Psychometrische Validierung der deutschen Version des Care Dependency Questionnaire

Zusammenfassung

Ziel

Psychometrische Validierung der deutschen Version des CDQ zur Messung der von Patientinnen empfundenen Abhängigkeit von ihren Psychotherapeutinnen (AvT).

Methodik

Mithilfe der Daten von 5 prospektiven Beobachtungsstudien führten wir eine explorative Faktorenanalyse (EFA) durch. Wir untersuchten die psychometrischen Eigenschaften des CDQ und seine Korrelationen mit anderen klinisch relevanten Variablen.

Ergebnisse

Unsere EFA (n=376) ergab ein faktorielle Struktur, die von der Initialversion abweicht. Daher schlagen wir den CDQ-R12 mit 3 Subskalen von jeweils 4 Items vor. Der CDQ-R12 ist reliabel (α=0,917), korrelierte positiv mit selbst eingeschätzter AvT (r=0,242), Symptomschwere (r=0,481 bzw. 0,395), Therapeutischer Allianz (r=0,380) sowie zwischenmenschlichen Problemen (r=0,338) und war negativ mit sozialer Unterstützung assoziiert (r=− 0,243) (p jeweils<0,01). Patientinnen mit Borderline-Persönlichkeitsstörung zeigten einen höheren CDQ-R12-Wert als jene mit depressiver Störung (r=0,13, p=0,013).

Fazit

Der CDQ-R12 eignet sich zur Erforschung des Einflusses von AvT auf den Erfolg von Psychotherapie. Diese Studie hat Pilotcharakter und die Ergebnisse sollten durch den Anschluss weiterer Untersuchungen überprüft werden.

Abstract

Objective

Psychometric validation of the German version of the CDQ to measure patients' perceived care dependency on their psychotherapists (CD).

Methods

Using data from 5 prospective observational studies, we conducted an exploratory factor analysis (EFA). We examined the psychometric properties of the CDQ and its correlations with other clinically relevant variables.

Results

Our EFA (n=376) revealed a factorial structure that differs from the initial version. Therefore, we propose the CDQ-R12 with 3 subscales of 4 items each. The CDQ-R12 is reliable (α.= 0.917), correlated positively with self-rated CD (r=0.242), symptom severity (r=0.481 and 0.395), therapeutic alliance (r=0.380) and interpersonal problems (r =0 .338), while it was negatively associated with social support (r=− 0.243) (p<0.01 each). Patients with borderline personality disorder showed a higher CDQ-R12 score than those with depressive disorder (r=0.13, p=0.013).

Conclusion

The CDQ-R12 is suitable for investigating the influence of CD on the success of psychotherapy. Our study is of a pilot nature and the results need to be verified by further studies.

Schlüsselwörter

Abhängigkeit in Psychotherapie - Psychotherapie - Therapeutische Beziehung - Nebenwirkungen - Explorative Faktorenanalyse - Psychometrie

Keywords

Care Dependency - Psychotherapy - Therapeutic Relationship - Side Effects - Exploratory Factor Analysis - Psychometrics

