청소년 내담자의 조기종결 관련 변인 = Factors associated with premature termination of counseling by adolescent clients

다국어 초록 (Multilingual Abstract)

Client's decisions to terminate counseling, like their decisions to begin it, depend on multiple factor influences. The more of these factors that we can take into accouns, and the better our understanding of the underline the phenomenon of premature termination.
The purpose of this study is to investigate psychological characteristics of premature-terminated adolescent clients, counselor and counseling process variables in adolescent individual counseling. The following research questions were established to obtain this goal.
First, What are the characteristics of counselors that predict the premature termination?
Second, What are the characteristics of clients that predict the premature termination?
Third, What are the variables of counseling process that predict the premature termination?
Clients who participated in this study were selected the total sample(N=86) of Youth Counseling Center on Seoul, Gyeonggi, Chungnam, Taegua and ChenBuk. A sample of 47 premature terminated clients was compared with a sample of 39 continued clients. And counselors participated in this study. Some of these counselors counseled both premature-terminated clients and clients who continued clients.
Demographic and psychological variables for counselor were measured using counselor questionaire and this questionaire was used regardless of counseling countinuance.
Client's motivation of counseling, expectancies for counseling, self-esteem, self-efficacy, session evaluation questionaire, counselor rating form, and working alliance was investigated as a possible predictor of premature termination. Reliability and validity of questionaire used in this study was found to be adequate. Collected data were analyzed using Crosstabulation, One-Way ANOVA, and Hierarchical Linear Models.
The results of the study were as follows:
First, Counselor's career and professional degree variables was significantly associated with premature termination.
Second, Adolescent client's self-rating of counseling of motivation and expectancies for counseling showed significant relationships between premature termination and continue counseling
Third, Clients rating of counseling process(counseling session evaluation, counselor evaluation and working alliance) variables was significantly associated with premature termination. A weaker working alliance was reported by clients early in counseling for the premature terminator. In the present study, these process variables significantly differentiated premature terminator from remainder.
These results show that the relationship between the counselors and the clients was well established, and the relationship with counselor is a important factor to prematured or continued counseling.
Fifth, Clients were more likely to terminate counseling after one session when counselors did not accurately identify the presenting problem. Thus, these results suggests that agreement between the counselor and the client on the presenting problem is important in preventing early premature termination.
Some important conclusions can be drawn from this study. It is clear that the counselor plays a critical role in the porcess; if the counselor is expert, trusty and favorable, the adolescent is more likely to remain in counseling. And it is clear that a strong working alliance is critical not only for facilitating a positive outcome, but also for keeping the client engage in counseling
In summary, the results of this study have important implications for counselors who work with adolescents. One logical implication highlights the relevance of client's motivation of counseling and expectancies of counseling.
The theoretical and clinical implications of the results are discussed in relation to identifying and intervening with adolescent clients at risk for premature termination. And it provides practical implication on the area of adolescent counseling since it analyzed the process of adolescent's counseling experiences and clarified factors of premature terminated counseling.

국문 초록 (Abstract)

