反馈的认知行为疗法”（共82,641次患者-治疗会话观测数据）。患者和心理治疗师在每次治疗结束后对情感联结进行评分，并使用霍普金斯症状清单-11（HSCL-11）评估症状。研究采用包含多项式系数的患者内动态交叉滞后面板模型及响应面分析，在考量时间动态性的前提下，检验了一致性与不一致性的效应。结果：与假设相反，患者与心理治疗师在联结评分上的一致性并未预测更好的治疗结果，且在联盟水平较高时也未出现更强的一致性效应。相反，研究发现联盟质量存在微弱的曲线型主效应，即在联盟水平较高时效应更强；患者和心理治疗师的评分均对此有贡献，但患者评分的效应更显著。此外观察到了不一致性效应：当治疗师对联结的评分低于患者时，治疗结果优于反之的情况。结论：联结的一致性并不能预测短期的症状改善。研究结果显示，心理治疗师对联结持审慎评估态度反而与更好的治疗结果相关。这些发现挑战了关于一致性价值的既有观点，提示我们需要重新思考如何在概念层面理解以及在实践中应用医患双方对联盟的共识。

【关键词】一致性；治疗联结；响应面分析；动态模型；交叉滞后面板模型

[Abstract] Objective: The working alliance is a robust predictor of psychotherapy outcomes, and recent theories suggest that congruence between therapist and patient perceptions of the alliance may further enhance outcomes. This study examined whether session-by-session congruence in emotional bond ratings predicted next-session symptom improvement. Method: Data were drawn from 2,575 patients (82,641 patient-by-session observations) receiving feedback-informed cognitive-behavioral therapy by 194 trainee therapists in a university outpatient clinic. Patients and therapists rated the emotional bond after each session. Symptoms were assessed with the Hopkins Symptom Checklist-11. Dynamic within-patient cross-lagged panel models with polynomial coefficients and response surface analysis were used to test congruence and incongruence effects, while accounting for temporal dynamics. Results: Contrary to hypotheses, congruence between patient- and therapist-bond ratings did not predict better outcomes, nor was there a stronger congruence effect at higher levels of alliance. Instead, a small curvilinear main effect of alliance quality was found, with stronger effects at higher levels. Both patient and therapist ratings contributed to this, though patient ratings showed the stronger effect. Incongruence effects were observed: outcomes were better when therapists rated the bond lower than patients than when the reverse pattern occurred. Conclusions: Bond congruence did not predict short-term symptom improvement. Instead, findings showed that a cautious therapist appraisal of the bond was associated with better outcome. The findings challenge prevailing assumptions about the value of congruence. Results call for a reconsideration of how therapist–patient agreement on the alliance is conceptualized and used in practice.

[Key words] congruence; therapeutic bond; response surface analysis; dynamic model; cross-lagged panel model

论文原文：Falkenström, Fredrik Rubel, Julian A. Stachelscheid, Antonia Lutz, Wolfgang (2026). Does congruence between therapist and patient in session-by-session bond ratings predict change in symptoms? Journal of Consulting and Clinical Psychology, Volume 94, Issue 7, Pages 415–424. July 2026.

https://doi.org/10.1037/ccp0001017

（翻译兼责任编辑：MARY）

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