바로가기메뉴

본문 바로가기 주메뉴 바로가기

logo

메뉴

내담자의 일방적 상담종결 영향변인 검증: 비연속시간 생존분석 적용

Testing the Determinants on the Unilateral Termination of the Clients: Applying Discrete-Time Survival Analysis

초록

본 연구는 상담과정에서 자주 발생하는 조기종결 중 내담자가 일방적으로 상담에 오지 않아 종결 회기를 진행하지 못하는 특성에 주목하여 이를 내담자의 일방적 종결로 정의하고, 상담을 진행하고 있는 상담자와 내담자를 대상으로 종단적으로 자료를 수집하여 내담자의 일방적 종결 발생 비율과 발생 양상, 영향변인을 알아보았다. 결과는 첫째, 전체 336사례 중 총 65사례가 일방적 종결을 하였고, 1회기에서 3회기까지는 지속적으로 증가하고 3회기에 가장 많은 내담자들이 일방적 종결을 하였다. 둘째, 영향변인으로는 작업동맹 하위변인 중 과제에 대한 동의 수준이 높을수록, 목표에 대한 합의 수준이 낮을수록 내담자의 일방적 종결이 발생할 가능성이 높았다. 내담자의 초기 증상수준은 낮을수록 내담자의 일방적 종결이 나타날 가능성이 높았다. 본 연구는 상담에서 내담자가 일방적으로 상담에 오지 않아 중단되는 경우를 상담 초기에 발생하는 이른 종결과 구분하여 내담자의 일방적 종결로 정의하고, 실제 상담현장에서 일방적 종결의 발생 비율과 영향 변인을 알아봄으로써 상담에서 발생하는 내담자의 일방적 종결에 대한 실제적인 이해에 도움이 되는 정보를 제공하고, 내담자들이 지속적으로 상담에 참여하여 도움을 받을 수 있도록 상담자가 해야 할 방안을 모색하였다는 데 의의가 있다.

keywords
dropout, unilateral termination, working alliance, discrete-time survival analysis., 조기종결, 내담자의 일방적 종결, 상담성과, 작업동맹, 생존분석

Abstract

Unilateral termination (UT), a type of drop out that occurs when a client unilaterally stops coming to sessions, is a common problem in counseling. We conducted a longitudinal study to examine the ratio, occurrence pattern, and the contributing variables of UT. Results showed that UT occurred in 65 out of 336 cases and the UT rate increased from the beginning and reached a peak at the 3rd session. Regarding contributing factors, the results showed that a high level of agreement on the task combined with a low level of agreement on the goal affected a higher rate of UT. Additionally, the severity of early symptoms affected negatively occurrence of UT. This study provides a valid understanding of UT and suggests ways of helping clients participate consistently throughout the entire session.

keywords
dropout, unilateral termination, working alliance, discrete-time survival analysis., 조기종결, 내담자의 일방적 종결, 상담성과, 작업동맹, 생존분석

참고문헌

1.

권영민 (1998). MMPI에 나타난 상담 조기종결자들과 상담 지속자들의 심리적 특성: 대학생 내담자 및 아동 내담자의 어머니를중심으로. 학생생활상담, 17, 29-54.

2.

권희경 (1999). 상담자 태도 및 저항에 대한 개입이 저항 감소와 상담 지속에 미치는 영향. 고려대학교 박사학위논문.

3.

권희경, 장재홍 (1995). 상담에 대한 내담자들의 기대. 심리검사 및 상담연구, 1, 75-96.

4.

김정욱 (1990). 초기상담에서 화제결정과 상담 효율성과의 관계. 서울대학교 석사학위논문.

5.

김현미 (2007). 청소년 내담자 조기종결 관련 변인 연구. 홍익대학교 박사학위논문.

6.

노언경, 홍세희 (2010). 비연속시간 생존분석을적용한 청소년의 최초 폭력 발생시점에대한 영향변인 검증. 조사연구, 11(3), 81-101.

7.

박재빈 (2006). 생존분석 이론과 실제. 서울: 신광출판사.

8.