본 연구의 목적은 청소년 상담에서 내담자의 조기종결에 영향을 미치는 변인을 규명하는데 있다. 이를 위하여 조기종결에 대한 선행연구의 결과들을 토대로 상담자, 내담자(상담동기, 상담기대, 자기효능감, 자아존중감), 상담과정(상담회기평가, 상담자평가, 작업동맹) 변인이 상담의 조기종결에 어떠한 영향을 미치는지 검증하였다.
위와 같은 연구목적을 달성하기 위하여 상담을 시작하는 서울, 경기, 대구, 충남, 전북 지역의 13~19세 청소년 내담자 86명을 대상으로 검사를 실시하였으며이들중 조기종결내담자는 47명, 상담지속내담자는 39명이었다. 자료는 SPSS/WIN 13.0과 HLM 6.02 프로그램을 사용하여, 차이검증, 일원변량분석, 위계적 선형 모형 분석을 하였다.
이 연구를 위하여 사용한 도구는 다음과 같다. 상담전 내담자의 특성인 내담자의 상담동기, 상담기대를 측정하기 위하여 정은미(2003)가 개발한 작업동맹특성 척도중 상담 동기 척도와 상담기대 척도를 사용하였고, 자아존중감을 측정하기 위하여 Rosenberg(1965)가 개발하고 전병제(1975)가 번안한 자료를 사용하였으며, 자기효능감은 Sherer, Maddux, Mercandante, Prentice-Dunn, Jacobs와 Rogers(1982)가 개발하고 홍혜영(1995)이 타당화한 자기효능감(Self-efficacy scale)을 사용하였다. 또한 상담과정 변인을 측정하기 위하여 Stiles(1989)가 개발하고 이상희(1993)가 타당화한 상담회기평가질문지(Session Evaluation Questionaire)와 Corrigan과 Schmidt(1983)가 개발하고 오경희(1985)가 타당화한 상담자평가질문지(Counselor Rating Form) 그리고 Horvath와 Greenberg(1989)가 개발하고 강혜영(1995)이 번안한 작업동맹척도를 사용하였다.
모든 가설은 유의 수준 ‘.05’이하에서 검증하였다.
본 연구의 가설을 검증하기 위하여 대상자들을 조기종결 내담자와 상담을 지 속하는 내담자 집단으로 구별하여 집단간에 차이가 있는지를 분석하였다. 구체적인 연구결과는 다음과 같다.
첫째, 상담의 조기종결 및 지속에 영향을 미치는 상담자 변인으로 상담자의 학력과 상담경력이 확인되었다. 청소년 상담 경력이 오래될 수록(7년 이상), 고학력의 상담자일 수록 조기종결율이 낮은 것으로 나타났다.
둘째, 내담자의 상담동기와 상담기대는 상담의 조기종결 및 지속에 영향을 미치는 중요한 요인으로, 상담을 지속하는 내담자들이 조기종결하는 내담자보다 상담동기와 상담기대가 현저히 높은 것으로 나타났으며, 상담을 지속하는 내담자는 상담과정 평가에 있어서도 조기종결 내담자와 유의미한 차이를 보였다. 즉, 진행된 상담회기에 대해 깊이와 순조로움을 느끼고, 상담자를 보다 전문적이며 신뢰롭고 호감을 느끼는 것으로 평가하였다. 또한 작업동맹의 강도가 더 높은 것으로 나타나 상담의 조기종결 및 지속에 상담과정이 미치는 영향을 중요성을 확인할 수 있었다.
셋째, 상담을 지속하는 내담자의 자아존중감과 상담동기는 작업동맹에 영향을 미치고, 상담회기평가와 상담자평가도 작업동맹에 영향을 미치는 것으로 나타났다.
이상의 연구 결과, 청소년 내담자의 조기종결 및 상담지속에 상담자의 학력과 경력, 내담자의 상담동기와 기대, 상담과정 변인이 영향을 미치고 있음을 알 수 있다. 따라서 청소년 상담의 실제에서 상담자는 전문적인 상담능력을 배양하기 위한 지속적인 노력을 해나감과 동시에 상담 초기에 내담자의 상담동기를 높이기 위한 다양한 전략을 개발하고, 상담과 상담자에 대한 긍정적인 기대를 가질 수 있도록 하기 위해 개입해야 할 것이다. 또한 상담과정에서 내담자로부터 전문적이며, 신뢰로운 상담자로 지각되고 상담협력관계를 구축해 나간다면 조기종결을 예방하고, 상담의 성과를 높일 수 있을 것이다.

목차 (Table of Contents)

• Ⅰ. 서 론 1
• 1. 연구의 필요성 및 목적 1
• 2. 연구문제 5
• Ⅱ. 이론적 배경 6
• 1. 조기종결의 정의 6
• 2. 상담의 조기종결 효과 7
• 3. 조기종결 연구 동향 10
• 4. 조기종결 관련 변인 15
• Ⅲ. 연구방법 35
• 1. 연구대상 35
• 2. 측정도구 38
• 3. 연구절차 42
• 4. 분석방법 42
• Ⅳ. 연구결과 45
• 1. 가설검증을 위한 기초통계 분석 45
• 2. 조기종결여부에 따른 내담자의 심리적 특성 48
• 3. 조기종결여부에 따른 내담자의 상담과정평가 49
• 4. 조기종결 내담자 집단에서 상담자 특성에 따른 상담과정평가 51
• 5. 조기종결 내담자 집단에서 내담자 특성에 따른 상담과정평가 54
• 6. 상담지속내담자의 심리적특성에 따른 상담회기평가와 상담자 평가가 작업동맹에 미치는 영향 55
• 7. 논의 60
• Ⅴ. 요약 및 결론 64
• 1. 요약 64
• 2. 결론 및 제언 67
• 참고문헌 72
• ABSTRACT 89
• 부 록 93

