치료 동맹의 위기 해결 과정
Crisis Resolution Process of Therapeutic Alliance
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초록
치료 동맹은 전 상담 회기에 걸쳐 변화하는 역동적인 개념이다. 본 연구는 상담 과정에서 동맹의 저하와 회복으로 드러나는 위기 해결 과정의 단계 및 특징을 알아보고자 하였다. 이 같은 연구 목적을 달성하기 위하여 의도적인 표본추출 과정을 통해 위기 해결의 과정을 가장 잘 밝혀줄 사례들을 선택한 후, 질적 연구 방법적 절차를 통해 해당 사례의 축어록과 상담자 및 내담자의 심층 면접 내용을 분석하였다. 연구 결과 첫째, 유의미한 치료 동맹 점수의 하락을 보인 회기에는 그러한 하락을 초래한 위기 촉발 사건이 존재하는 것으로 나타났다. 이러한 위기 촉발 사건은 한 회기 혹은 두 회기동안 일련의 위기 해결 과정을 거쳐 해결되었다. 둘째, 치료 동맹 관계에서의 위기 해결은 ① 위기 촉발 단계 ➝ ② 위기 대처 단계(협상) ➝ ③ 위기 탐색 단계 ➝ [재위기-재협상 단계] ➝ ④ 위기 해결 단계와 같은 4단계에 걸쳐 이루어졌다. 셋째, 이론적 모형과 달리 이 연구에서는 상담자가 상담이나 내담자와의 관계에서 위기를 먼저 지각하고 이를 해결하기 위해 새로운 행동을 시도했을 때 위기가 촉발되는 것으로 나타났으며 안정적인 위기 해결 단계에 도달하는 과정은 선형적이기 보다는 순환적인 것으로 확인되었다. 이러한 연구 결과들의 의의와 제한점에 대해 논의하였다.
Abstract
The purpose of this study is to examine the crisis resolution process of therapeutic alliance by stage. Four cases that revealed the crisis resolution process were selected through the process of purposeful sampling. After that, through qualitative research method procedures, transcript of the case and the contents of in-depth interview between the counselor and the client were analyzed. The results are as follows. First, in a session where the score of therapeutic alliance significantly declined, an event that triggered such crisis normally exists. The events that triggered crisis are resolved through a series of resolution process during one or two sessions. Second, crisis resolution goes through the following four stages: ① crisis trigger stage ➝ ② crisis coping stage(negotiation) ➝ ③ crisis exploration stage ➝ [re-crisis/renegotiation stage] ➝ ④ crisis resolution stage. Third, unlike a theoretical model, crisis in this study is triggered when the counselor perceived the crisis first during the process of counseling or in the relationship with the client and attempted a new behavior to resolve the crisis. The process of reaching a stabilized crisis resolution stage was found to be recursive rather than linear. At last, the implications and limitations of this study was discussed.
참고문헌 (38)
- 김정욱, "방어 성숙도와 상담자 개입이 심리증상 및 작업동맹에 미치는 영향", 박사, pp.2002
- 김진숙, "상담과 심리치료에서 대상관계이론의 적용 -대상관계이론에 기초한 사례개념화와 상담관계의 활용", 한국심리학회: 연차학술발표대회 논문집, pp.132~138 (2002)
- 박연수, "상담자 행동 양식이 상담 협력관계에 미치는 영향.", 한국심리학회지: 상담 및 심리치료, 11, pp.23~41 (1999)
- Agnew, R. M, "Resolving a challenge to the therapeutic relationship: A single-case study", British Journal of Medical Psychology, 67, pp.155~170 (1994)
- Arnkoff,D.B, "Two examples of strains in the therapeutic alliance in an integrative cognitive therapy", Journal of clinical psychology, 56, pp.187~200 (2000)
- Bennett, D, "Maintaining the therapeutic alliance: Resolving alliance-threatening interactions related to the transference. In Core processes in brief psychodynamic psychotherapy: Advancing effective practice", pp.251~272 (2004), Erlbaum
- Butler, S. F, "Specific and nonspecific factors in psychotherapy: A problematic paradigm for psychotherapy research", Psychotherapy, 23, pp.30~40 (1986)
- Eaton, T. T, "Therapeutic alliance and outcome: Impact of treatment length and pretreatment symptomatology", Psychotherapy, 25, pp.536~542 (1988)
- Foreman, S. A, "Therapist actions that address initially poor therapeutic alliances in psychotherapy", American Journal of Psychiatry, 142, pp.922~926 (1985)
- Gaston,L, "The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations", Psychotherapy, 27, pp.143~153 (1990)
- 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)
- Golden, B, "The working alliance within time-limited therapy: A case analysis", Professional Psychology: Theory, Research, and Practice, 21, pp.476~481 (1990)