박해송 (1999). 내담자의 대인애착 특성과 상담자에 대한 신뢰감이 초기 조기종결에 미치는영향. 연세대학교 석사학위논문.

9.

손난희, 유성경 (2012). 상담성과 측정을 위한상담성과척도(Outcome Questionnaire: OQ -30)의 타당화. 상담학연구, 13(1), 1-15.

10.

손유미 (2005). 초심상담자와 내담자의 조기종결경험에 관한 질적 분석. 가톨릭대학교 석사학위논문.

11.

안이환 (2002). 대학생 개인상담에서 조기종결에영향을 미치는 변인: 상담자 변인과 내담자변인을 중심으로. 부산대학교 박사학위논문.

12.

양미진 (2005). 질적 분석을 통한 비자발적 청소년 내담자의 상담지속변인 연구. 숙명여자대학교 박사학위논문.

13.

윤지원 (2009). 초등학교 학교상담의 조기종결 관련변인 분석. 경인교육대학교 교육대학원석사학위논문.

14.

이남옥, 최승미, 조현, 권정혜, 오현주, 정정숙 (2011). 부부상담연구소를 방문한 내담자 특성 및 조기 종결관련 변인의 탐색. 한국심리학회지: 상담 및 심리치료, 23, 543- 575.

15.

이명아 (1996). 상담의 조기중단과 상담에 대한내담자의 기대와의 관계. 영남대학교 석사학위논문.

16.

이민영 (2002). 내담자 반발 특성과 조기종결. 이화여자대학교 석사학위논문.

17.

이장호, 정남운, 조성호 (2005). 상담심리학의 기초. 서울: 학문사.

18.

이정화, 연문희 (2009). 치료 동맹의 발달 유형과 상담 성과. 한국심리학회지: 상담 및 심리치료, 21(1), 1-24.

19.

조도현 (1998). 상담지속에 영향을 미치는 상담자특징들. 카톨릭대학교 석사학위논문.

20.

홍세희 (2012). 고급연구방법론 워크샵 시리즈15: 종단자료 분석을 위한 종단다층 모형. 서울: S & M 리서치 그룹.

21.

홍세희, 노언경 (2010). 비연속시간 사건사 분석을 위한 분할함수 모형화 방법의 제시및 적용. 교육평가연구, 23(4), 953-973.

22.

Arnow, B., Blasey, C., Manber, R., Constantino, M., Markowitz, J., Klein, D., Thase, M., Kocsis, J., & Rush, A. J. (2007). Dropouts versus completers among chronically depressed outpatients. Journal of Affective Disorders, 97, 197-202.

23.

Aubuchon-Endsley, N. L., & Callahan, J. L. (2009). The hour of departure: Predicting attrition in the training clinic from role expectancies. Training and Education in Professional Psychology, 3, 120-126.

24.

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome relation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842-852.

25.

Barrett, M. S., Chua, W. J., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008). Early withdrawal from mental health treatment:Implications for psychotherapy practice. Psychotherapy Theory, Research, Practice, Training, 45, 247-267.

26.

Beck, N. C., Lambert, J., Gamache, M., Lake, E. A., Fraps, C. L., McReynolds, W. T., Heisler, G. H., & Dunn, J. (1987). Situational factors and behavioral self - prediction in the identification of clients at high risk to drop out of psychotherapy. Journal of clinical Psychology, 43, 511-520.

27.

Beckham, E. E. (1992). Predicting patient dropout in psychotherapy. Psychotherapy, 29, 177-182.

28.

Berrigan, L. P., & Garfield, S. L. (1981). Relationship of missed psychotherapy appointments to premature termination and social class. British Journal of Clinical Psychology, 20, 239-242.

29.

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252-260.

30.

Cahill, J., Barkhan, M., Hardy, G., Rees, A., Shapiro, D. A., Stiles, W. B., & Macaskill, N. (2003). Outcomes of patients competing and not competing cognitive therapy for depression. British Journal of Clinical Psychology, 42, 133-143.

31.

Clarkin, J. F., & Levy, K. N. (2003). The influence of client variables on psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 194-226). New York: Wiley.