Publication History

Received: 10 May 2024

Accepted after revision: 29 April 2025

Article published online:
18 June 2025

• Literatur

• 1 Geurtzen N, Keijsers GPJ, Karremans JC. et al. Care dependency may help and hurt psychological treatment: A treatment-analogue study with students in clinical training. J. Psychother. Integr. 29 S. 374-388 Dez. 2019;
• 2 Leitner A. u. a., „Patients’ Perceptions of Risky Developments During Psychotherapy“. J. Contemp. Psychother 43 S. 95-105 2013;
• 3 Berk M, Parker G. „The Elephant on the Couch: Side-Effects of Psychotherapy“. S. 8. 2009
• 4 Porcerelli JH, Bornstein RF, Markova T. et al Physical Health Correlates of Pathological and Healthy Dependency in Urban Women“. J. Nerv. Ment. Dis. 197 S. 761-765 Okt 2009;
• 5 Huprich S, Rosen A, Kiss A. „Manifestations of interpersonal dependency and depressive subtypes in outpatient psychotherapy patients: Dependency and health status“. Personal. Ment. Health 7 S. 223-232 2013;
• 6 Rozental A, Kottorp A, Boettcher J. et al Negative Effects of Psychological Treatments: An Exploratory Factor Analysis of the Negative Effects Questionnaire for Monitoring and Reporting Adverse and Unwanted Events“. PLOS ONE 11 S. e0157503 2016;
• 7 Schermuly-Haupt M-L, Linden M, Rush AJ. Unwanted Events and Side Effects in Cognitive Behavior Therapy“. Cogn. Ther. Res. 42 S. 219-229 2018;
• 8 Geurtzen N, Keijsers GPJ, Karremans JC. et al „Patients’ care dependency in mental health care: Development of a self-report questionnaire and preliminary correlates“. J. Clin. Psychol. 74 S. 1189-1206 2018;
• 9 Bystedt S, Rozental A, Andersson G. et al Clinicians’ Perspectives on Negative Effects of Psychological Treatments“. Cogn. Behav. Ther. 43 S. 319-331 2014;
• 10 Nutt DJ, Sharpe M. Uncritical positive regard? Issues in the efficacy and safety of psychotherapy“. J. Psychopharmacol. (Oxf.) 22 S. 3-6 2008;
• 11 Glanert S. u. a., „Investigating Care Dependency and Its Relation to Outcome (ICARE): Results From a Naturalistic Study of an Intensive Day Treatment Program for Depression“. Front. Psychiatry 12 S. 644972 2021;
• 12 Geurtzen N, Karremans JC, Keijsers GPJ. et al. “I Need You!” Patients’ Care Dependency Patterns During Psychotherapy for Personality Disorders and Its Association with Symptom Reduction and Wish for Treatment Continuation“. J. Contemp. Psychother. 2023;
• 13 Fassbinder E. u. a., „PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial“. BMC Psychiatry 18 S. 341 2018;
• 14 Schaich A. u. a., „PRO*MDD Study Protocol: Effectiveness of Outpatient Treatment Programs for Major Depressive Disorder: Metacognitive Therapy vs. Behavioral Activation a Single-Center Randomized Clinical Trial“. Front. Psychiatry 9 S. 584 2018;
• 15 Beaton DE, Bombardier C, Guillemin F. et al „Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures“. Spine 25 S. 3186-3191 2000;
• 16 Bühner M. Einführung in die Test- und Fragebogenkonstruktion, 3., Aktualisierte und erw. Aufl. in Pearson Studium – Psychologie. München: Pearson Studium; 2011
• 17 Field AP. Discovering statistics using SPSS: and sex, drugs and rock „n“ roll, 3rd ed. Los Angeles: SAGE Publications; 2009
• 18 Tabachnick BG, Fidell LS. Using multivariate statistics, 6. ed., International ed. in Always learning. Boston Munich: Pearson; 2013
• 19 Coaley K. An Introduction to Psychological Assessment and Psychometrics. 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP. United Kingdom: SAGE Publications Ltd; 2010.
• 20 Tavakol M, Dennick R. Making sense of Cronbach’s alpha“. Int. J. Med. Educ. 2 S. 53-55 2011;
• 21 Middel B, Van Sonderen E. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research“. Int. J. Integr. Care 2 2002;
• 22 Norman GR, Wyrwich KW, Patrick DL. The mathematical relationship among different forms of responsiveness coefficients“. Qual. Life Res., Bd. 16 S. 815-822 2007;
• 23 Lowyck B, Luyten P, Vermote R. et al Self-critical perfectionism, dependency, and symptomatic distress in patients with personality disorder during hospitalization-based psychodynamic treatment: A parallel process growth modeling approach. Personal. Disord. Theory Res. Treat. 8 S. 268-274 2017;
• 24 Halleröd B, Gustafsson J-E. A longitudinal analysis of the relationship between changes in socio-economic status and changes in health“. Soc. Sci. Med. 72 S. 116-123 2011;
• 25 Mackenbach JP, Roskam A-JR, Schaap MM. et al. Socioeconomic Inequalities in Health in 22 European Countries“. N Engl J Med. S. 14. 2008
• 26 de Wilde Brand O, Clarke S, Arntz A. „The use of borderline personality disorder severity index-iv feedback in adjusting borderline personality disorder treatment: therapists and patients perspectives“. BMC Psychiatry 22 S. 469 2022;
• 27 Mackrill T. Goal Consensus and Collaboration in Psychotherapy: An Existential Rationale“. J. Humanist. Psychol. 50 S. 96-107 2010;
• 28 Tryon GS, Birch SE, Verkuilen J. Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy 55 S. 372-383 2018;
• 29 Linden M, Strauß B, Scholten S. et al Definition und Entscheidungsschritte in der Bestimmung und Erfassung von Nebenwirkungen von Psychotherapie“. PPmP – Psychother. · Psychosom. · Med. Psychol. 68 S. 377-382 2018;