참고문헌 (Reference)

1. Self-efficacy, Prussia, Manz, Self-efficacy:, , 1998

2. 상담심리학, 정인석, , 1991

3. On becomin a person, Rogers, , 1961

4. Coping with dropouts, Pekarik, , 1985

5. 상담심리학 연구, 김계현, 학지사, 상담심리학 연구, , 2000

6. Change process research, Greenberg, , 1986

7. Psychoanalytic counseling, Patton, Michael J., Wiley, , 1992

8. Clinical, sociodemographic, Fallon, Armbruster, "Clinical, , 1994

9. The illusion of psychotherapy, Epstein, William M., Transaction Publishers, , 1995

10. Issues in psychotherapy research, Bellack, Hersen, Michelson, , 1984

11. Predictive psychotherapy dropout, Young, , 1997

12. Personality and the power of belief, Bednar, , 1970

13. Waiting list dropouts: An evaluation, Morris, Pulkaos, , 1995

14. 조기종결 변인에 대한 연구, 안이환, , 2001

15. Return rate following intake revisited, Baumgardner.A, racchia, Krauskopf, , 1981

16. 집단상담활동의 유형화 연구, 김창대, 권석만, 권경인, 집단상담 활동의 유형화 연구, , 2001

17. A meta-analysis of psychotherapy dropout, Pekarik, Wierzbicki, , 1993

18. 위계적 선형모형의 이해와 활용, 유정진 ( Jeong Jin Yu ), 한국아동학회, "아동학회지, , 2006

19. Self-terminations at a child guidance center, Peterson, Spanos, Farley, , 1975

20. Short-term psychotherapy and emotional crisis, Sifneos, Peter E, Harvard University Press, , 1972

21. Revision of psychotherapy expectancy inventory, Berzin, , 1971

22. The helping alliance and premature termination, Tryon, Kane, , 1990

23. Working alliance in theearly phase of counseling, Tracy, Kokotovic, , 1990

24. Expertness, attractiveness, and influence process, Dixon, Strong, "Expertness, , 1971

25. 내담자에 따른 상담기대에 관한 연구, 이수현, 숙명여자대학교 대학원, 숙명여자대학교 대학원 석사학위 논문, , 2000

26. 우리나라 대학생의 상담에 대한 기대, 금명자, 이장호, , 1991

27. Measurement of the impact of psychotherapy session, Stiles, , 1980

28. Factors related to client return rate following intake, Schullman, Betz, , 1979

29. Handbook of psychotherapy and behavior change (4th ed), Garfield, Bergin, , 1994

30. The patient and his experience in an outpatient clinic, Katz, , 1958

31. Wating list dropouts in a university counseling center, Archer, , 1984

32. Client's perception of helpful experience in counseling, Stuart, Paulson, Truscott, , 1999

33. Premature termination at a university counseling center, Kokotovic, Tracey, , 1987

34. A methodological note do students expect what clients do, Subich, Hardin, A Methodological note do students expect what clients do, , 1985

