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Klijentovo Oĉekivanje Ishoda Psihološkog Tretmana Kao Faktor Psihološke Promene

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Klijentovo Oĉekivanje Ishoda Psihološkog Tretmana Kao Faktor Psihološke Promene UNIVERZITET U NOVOM SADU FILOZOFSKI FAKULTET ODSEK ZA PSIHOLOGIJU KLIJENTOVO OĈEKIVANJE ISHODA PSIHOLOŠKOG TRETMANA KAO FAKTOR PSIHOLOŠKE PROMENE DOKTORSKA DISERTACIJA Mentor: Kandidat: Prof. Dr Vesna Gavrilov – Jerković Dragan Ţuljević, MA Novi Sad, 2015. godine UNIVERZITET U NOVOM SADU FILOZOFSKI FAKULTET KLJUĈNA DOKUMENTACIJSKA INFORMACIJA Redni broj: RBR Identifikacioni broj: IBR Tip dokumentacije: Monografska dokumentacija TD Tip zapisa: Tekstualni štampani materijal TZ Vrsta rada (dipl., mag., dokt.): Doktorska disertacija VR Ime i prezime autora: Dragan Ţuljević AU Mentor (titula, ime, prezime, zvanje): Prof. dr Vesna Gavrilov-Jerković, redovni profesor. MN Odsek za psihologiju u Novom Sadu Naslov rada: Klijentovo oĉekivanje ishoda psihološkog tretmana NR kao faktor psihološke promene Jezik publikacije: Srpski jezik JP Jezik izvoda: srp. / eng. JI Zemlja publikovanja: Republika Srbija ZP Uţe geografsko podruĉje: Autonomna pokrajina Vojvodina UGP Godina: 2015. GO Izdavaĉ: autorski reprint IZ Mesto i adresa: Dr Zorana ĐinĊića 2, 21000 Novi Sad, Republika MA Srbija Fiziĉki opis rada: 4 poglavlja, 198 stranica, 19 slika, 54 tabele, 511 FO referenci, 4 priloga Nauĉna oblast: Psihologija NO Nauĉna disciplina: Psihoterapija, kliniĉka psihologija, psihološko ND savetovanje Predmetna odrednica, kljuĉne reĉi: Oĉekivanje ishoda tretmana, opšti faktori promene PO UDK Ĉuva se: Biblioteka Filozofskog fakulteta, Univerzitet u ĈU Novom Sadu Vaţna napomena: Nema VN Izvod: IZ Decenijama unazad, klijentova oĉekivanja ishoda tretmana isticana su od strane teoretiĉara kontekstualnih psihoterapijskih modela kao jedan od kljuĉnih opštih faktora psihoterapijske promene. MeĊutim, rezultati dosadašnjih istraţivanja uloge ovog fenomena daju nekonzistentne rezultate jer se ovom konstruktu pristupa veoma raznovrsno. Pojedini istraţivaĉi istiĉu vaţnost poĉetnih pretretmanskih oĉekivanja ishoda tretmana, drugi ulogu promene oĉekivanja ishoda tretmana u postizanju ţeljene terapijske promene, dok treći istiĉu da se efekti oĉekivanja ishoda tretmana na ishod ostvaruju kako direktno tako i indirektno posredstvom promene klijentovih generalnih oĉekivanja. Da bismo detaljnije istraţili ulogu klijentovih oĉekivanja ishoda tretmana u ostvarivanju psihoterapijske promene, sproveli smo longitudinalno korelaciono istraţivanje koje je za cilj imalo praćenje kako promene klijentovih oĉekivanja ishoda tretmana i generalnih oĉekivanja, tako i varijabli ishoda - opšte uznemirenosti, pozitivnog i negativnog afekta, te zadovoljstva ţivotom u funkciji protoka psihoterapijskog tretmana. Uzorak se sastojao od ispitanika koji pate od neke forme psihološkog problema subkliniĉkog intenziteta i samoinicijativno su se javili na tretman. Od 117 klijenata inicijelnog uzorka, 36 ispitanika proseĉne starosti 31 godinu i dominantno ţenskog pola (80.6%) privelo je tretman kraju i popunilo upitnike tri meseca nakon završetka tretmana. Tretman se sastojao od deset susreta sa psihoterapeutom po principu rutinske terapijske prakse Centra za ratnu traumu u Novom Sadu koji su sprovodili 19 psihoterapeuta edukovanih u okvirima razliĉitih psihoterapijskih orijentacija. Istraţivanje je obuhvatalo ukupno šest merenja - prvo prilikom dijagnostiĉkog susreta sa klijentom, drugo u proseku dve nedelje kasnije neposredno pre poĉetka prve tretmanske seanse, treće nakon treće seanse tretmana, ĉetvrto nakon šeste seanse, peto na kraju tretmana, te šesto merenje tri meseca nakon završetka tretmana. Primenjivani su sledeći instrumenti: Skala depresivnosti, anksioznosti i stresa (DASS 21) za procenu opšte uznemirenosti, Srpski inventar afekata baziran na Positive and Negative Affect Schedule - X (SIAB - PANAS) za procenu pozitivnog i negativnog afekta, Skala zadovoljstva ţivotom (SWLS) za procenu zadovoljstva ţivotom, Skala generalizovane self-efikasnosti (SGSE) i Skala liĉnog optimizma (PO) za procenu generalnih oĉekivanja, te Skala oĉekivanja promene (ACES) za procenu oĉekivanja ishoda tretmana. Serijom analiza kriva latentnog rasta te multilevel analiza mešovitih efekata dobijeni su rezultati koji sugerišu da dolazi do znaĉajne redukcije opšte uznemirenosti i negativnog afekta i to pre poĉetka tretmana i u njegovim ranim fazama, dok se zadovoljstvo ţivotom i pozitivni afekat znaĉajno ne menjaju u funkciji protoka tretmana. Promena pozitivnih i negativnih pokazatelja klijentovog stanja ne prate obrnuto proporcionalni obrazac. Oĉekivanja ishoda tretmana i liĉni optimizam linearno rastu nakon poĉetka tretmana, dok generalizovana self-efikasnost znaĉajno raste u završnoj fazi tretmana. Vrednosti praćenih varijabli stabilne su tri meseca nakon kraja tretmana. Pretretmanska oĉekivanja