낮은 성과를 보인 상담과정에 대한 질적연구
A Qualitative Study on Counseling Process with Low Effects
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초록
본 연구는 낮은 성과의 상담에서 상담자들이 무엇을 경험했는지를 탐색하여 낮은 성과의 상담과정에 관한 실체이론을 도출하고자 하였다. 한국의 현장 상담성과에 대한 대단위 종단 연구에 참여한 350명의 내담자들을 상담한 44명의 상담자 중에서, 가장 낮은 성과를 보인 하위 20명의 내담자를 상담한 상담자 9명이 연구에 참여하였다. 2010년 12월에서 2011년 9월까지 2차에 걸쳐 비구조화된 심층면접을 실시하였고, 근거이론 방법론으로 분석하였다. 분석과정을 통하여 최종 64개의 개념과 24개의 하위범주, 그리고 14개의 범주를 도출하였다. 낮은 성과의 상담과정에서 핵심범주는 ‘불일치로 인한 불편감, 밋밋함을 상담과정에서 다루지 않고 미진한 상태로 종결함’이었다. 낮은 성과의 상담에서 상담자들은 ‘표면적으로 괜찮아 보이지만 실상은 무겁고 깊은 문제를 가진 내담자’, ‘초기 평가의 오류’라는 맥락과 인과조건하에서 ‘밋밋하고 미진함’이라는 중심현상을 경험하였다. ‘역전이’와 ‘여력이 없는 상황’ 등의 중재조건의 영향 하에서 중심현상을 ‘상담의 한계’로 여기거나, ‘직접 다루지 않고 표면적이고 소극적 역할’을 하면서 나름의 성과가 있지만 미진한 종결을 한 것으로 드러났다. 내담자들의 경험과 관련하여 논의하였으며, 연구 결과를 토대로 낮은 성과와 잠재적 유해성을 관리할 실무자들을 위한 지침을 제시하였다.
Abstract
The present study aims to explore what counselors and clients experience in counseling process with low effects and to suggest substantial theory on counseling process with low effects. Among 350 counseling dyads who participated in the longitudinal study of Korean counseling outcome, 20 dyads which showed the lowest rate of change were selected. 9 Counselors from selected dyads who agreed to participated in this study were interviewed. The trained interviewers of doctoral level in counseling psychology interviewed participants about their counseling experiences the recalled within sessions. Grounded theory method within hermeneutical framework was used to analyze the interview data, creating 64 themes, 24 subcategories, and 14 categories. The core category of counseling process with low effects were “Discrepancy, from which results uncomfortable and flat process, and loose termination without dealing with the feeling from discrepancy”. Implications for PHTs research and guidelines preventing PHTs(Potential Harmful Treatments) were discussed based on findings from the perspective of counselors and clients.
참고문헌 (56)
- 권경인, "상담성과가 낮은 내담자들의 상담경험에 대한 질적 분석", 상담학연구, 12(6), pp.1977~2005 (2011), 한국상담학회
- 김정규, "게슈탈트 심리치료" (2006), 학지사
- 김창대, "상담 성과를 가져오는 한국적 상담자 요인", 상담학연구, 9(3), pp.961~986 (2008), 한국상담학회
- 김창대, "상담전공 내담자가 지각한 효과적인 상담자 요인", 상담학연구, 10(1), pp.83~107 (2009), 한국상담학회
- 김창대, "한국 현장 상담성과에 관한 종단연구", 미발간 연구자료, ~ (2011)
- 양진향, "질적 연구 방법론" (2004), 이화여자대학교출판부
- 유성경, "상담환경의 위험요소, 지각된 사회적 지지가 상담자의 심리적 소진에 미치는 영향", 한국심리학회지: 상담 및 심리치료, 14(2), pp.389~400 (2002), 한국상담심리학회
- 유성애, "동양 사회의 인간 이해와 상담에 대한 인식이 상담자에게 주는 시사점", 한국상담학회 연차대회 심포지엄 미발간 자료 (2009)
- 윤아랑, "상담자 소진: 개관", 한국심리학회지: 상담 및 심리치료, 23(2), pp.231~256 (2011), 한국상담심리학회
- 한영주, "높은 상담 성과의 내담자가 지각한 상담경험", 박사, pp.2010
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (1994), American Psychiatric Association
- American Psychological Association, "Ethical principles of psychologists and code of conduct", American Psychologist, 57, pp.1060~1073 (2002)
- Auerbach, J. S., "The contributions of Sidney Blatt: Relatedness, self-definition, and mental representation, In Bringing psychotherapy research to life: Understanding change through the work of leading clinical researchers: Legacies from the Society for Psychotherapy Research", American Psychological Association
- Barlow, D. H., "Negative effects form psychological treatments: A perspective", American Psychologist, 65, pp.13~20 (2010)
- Bergin, A. E., "Some implications of psychotherapy research for therapeutic practice", Journal of Abnormal Psychology, 71, pp.235~246 (1966)
- Bergin, A. E., "The evaluation of therapeutic outcomes, In Handbook of psychotherapy and behavior change", pp.217~270 (1971), Wiley
- Beutler, L. E., "Participant factors in treating dysphoric disorder s, In Principles of therapeutic change that work", pp.13~63 (2006), Oxford Unive rsity Press
- Bohart, A. C., "Insight and the active client, In Insight in psychotherapy", pp.257~277 (2007), American Psychological Association
- Castonguay, L. G., "Predicting the effect of cognitive therapy for depression : A study of unique and common factors", Journal of Consulting and Clinical Psychology, 64, pp.497~504 (1996)
- Castonguay, Louis G., "Training implications of harmful effects of psychological treatments", American Psychologist, 65, pp.34~49 (2010)
- Chambless, D. L., "Defining empirically supported therapies", Journal of Consulting and Clinical Psychology, 66, pp.7~18 (1998)
- Chambless, D. L., "Empirically supported psychological interventions : Controversies and evidence", Annual Review of Psychology, 52, pp.685~716 (2001)