35. 완벽주의성향, 자기효능감, 우울과의 관계, 홍혜영, "완벽주의성향, , 1995

36. 상담학 연구방법론의 패러다임과 분석방법, 박성희(Sung Hee Park), 韓國心理學會 相談心理 및 心理治療學會, , 1996

37. Length of time on a wating list and attrition after intake, Magnoon, Anderson, Hogg, , 1987

38. Predicting patient dropout of treatment: A critical review, Beckham, , 1992

39. Factors influencing failure to show for a family evaluation, Gaines, , 1978

40. Psychotherapists' perception of successful patient behavior, Farber, , 1983

41. A study of factors related to length of stay in psychotherapy, Warshaw, Bailey, Eichler, , 1959

42. Adolescents' dropout from individual psychotherapy-Is it true, Suzuki.R, , 1989

43. Identifying early dropouts from psychotherapy. Psychotherapy:, Cartwright, Wicklund, Lloyd, , 1980

44. Intrinsic motivation and self-determination in human behavior, Deci, Edward L, Plenum, Intrinsic motivation and self-determination in human behavior, , 1985

45. 청소년 내담자의 기대감과 상담협력관계 연구, 박정주, 박영호, , 2002

46. Social influence research in counseling: A review and critique, Heppner, Claiborn, Social influence research in counseling:A review and critique, , 1989

47. The characteristics of dropouts from a child psychiatry clinic, Kaplan, Shaffer, Gould, , 1985

48. Expectancies for counseling in relation to premature termination, Subich, Hardin, Holvey, , 1988

49. Waiting time and no-show rate in a community mental health center, Folkins, Dahlen, Hersch, , 1980

50. 초기 상담에서 화제결정과 상담 효율성과의 관계, 김정욱, 서울大學校 大學院, 초기상담에서 화제결정과 상담 효율성과의 관계, , 1990

51. Relationship of working alliance to mutual and uniteral termination, Tryon, Kane, , 1993

52. Continuance beyond application interviwes at a child guidance clinic, Lake, Levinger, , 1960

53. Factor analysis of the domain of client expectation about counseling, Tinsley, Workman, Kass, , 1980

54. Predictor of premature termination from counseling at semester recess, Tryon, Kane, , 1988

55. A restrospective study of case attrition in a child psychiatirc clinic, Cohen, Richardson, , 1970

56. Assessment factors associated with premature psychotherapy termination, Frayn, , 1992

57. Expectation of psychotherapy in patients of lower socioeconomics class, Overall, Aronson, , 1963

58. Patient suitability and outcome in short-term individual psychptherapy, Piper, Joyce, Azim, McCallum, , 1990

59. Factors associated with premature termination from outpatient treatment, Noones, Swett, , 1989

60. Characteristic of children with behavior disorder who drop out of therapy, Durrant, , 1999

61. Cognitive-behavior time-limited therapy in a university counseling center, Albright, , 1988

62. Patient motivation as a predictor of process and outcome in psychotherapy, Keithly, Samples, Strupp, , 1980

63. Factor relates to duration of counseling in a university counseling center, Jenkins, Blum, Fuqua, , 1986

64. Predictors of appointment noncompliance in community mental health patients, Dubinsky, , 1986

65. 상담의 조기중단과 상담에 대한 내담자의 기대와의 관계, 이명아, 嶺南大學校, , 1996

66. 초심상담자와 내담자의 조기종결 경험에 관한 질적 분석, 손유미 ( Yu Mi Shon ), 정남운 ( Nam Woon Chung ), 한국심리학회, 가톨릭대학교 대학원 석사학위논문, , 2005

67. Clients' expectation about counseling and perception of the working alliance, Tokar, , 1996

68. Client expectations about counseling and involvement during career counseling, Helwig, Tokar, Tinsley, , 1994

69. The application of survival analysis to the study of psychotherapy termination, Malofeeva, Corning, , 2004

70. 청소년 상담에서 내담자의 작업동맹특성 분석에 관한 연구, 정은미, 숙명여자대학교 대학원, , 2003

71. Evaluation of the patients' motivation for treatment during the first interview, Gillie'ron, , 1989

72. Single session therapy: Maxmizing the effect of the first therapeutic encounter, Tolman, , 1990

73. Social cognitive variables in the prediction of client motivation and attrition, Brown, Longo, Lent, , 1992

74. 청소년과 부모의 내외통제성에 따른 상담에 대한 기대 차이, 양미진(Mi Jin Yang), 금명자(Myoung Ja Keum), 한국심리학회, "한국심리학회지 : 상담 및 심리치료, , 2001