ishoda tretmana, kao i njihov porast tokom tretmana, znaĉajani su prediktori trendova svih praćenih varijabli. Porast liĉnog optimizma ima nedvosmislenu medijacionu ulogu u relacijama porasta oĉekivanja ishoda tretmana i promene u kriterijumima, dok porast generalizovane self-efikasnosti nema tu ulogu, te se više moţe smatrati ishodom nego medijatorom ishoda tretmana. Nasumiĉni efekti i rezidualne varijanse ovih modela sugerišu postojanje moderacionog efekta trećih varijabli, ali rezultati pokazuju da pretretmanska oĉekivanja ishoda tretmana takvu ulogu ne poseduju. Rezultati snaţno idu u prilog kontekstualnim modelima u psihoterapiji i istiĉu da su klijentova pretretmanska oĉekivanja ishoda tretmana i promena tih oĉekivanja tokom tretmana neosporivo moćni opšti faktori promene koji u znaĉajnoj meri predviĊaju i objašnjavaju ishod psihoterapijskog tretmana. Datum prihvatanja teme od strane NN 12. septembar 2014. veća: DP Datum odbrane: DO Ĉlanovi komisije: predsednik: (ime i prezime / titula / zvanje / naziv organizacije / status) KO ĉlan: ĉlan: University of Novi Sad Faculty of Philosophy Key word documentation Accession number: ANO Identification number: INO Document type: Monograph documentation DT Type of record: Textual printed material TR Contents code: PhD thesis CC Author: Dragan Ţuljević AU Mentor: Vesna Gavrilov-Jerković, PhD, full professor MN Title: Client´s Expectancy of Psychological Treatment TI Outcome as a Factor of Psychological Change Language of text: Serbian Language LT Language of abstract: eng. / srp. LA Country of publication: Republic of Serbia CP Locality of publication: Autonomous Province of Vojvodina LP Publication year: 2015 PY Publisher: Author´s reprint PU Publication place: Dr Zorana ĐinĊića 2, 21000 Novi Sad, Republic of PP Serbia Physical description: 4 chapters, 198 pages, 19 figures, 54 tables, 511 PD references, 4 appendices Scientific field Psychology SF Scientific discipline Psychotherapy, clinical psychology, psychological SD counseling Subject, Key words Treatment outcome expectancy, Common factors of SKW change UC Holding data: Library of Faculty of Philosophy, University of Novi HD Sad Note: None N Abstract: AB For decades, a client’s expectations of treatment outcome in achieving psychotherapeutic change have been emphasized by theorists of contextual models of psychotherapy as one of the crucial common factors of psychotherapeutic change. However, the results of previous studies regarding this phenomenon proved to be inconsistent because the theoretical approaches to this construct were very varied. Some researchers point out the importance of initial pretreatment outcome expectations, others emphasize the role of change in outcome expectations in achieving the desired therapeutic outcome, while a third group points out that treatment outcome expectations have an effect on therapy outcome both directly and indirectly, via changes in the client’s general expectations. In order to further investigate the role of a client’s treatment outcome expectations in achieving psychotherapeutic change, we conducted a correlation longitudinal study aimed at monitoring the changes in the client’s treatment outcome expectations as well as changes in general expectations and outcome variables - general distress, positive and negative affect, and life satisfaction, all as a function of the progress of psychotherapeutic treatment. The sample consisted of clients suffering from a problem of subclinical intensity who had voluntarily applied for treatment. Of the initial sample consisting of 117 clients, 36 participants with an average age of 31 and predominantly female (80.6%) completed the treatment and filled in questionnaires three months following the treatment. The treatment consisted of ten sessions of routine psychotherapy practice in The War Trauma Center in Novi Sad. It was conducted by 19 psychotherapists educated in various psychotherapeutic orientations. The study included a total of six assessments – the first one during the diagnostic session with the client, the second one an average of two weeks later, just before the start of the first treatment session, the third one after the third treatment session, the fourth one after the sixth treatment session, the fifth one at the end of the treatment and the sixth one three months after the end of the treatment. The following instruments were used: The Depression, Anxiety and Stress Scale (DASS 21) for assessment of general distress, the Serbian Affect Inventory based on the Positive and Negative Affect Schedule - X (SIAB - PANAS) for the assessment of positive and negative affect, the Satisfaction With Life Scale (SWLS) for the assessment of life satisfaction, the Generalized Self-efficacy Scale (SGSE) and the Personal Optimism Scale (PO) for the assessment of general expectations, and the Expectations of Change Scale (ACES) for the
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