循证心理治疗本土化实施的问题及对策

杨文登
广州大学心理学系，广州，510006，yangwendeng@163.com

摘 要 循证心理治疗是治疗者在意识到病人的特征、文化与偏好的情况下，将最好的、可供使用的
研究证据与自己的临床技能整合起来所进行的心理治疗，主要包括研究者及其最佳证据，治疗者及其临床
技能，病人的特征、文化与偏好，政府及第三方机构的管理等四个大的方面。其实施过程涉及评估、案例
编制、目标确定、治疗计划、联盟建立、以研究为基础的干预、进展监测、按需调整或终止治疗等一系列
临床操作，大致可分为提出问题、检索证据、评价证据、迁移证据与评估反思等五个实施步骤。当前，循
证理念在西方心理治疗界已经深入人心，主要关注如何全面、深入、具体地进行实施等细节问题。
循证心理治疗理念在中国正在不断普及，但由于种种原因，其实施过程仍存在一些问题，如：①对证
据的内涵缺乏统一共识，部分治疗师甚至研究者将证据视为“可装任何花的筐”，“按需取用”证据或按
“金字塔”标准对证据进行僵化理解；②证据的数量无法满足现实需要，少有本土化的证据数据库，翻译
的指南、手册与标准尚不多见；③循证理念有待进一步推广，社会大众对循证心理治疗了解很少，部分治
疗师对循证理念缺乏深入理解或理解该概念但较少予以实施；④政府与行业推动力度不够，由于现阶段国
内心理治疗界有更重要的工作（如培训合格治疗师、制定行业标准等）需要完成，循证心理治疗仍未排上
工作日程。
今后，在本土化实施循证心理治疗的过程中（并非必须使用“循证”一词），需要适当注意以下方面：
①加强对“证据”内涵、结构、来源、评价标准等方面的批判性理论研究；②以疾病为中心，以中国人为
被试进行严谨的原始研究，创造或验证符合中国人特点的证据，建构数据库，完善相关的手册、指南与标
准；③在人才培养过程中逐渐整合循证理念，针对具体的疾病培训典型的、当前世界公认的循证治疗方案；
④政府与行业协会在政策层面适度地“自上而下”进行推动。总体目标是增进心理治疗的科学化、有效化、
标准化与协同化，最终让病人获得最大的收益。

关键词 循证心理治疗，证据，本土化，实施，问题

Four problems in the indigenization of evidence-based psychotherapy

Yang Wendeng
(Department of Psychology, Guangzhou University, Guangzhou, yangwendeng@163.com）

Abstract：Evidence-based psychotherapy (EBP) is the integration of the best available research with
clinical expertise in the context of patient characteristics, culture, and preferences. It mainly include the
researchers and the best evidences, therapists and their clinical expertise, the patient's characteristics, cultures and
preferences, the management of government and the third party organization, and so on. EBP implies a coherent
and clinically expert process of assessment, case formulation, identification of goals, treatment planning, alliance
building, research-informed intervention, monitoring of progress, adjustments as needed, and termination—all in
the context of collaboration with the client. EBP’s implement roughly divided into asking questions, accessing
evidences, appraising researches, translating evidence into the real world, evaluating the results. At present, EBP
has been deeply rooted in the western psychotherapy, mainly focusing on how to implement EBP comprehensively,
deeply, and specifically.
Due to various reasons, EBP is becoming popular in China, but its implementation still exist the following
problems: (1) lacking of consensus about EBP’s concept. Certain members of the general public and sometimes
even professionals use the term “evidence-based” as a form of rhetoric. They reframe the definition of “evidence”
in favor of their particular understanding of psychotherapy; (2) the amount of evidence cannot meet the needs of
the real world, local database, translated guidelines, manuals and standards are also rare; (3) The public has little
understanding of EBP, and some therapists lack a deep understanding about EBP or understanding the concept of
EBP but rarely implement it; (4) due to the more important work (such as training qualified therapists, setting
standards, etc.) needed to be completed in the current China, EBP is still not on China’s agenda.
In the future, due attention should be paid to the following aspects in the indigenization of EBP (but it is not
necessary to use the word “evidence-based” ): (1) Strengthen our critical thinking on the concept, structure, source
and evaluation standard of “evidence”; (2) take the disease as the center, conduct rigorous original research, create
evidences database, and establish relevant manuals, guidelines and standards; (3) gradually integrating EBP in the
process of training psychotherapists, and teaching typical evidence-based treatment for specific diseases; (4) the
government should generalize EBP to the public. The overall goal is to make psychotherapy scientifically,
effectively, standardized and collaboratively, and ultimately to maximize the patients’ benefits.

Keywords：evidence-based psychotherapy, evidence, indigenization, implementation, problems