75. Critical review of research on psychothreapy outcome with adolescents: 1967-1977, Tranmontana, , 1980

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

77. Contributing factor to early premature termination at a college counseling center, Hight.W, Martin, McNair.d, , 1988

78. Strategies for reducting patient-initiated premature termination of psychotherapy, Ogrodniczuk, Piper, Joyce, , 2005

79. 상담자와 내담자의 역할범주화가 공감적 이해에 미치는 영향, 하정희, , 1998

80. 스트레스, 사회적 지지, 자아존중감과 우울 및 불안과의 관계, 이영자, 서울여자대학교, "스트레스, , 1994

81. 자아강도와 자기은폐에 따른 상담동기와 상담자에 대한 기대, 황주연, , 2002

82. Reasons for dropout from drug abuse treatment: Symptoms, personality, and motivation, Rounsaville,B., Canning-Ball, Caroll, Ball, "Reasons for dropout from drug abuse treatment: Symptoms, , 2006

83. 상담에 대한 여대생 내담자의 기대감과 작업동맹과의 관계연구, 최지원, 서울여자대학교, , 1998

84. Improvement in clients who have given different reasons for dropping out of treatment, Pekarik, , 1983

85. 상담종결방식에 따른 상담자와 내담자 특성의 차이에 관한 연구, 이현숙, 한국외국어대학교 교육대학원, , 2000

86. 질적 분석을 통한 비자발적 청소년 내담자의 상담지속요인 연구, 양미진, 숙명여자대학교 대학원, 숙명여자대학교 대학원 박사학위논문, , 2005

87. Dropping out of child psychotherapy: Issues for research and implications for practice, Kazdin, , 1996

88. Influencing client expectations about career counseling using a videotape intervention, Tokar, Whitaker, Phillips, , 2004

89. A comparison of clients and counselor expectancies regarding the duration of counseling, Lee.N, Smith, , 1983

90. Giving up on child psychotherapy: Who drops out? Comment on Weisz, Weiss, and Langmeyer, Garfield, "Giving up on child psychotherapy: Who drops out? Comment on Weisz, , 1989

91. Perceived counselor characteristic, client expectation and satisfaction with counseling, Heppner, Heesacker.M, "Perceived counselor characteristic, , 1983

92. Discriminating variables among psychotherapy dropouts from psychological training clinic, Richmond, , 1992

93. 집단상담이 여고생의 자아존중감과 사회성 및 욕구에 미치는 영향, 박민정, , 1996

94. Caretaker psychological factors predicting premature termination of children's counseling, Venable, Thompson.B, , 1998

95. Cognitive factor in early counseling termination: Social insight and level of defensiveness, Heilbrun, , 1982

96. Problem children's treatment attrition and parents' perception of the diagnostic evaluation, Janes, Schechtman, Singh, , 1982

97. Counselor gender and early premature termination from counseling: A replication and extension, Epperson, , 1981

98. Parent expectancies for child therapy : Assessment and relation to participation in treatment, Nock, Kazdin, , 2001

99. Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad, Reis, Brown, , 1999

100. Selected MMPI-2 scales ability to predict premature termination and outcome from psychotherapy, Crowther, Chisholm, BEN-PORATH, , 1997

101. Family situation factors related to remainers and terminators of treatment. Psychotherapy, Theory, Magnussen, Cole, "Family situation factors related to remainers and terminators of treatment. Psychotherapy, , 1967

102. Factor that predict premature termination among Mexican-American children in outpatient psychotherapy, McCabe, , 2002

103. Gender and psychotherapy. In A. M. Brodsky & R. T. Hare-Mustin (Eds.), Woman and psychotherapy(pp, 3-34), Orlinsky, Howard, "Gender and psychotherapy. In A. M. Brodsky & R. T. Hare-Mustin (Eds.), , 1980

104. Therapeutic alliance and outcome: Impact of treatment length and pretreatment symptomatology. Psychotherapy:, Gutfreund, Eaton, Abeles, , 1988

105. Comparison of four operational definition of premature termination. Psychotherapy: Theory, Research, Practice, Hatchett, Park, "Comparison of four operational definition of premature termination. Psychotherapy: Theory, , 2003