- Greenberg, J. R, "정신분석학적 대상관계이론 in Object relations in psychoanalytic theory" (1999), 한국심리치료연구소
- Greenberg,L.S, "Task analysis: Identifying components of intrapersonal conflict resolution in Psychotherapy process research: Paradigmatic and narrative approaches", pp.22~50 (1992), Sage
- Greenberg,L.S, "A guide to conducting a task analysis of psychotherapeutic change", Psychotherapy Research, 17, pp.15~30 (2007)
- Greenberg, L. S, "An approach to psychotherapy change process research: Introduction to the special section", Journal of Consulting and Clinical Psychology, 64, pp.435~438 (1996)
- Hill, C. E, "Therapist retrospective recall of impasses in long-term psychotherapy: a qualitative analysis", Journal of Counseling Psychology, 43, pp.207~217 (1996)
- Horvath,A.O, "Research on the alliance in The working alliance: Theory, research and practice", pp.259~286 (1994), Wiley
- Horvath,A.O, "The therapeutic relationship: From transference to alliance", Journal of Clinical Psychology, 56, pp.163~173 (2000)
- Jilton, R, "Content analysis of therapeutic alliance rupture events. Paper presented at the annual meeting of the Society for Psychotherapy Research, York, England", ~ (1994)
- Kiesler, D. J, "Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy", Psychotherapy, 26, pp.183~194 (1989)
- Kivlighan, D. M, "Patterns of working alliance development: A typology of working alliance ratings", Journal of Counseling Psychology, 47, pp.362~371 (2000)
- Levitt, H, "What clients find helpful in psychotherapy: Developing principles for facilitating moment-to-moment change", Journal of Counseling Psychology, 53, pp.314~324 (2006)
- Moras, K., "Pretherapy interpersonal relations, patients' alliance, and outcome in brief therapy", Archives of General Psychology, 39, pp.405~409 (1982)
- Omer,H, "Trobles in the therapeutic relationship: a pluralistic perspective", Journal of Clinical Psychology, 56, pp.201~210 (2000)
- Piper, W. E, "Quality of object relations vs. international functioning as predictors of therapeutic alliance and psychotherapy outcome", Journal of Nervous and Mental Disease, 179, pp.432~438 (1991)
- Safran,J.D, "Breaches in the therapeutic alliance: An arena for negotiation authentic relatedness", Psychotherapy, 30, pp.11~24 (1993)
- Safran, J. D., "Therapeutic alliance rupture as therapy event for empirical investigation", Psychotherapy, 27, pp.154~165 (1990)
- Safran, J. D., "Integrating psychotherapy research and practice: Modeling the change process", Psychotherapy, 25, pp.1~17 (1988)
- Safran, J. D, "The resolution of ruptures in the therapeutic alliance", Journal of Consulting and Clinical Psychology, 64, pp.447~458 (1996)
- Safran, J. D, "Negotiating the therapeutic alliance" (2000), The Guilford Press
- Safran, J. D, "Resolving therapeutic alliance ruptures: Diversity and integration", Journal of Clinical Psychology, 56, pp.233~243 (2000)
- Safran, J. D, "Has the concept of the therapeutic alliance outlived its usefulness?", Psychotherapy, 43, pp.286~291 (2006)
- Safran, J. D, "Resolving therapeutic alliance ruptures: A task analytic investigation in The working alliance: Theory, research and practice", pp.235~255 (1994), Wiley
- Samstag, L. W, "Defining and identifying alliance ruptures in Core processes in brief psychodynamic psychotherapy: Advancing effective practice", pp.187~214 (2004), Erlbaum
- Stiles, W. B, "Patterns of alliance development and the rupture-repair hypothesis: are productive relationships U-shaped or V-shaped?", Journal of Counseling Psychology, 51, pp.81~92 (2004)
- Watson, J. C, "Alliance ruptures and repairs in experiential therapy", Journal of Clinical Psychology, 56, pp.175~186 (2000)
- Yin,R.K, "사례연구방법 in case study research:Design and Methods" (2005), 한경사