32.

Constantino, M. J., Arnow, B. A., Blasey, C., & Agras, W. S. (2005). The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. Journal of consulting and clinical Psychology, 73, 203-211.

33.

Devilly, G. J., & Borkovec, T. C. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 73-86.

34.

Ellsworth, J. R., Lambert, M. J., & Johnson, J. (2006). A comparison of the Outcome Questionnaire-45 and Outcome Questionnaire-30 in classification and prediction of treatment outcome. Clinical Psychology and Psychotherapy, 13, 380-391.

35.

Epperson, D. L., Bushway, D. J., & Warman, R. E. (1983). Client self termination after one counseling session: Effects of problem recognition, counselor gender, and counselor experience. Journal of Counseling Psychology, 30, 307-315.

36.

Finch, A. E., Lambert, M. J., & Schaalje, B. J. (2001). Psychotherapy quality control: The statistical generation of expected recovery curves for integration into an early warning system. Clinical Psychology and Psychotherapy, 8, 231-242.

37.

Garfield, D. H. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 190-228). New York:Wiley.

38.

Greenberg, R. P., Constantino, M. J., & Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26, 657-678.

39.

Hatchett, G. T., Han, K., & Cooker, P. G. (2002). Predicting premature termination from counseling using the Butcher Treatment Planning Inventory Assessment. Counseling Psychologist, 9, 156-163.

40.

Hatchett, G. T., & Park, H. L. (2003). Comparison of four operational definitions of premature termination. Psychotherapy: Theory, Research, Practice, Training, 40, 226-231.

41.

Horvath, A. O. (2001). The alliance. Psychotherapy:Theory, Research, Practice, Training, 38, 365-372.

42.

Horvath, A. O., & Greenberg, I. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-233.

43.

Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 38, 139-149.

44.

Hox, J. (2010). Multilevel analysis: Techniques and applications (2nd ed., pp. 159-170). New York:Routledge.

45.

Kahn, J. H. (2011). Multilevel modeling: Overview and application to research in counseling Psychology. Journal of Counseling Psychology, 58, 257-271.

46.

Kim, B. S., Ng, G. F., & Ahn, A. J. (2005). Effects of client expectation for counseling success, client-counselor worldview match, and client adherence to asian and european american cultural values on counseling process with asian americans. Journal of Counseling Psychology, 52, 67-76.

47.

Klein, J. S., Stone, W. N., Hicks, M. H., & Pritchard, I. L. (2003). Understanding dropouts. Journal of Mental Health Counseling, 25, 89-100.

48.

Kokotovic, A. M., & Tracey, T. J. (1987). Premature termination at a university counseling center. Journal of Counseling Psychology, 34, 80-82.

49.

Kokotovic, A. M., & Tracey, T. J. (1990). Working alliance in the early phase of counseling. Journal of Counseling Psychology, 37, 16-21.

50.

Kolb, D. L., Beutler, L. E., Davis, C. S., Cargo, M., & Shanfield, S. B. (1985). Patient and therapy process variables relating to dropout and change in psychotherapy. Psychotherapy:Theory, Practice, & Research, 22, 702-710.

51.

Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C., & Yanchar, S. C. (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology and Psychotherapy, 3, 249-258.

52.

Lambert, M. J., Hatfield, D. R., Vermeersch, D. A., Burlingame, G. M., Reisinger, C. W., & Brown, G. S. (2001). Administration and Scoring Manual for the LSQ. Wilmington, DE:American Professional Credentialing Services.

53.

Longo, D. A., Lent, R. W., & Brown, S. D. (1992). Social cognitive variables in the prediction of client motivation and attrition. Journal of Counseling Psychology, 39, 447-452.

54.

Masi, M. V., Miller, R. B., & Olson, M. M. (2003). Differences in dropout rates among individual, couple and family therapy clients. Contemporary Family Therapy, 25(1), 63-72.

55.

McMurran, M., Huband, N., & Overton, E. (2010). Non-completion of personality disorder treatments: A systematic review of correlates, consequences, and interventions. Clinical Psychology Review, 30, 277-287.