- Clarkin, J. F., "The influence of client variables on psychotherapy, In Bergin and Garfield’s handbook of psychotherapy and behavior change", pp.194~226 (2004), Wiley
- Corbin, J., "The unstructured interactive interview : issues of reciprocity and risks when dealing with sensitive topics", Qualitative Inquiry, 9, pp.335~354 (2003)
- 조흥식, "질적연구방법론(Qualitative Inquiry and Research Design)" (2005), 학지사
- Crits-Christoph, P., "Relational interpretations, In Psychotherapy relationships that work: Therapist contributions and responsiveness to patients", pp.285~300 (2002), Oxford University Press
- Dimidjian, S., "How would we know if psychotherapy were harmful?", American Psychologist, 65, pp.21~33 (2010)
- Eysenck, H. J., "The effects of psychotherapy : An evaluation", Journal of Consulting Psychology, 16, pp.319~324 (1952)
- Eysenck, H. J., "Negative outcome in psychotherapy: The need for a theoretical framework, In Negative outcome in psychotherapy and what to do about it", pp.267~277 (1985), Springer
- Foa, E. B., "Failures in behavior therapy" (1983), Wiley
- Foa, E. B., "Treatment of obsessive-compulsives: When do we fail?, In Failures in behavior therapy", pp.10~34 (1983), Wiley
- Freud, S., "Introductory lectures on psycho- analysis, In The standard edition of the complete psychological works of Sigmund Freud Vol. 15" (1963), Hogarth Press
- Gaston, L., "Relation of patient pretreatment characteristics to the therapeutic alliance in diverse psychotherapies", Journal of Consulting and Clinical Psychology, 56, pp.483~489 (1988)
- Guba, E. G., "Effective evaluation" (1981), Jossey-Bass
- Gunderson, J. G., "Define borderline patients : An overview", American Journal of Psychiatry, 132, pp.1~10 (1975)
- Hayes, S. C., "마음에서 빠져나와 삶 속으로 들어가라: 새로운 수용전념치료" (2010), 학지사
- Henry, W. P., "Structural analysis of social behavior : Application to a study of interpersonal process in differential psychotherapeutic outcome", Journal of Consulting and Clinical Psychology, 54, pp.27~31 (1986)
- Henry, W. P., "Patient and therapist introject, interpersonal process, and differential psychotherapy outcome", Journal of Consulting and Clinical Psychology, 58, pp.768~774 (1990)
- Hill, C. E., "Beneath the surface of long-term therapy : Therapist and client report of their own and each other's covert processes", Journal of Counseling Psychology, 40, pp.278~287 (1993)
- Hilliard, R. B., "An interpersonal model of psychotherapy : Linking patient and therapist developmental history, therapeutic process, and types of outcome", Journal of Consult ing and Clinical Psychology, 68, pp.125~133 (2000)
- Kelly, A. E., "Client's secret keeping in outpatient therapy", Journal of Counseling Psychology, 45, pp.50~57 (1998)
- Lambert, M. J., "The efficacy and effectiveness of psychotherapy, In Bergin and Garfield’s handbook of psychotherapy and be havior change", pp.139~193 (2004), Wiley
- Levitt, H., "What clients find helpful in psychotherapy : Developing principles for facilitating mo ment-to-moment change", Journal of Counseling Psychology, 53, pp.314~324 (2006)
- Lilienfeld, S. O., "The scientific review of mental health practice : Our raison d’être. Scientific", Review of Mental Health Practice, 1, pp.5~10 (2002)
- Lilienfeld, S. O., "Psychological treatments that cause harm", Perspectives on Psychological Science, 2, pp.53~70 (2007)
- Mays, D. T., "Negative outcome in psychotherapy and what to do about it" (1985), Springer
- Morse, J. M., "Qualitative research methods for health professionals" (1995), Sage
- Rennie, D. L., "Clients' deference in psychotherapy", Journal of Counseling Psych ology, 41, pp.427~437 (1994)
- Rennie, D. L., "Embodied categorizing in the grounded theory method", Theory & Psychology, 16, pp.483~503 (2006)
- Rogers, C., "칼 로저스의 사람중심상담" (2007), 학지사
- Sexton, T. L., "The relevance of counseling outcome research : Current trends and practical implications", Journal of Counseling and Development, 74, pp.590~600 (1996)
- 김선경, "건강한 상담자만이 남을 도울 수 있다" (2003), 학지사
- Strauss, A., "Basics of qualitative research" (1998), Sage
- Strupp, H. H., "Psychotherapy for better or worse: The problem of negative effects" (1977), Jason Aronson
- Vermeersch, D. A., "Outcome Questionnaire: Item sensitivity to change", Journal of Personality Assessment, 74, pp.242~261 (2000)
- Wampold, B. E., "The psychotherapist, In Evidence-based practices in mental health: Debate and dialogues on fundamental questions", pp.200~208 (2006), American Psychological Association