106. 내담자의 심리유형과 상담에 대한 기대에 따른 집단상담 치료적 요인에 대한 연구, 심혜숙, 최지화, 한국심리유형학회, "한국심리유형학회지, , 2002

107. 진로결정자기효능감, 진로상담태도, 진로상담에 대한 기대와 상담성과 간의 관계모형, 최정인, "진로결정자기효능감, , 2006

108. Interactive effects of counselor-client similarity and client self-esteem on termination type and number of session, Sipps, Berry, , 1991

109. Client motivation for therapy: A measure of intrinsic motivation and extrinsic motivation and amotivation for therapy, Tuson, Pelletier, Haddad, , 1987

110. Perceptions of counselors' qualities: Impact of subjects' self-concepts, counselor gender and counselor introductions, Goodyear, Angles, "Perceptions of counselors' qualities: Impact of subjects' self-concepts, , 1984

111. Non-compliance in community psychiatry: Failed appointments in the referral system to psychiatric outpatient treatment, Sorensen, Kistrup, Glyngdal, , 2002

112. Variables related to premature termination in a university counseling service: A comment on Rodolfa, Rapaport, and Lee, Saltzman, "Variables related to premature termination in a university counseling service: A comment on Rodolfa, , 1984

113. 성인 원격교육 효과성에 영향을 미치는 요인 분석 연구 : 교원 정보화 원격교육을 중심으로, 구교정, 성인원격교육 효과성에 영향을 미치는 요인 분석 연구:교원정보화원격교육을 중심으로, , 2005

114. Client-therapist congruence in prognostic and role expectation related to client's improvement in short-term psychotherapy, Gulas, , 1974

115. 해결중심 집단상담 프로그램이 알코올중독자의 삶의 의미와 금주자기효능감에 미치는 효과, 권영란, 이정숙, 대한간호학회정신간호학회, 해결중심 집단상담 프로그램이 알코올 중독자의 삶의 의미와 금주 자기효능감에 미치는 효과, , 2002

116. Treatment outcome among children with externalizing disorder who terminate prematurely versus those who complete psychotherapy, Kazdin, Mazurick, Siegel, , 1994

117. Client self termination after one counseling session: Effects of problem recognition, counselor gender, and counselor experience, Warman, Bushway, Epperson, "Client self termination after one counseling session: Effects of problem recognition, , 1983

118. Self-described reasons for premature termination of psychotherapy by Mexican-American, Black-American and Anglo-American pstients, Acosta, "Self-described reasons for premature termination of psychotherapy by Mexican-American, , 1980

119. Manipulation of expectation about counseling and psychotherapy: Review and analysis of expectancy manipulation stratigies and results, Ray, Bowman, Tinsley, , 1988

120. Influence of length of delay between intake session and initial counseling session on client perceptions of counselor and counseling outcome, Freund, Russell, Schweitzer, , 1991

121. Scoring parental responses to an application form as a method to discriminate uniterial from bilateral terminations at a child guidance clinic, Fisher, , 1975

122. Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield(Eds.), Handbook of psychotherapy and behavior change(pp. 190-228), Garfield, "Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield(Eds.), , 1994

123. Effects of structured clinician training on patient and therapist perspectives of alliance early in psychotherapy. Psychotherapy: Theory, Research, Hilsenroth, "Effects of structured clinician training on patient and therapist perspectives of alliance early in psychotherapy. Psychotherapy: Theory, , 2002

124. Counseling psychologists' perception of the occurrence and effects of unrealistic expectations about counseling and psychotherapy among their clients, Barich, Bowman, Tinsley, , 1993

125. MMPI에 나타난 상담 조기종결자들과 상담 지속자들의 심리적 특성: 대학생 내담자 및 아동 내담자의 어머니를 중심으로, 권영민, , 1998

126. REBT를 중심으로 한 진로 집단 상담 프로그램이 대학생의 자기 효능감, 대인관계 능력, 진로태도 성숙, 의사결정 유형에 미치는 효과, 김희수, 건국대학교, "REBT를 중심으로 한 진로집단상담 프로그램이 대학생의 자기효능감, , 2001