56.

Murdock, N., Edwards, C., & Murdock, T. (2010). Therapists' attributions for client premature termination: Are they self-serving? Psychotherapy:Theory, Research, & Practice, 47, 221-234.

57.

Ogrodniczuk, J. S., Joyce, A. S., & Piper, W. E. (2005). Strategies for reducing patient -initiated premature termination of psychotherapy. Harvard Review of Psychiatry, 13, 57-70.

58.

Pekarik, G. (1983). Improvement in clients who have given different reasons for dropping out of treatment. Journal of Clinical Psychology, 39, 909-913.

59.

Pekarik, G. (1992). Posttreatment adjustment of clients who drop out early vs. late in treatment. Journal of Clinical psychology, 48, 379-387.

60.

Rapaport, R., Rodolfa, E. R., & Lee, V. E. (1985). Variables related to premature terminations in a university counseling service: A reply to Saltzman's(1984) comment. Journal of Counseling Psychology, 32, 469-471.

61.

Reis, B. F., & Brown, L. G. (1999). Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy, 36, 123-136.

62.

Rodolfa, E. R., Rapaport, R., & Lee, V. E. (1983). Variables related to premature termination in a university counseling services. Journal of Counseling Psychology, 30, 87-90.

63.

Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis if adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47, 637-645.

64.

Skovholt, T. M. (2001). The resilient practitioner:Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professional. Boston MA: Allyn and Bacon.

65.

Smith, K. J., Subich, L. M., & Kalodner, C. (1995). The transtheoretical model's stages and processes and their relation to premature termination. Journal of Counseling Psychology, 42, 34-40.

66.

Swift, J. K., & Callahan, J. L. (2008). A delay discounting measure of great expectations and the effectiveness of psychotherapy. Professional psychology: research and practice, 39(6), 581-588.

67.

Swift, J. K., Callahan, J. L., & Levine, J. C. (2009). Using clinically significant change to identify premature termination. Psychotherapy:Theory, Research, Practice, Training, 46, 328-335.

68.

Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meat-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547-559.

69.

Thormählen, B., Weinryb, R. M., Noren, K., Vinnars, B., Bågedahl-Strindlund, M., & Barber, J. P. (2003). Patient factors predicting dropout from supportive-expressive psychotherapy for patients with personality disorders. Psychotherapy Research, 13, 493-509.

70.

Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the working alliance inventory. Psychological Assessment, 1, 207-210.

71.

Tryon, G. S., & Kane, A. S. (1990). The helping alliance and premature termination. Counseling Psychology Quarterly, 3, 233-238.

72.

Tryon, G. S., & Kane, A. S. (1993). Relationship of working alliance to mutual and unilateral termination. Journal of Counseling Psychology, 40, 33-36.

73.

Tryon, G. S., & Winograd, G. (2011). Goal consensus and collaboration. In J. C. Norcross (Ed.), Psychotherapy relationship that work (2nd ed., pp. 153-167). New York, NY: Oxford University Press.

74.

Vermeersch, D. A., Lambert, M. J., & Burlingame, G. M. (2000). Outcome Questionnaire: Item sensitivity to change. Journal of Personality Assessment, 74, 242-261.

75.

Wampold, B. E. (2010). The research evidence for common factors models: A historically situated perspective. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works (2nd ed.). Washington: American Psychological Association.

76.

Wampold, B. E., & Brown, G. S. (2005). Estimation therapist variability: A naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73, 914-923.

77.

Weisz, J. R., & Langmeyer, D. B. (1987). Giving up on child psychotherapy: Who drops out? Journal of Consulting and Clinical Psychology, 55, 916-918.

78.

Westmacott, R., Hunsley, J., Best, M., Rumstein-Mckean, O., & Schindler, D. (2010). Client and therapist view of contextual factors related to termination from psychotherapy: A comparison between unilateral and mutual terminators. Psychotherapy Research, 20, 423-435.

79.

Wierzbicki, M., & Pekarik. G. (1993) A metaanalysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24, 190-195.

logo