关键词: 当事人的投入, 会谈效果, 咨询效果

Abstract: It is generally acknowledged that client engagement is a prerequisite for clients to benefit from counseling and psychotherapy, but there is still no unanimous conclusion on the relationship between client’s engagement and outcome. This study was aimed to explore the relationship between client engagement and instant session outcome, as well as associations between client initial engagement and treatment outcome. To investigating the relationship between client engagement with instant session outcome, Client Engagement Questionnaire (CEQ, self-developed) and Session Evaluation Questionnaire (SEQ) were employed. One hundred and forty-two clients from 7 mental health education center in universities and 1 mental health clinic in hospital were acted as partisans (46 males and 70 females; Mean age = 20.84 ± 2.23, some clients provided no information of sex and age; Mean session-time = 5.87 ± 5.34), most of whom were college students. Clients were requested to fill in the CEQ and SEQ after one given session, and correlation between CEQ and SEQ were computed. Findings revealed that client engagement may have positive effect on session outcome. Concretely speaking, intra-session engagement, inter-session reflection, inter-session action, session adherence (four of five dimensions of CEQ) had a significant positive correlation with instant session outcome, but session attendance (one dimension of CEQ) was not the case. The second study examined the associations between different dimensions of clients’ initial engagement and treatment outcome assessed by continuous self-report among 38 college students (4males and 34females; Mean age = 20.41 ± 2.28; Mean session-time = 4.39 ± 1.23). This was a tracking study, clients were requested to complete Outcome Rating Scale (ORS) before each session until the counseling ends, while Client Engagement Questionnaire (CEQ) was completed only after the second session. Multilayer linear model analysis results showed that clients’ ORS score increases with the increase of dose of psychotherapy, which approved that clients could benefit from psychological counseling, but there was significant individual difference on the changing speed of ORS score, and have shown no linear relationship between clients’ initial engagement and treatment outcome (the changing speed of ORS score). This might indicate that traditional linear correlation analysis methods were incomplete to describe the relationship between engagement and outcome. Further regression analysis showed that the relationship between clients’ initial engagement and treatment outcome showed a U-shape curve relationship. For very few clients who showed lowest level of engagement obtained moderate level outcome; for those who had middle level of initial engagement, the worst of outcome were obtained; and clients with the highest level of initial engagement got best treatment outcome. Generally speaking, it is proved that the client engagement had influence on the outcome, yet this relationship was also influenced by other factors. One possible explanation is that treatment outcome may be influenced by clients’ engagement, clients’ internal resources and severity of symptoms. Specifically, for those very few clients with lowest level of engagement, they may have little symptoms with self-exploration consulting goals, or have little symptoms with positive goals for change, both of whom have more internal resources(e.g., more capable of self-awareness, more motivation for change), the relationship between engagement level with counseling outcomes were not clear up to now. Well for most clients who really seek professional psychological help, their benefits from counseling may depend on their motivation for change and internal resources, higher level of engagement could bring them significant counseling outcomes.

Key words: Client Engagement, Session Outcome, Treatment Outcome