비자살적 자해 청소년의 상담 경험에 대한 현상학적 연구 = A phenomenological study on the counseling experience of non-suicidal self-injury adolescents

국문 초록 (Abstract)

최근 상담 현장에서는 청소년들의 비자살적 자해와 관련된 상담이 증가함에
따라 이에 관한 연구도 활발히 진행되고 있다. 하지만 비자살적 자해 청소년
내담자의 관점에서 바라본 상담 경험에 관한 연구는 미흡한 실정이다. 따라서
본 연구는 비자살적 자해 청소년이 상담 과정에서 무엇을 경험하는지 그리고
상담 이후 미친 영향은 어떠한지를 알아보는 데 그 목적이 있다.
이와 같은 연구 목적을 달성하기 위하여 최근 1년 이내 그리고 적어도 5회
기 이상 상담을 진행하고, 조기 종결 없이 상담을 종결한 비자살적 자해 경험
이 있는 청소년 7명을 대상으로 면담을 실시하였다. Giorgi의 현상학적 연구
방법을 통해 총 2개의 주제, 14개의 상위범주와 36개의 하위범주, 132개의 의
미 단위를 도출하였다. 주제는 ‘자해 상담 경험’, ‘자해 상담으로 인한 영향’이
도출되었다.
먼저 ‘자해 상담 경험’으로 다양한 경로를 통해 자해 상담에 참여하여 걱정
과 두려움, 검사를 통한 자기 탐색, 전문가를 통한 자해 고지로 걱정 완화와
혼란을 경험하며 위로받고 부정적 감정을 해소하였다. 그리고 자해 완화를 위
해 여러 가지 활동을 진행하였고 그 과정 중 상담 선생님과의 관계를 통해 치
료적 기반을 형성하였지만 효과적인 상담을 방해하는 여러 요인도 있었다. 또
한, 자해 청소년은 정신건강의학과에서의 치료와 약물치료에 대한 효과와 거
부감도 경험하였다. ‘자해 상담으로 인한 영향’에서는 상담 이후 자해에 대한
생각과 행동이 변화하였으며, 자해에 대응할 능력을 획득하였다. 그리고 인적
자원이 형성되어 인간관계에도 변화가 나타났고, 상담에 대해 긍정적 인식을
가지게 되었다.
이와 같은 연구 결과는 비자살적 자해 청소년을 대상으로 상담 경험을 분석
하여 내담자가 지각한 자해 상담의 긍정적 요인과 방해요인을 도출한 것에 의
의가 있으며 추후 비자살적 자해 청소년을 상담하는 상담자들을 위한 기초 자
료로 제공될 수 있다. 하지만 6명의 여자 청소년과 1명의 남자 청소년으로 비
자살적 자해 청소년의 상담 경험을 일반화하기엔 한계가 있고, 7명 모두 상담
환경이 상이하여 공통 경험을 탐색하는 데 어려움이 있었으므로 후속 연구에
서는 지역, 상담기관 등 자해 상담 환경이 비슷한 내담자들의 경험을 탐색하
여 자료를 분석하는 것이 필요할 것으로 사료된다.

목차 (Table of Contents)

• Ⅰ. 서 론 ············································································································1
• 1. 연구의 필요성 및 목적 ·······················································································1
• 2. 연구 문제 ···············································································································8
• Ⅱ. 이론적 배경 ·······························································································9
• 1. 비자살적 자해 ·······································································································9
• 가. 비자살적 자해의 정의와 특징 ·····································································9
• 나. 비자살적 자해의 원인 ·················································································12
• 2. 청소년의 비자살적 자해 ·····················································································13
• 가. 청소년기의 발달적 특징 ·············································································13
• 나. 청소년의 비자살적 자해 행동 ···································································16
• 3. 비자살적 자해 청소년 상담 ···············································································18
• 가. 비자살적 자해 청소년 상담의 상담자 경험에 관한 연구 ···················18
• 나. 비자살적 자해 청소년 상담의 개입방안과 효과성 ·······························20
• Ⅲ. 연구 방법 및 절차 ················································································22
• 1. 현상학적 질적 연구 방법 ·················································································22
• 2. Giorgi의 현상학적 연구의 적용 ······································································23
• 3. 연구 참여자 ·········································································································26
• 가. 연구 참여자 선정 ·························································································26
• 나. 연구 참여자 정보 ·························································································27
• 4. 자료 수집 방법 ···································································································28
• 5. 자료 분석 방법 ···································································································30
• 6. 연구자의 선이해 ·································································································32
• 7. 연구평가 ···············································································································33
• - ii -
• Ⅳ. 연구결과 ···································································································35
• 1. 자해 상담 경험 ···································································································35
• 가. 어쩌다보니 받게 된 자해상담 ····································································42
• 나. 자해 상담에 대한 걱정과 두려움 ······························································44
• 다. 생각지 않았던 나를 마주함 ········································································46
• 라. 전문가를 통한 자해 고지로 걱정 완화와 혼란 발생 ····························48
• 마. 자해 상담을 통한 위로와 부정적 감정 해소 ··········································51
• 바. 자해 완화를 위한 상담개입 방법 ······························································53
• 사. 상담선생님과의 관계를 통한 치료적 기반 형성 ····································56
• 아. 효과적인 상담의 방해요인 ··········································································59
• 자. 정신건강의학과에서의 치료경험 ································································61
• 차. 약물치료에 대한 효과와 거부감 ································································65
• 2. 자해 상담으로 인한 영향 ·················································································66
• 가. 자해에 대한 생각과 행동 변화 ··································································69
• 나. 자해에 대응할 능력 획득 ············································································72
• 다. 인간관계의 변화 ····························································································74
• 라. 상담의 긍정적 인식 구축 ············································································76
• Ⅴ. 논의 ···········································································································79
• 1. 논의 ·······················································································································79
• 2. 연구의 의의 ·········································································································86
• 3. 연구의 제한점 및 제언 ·····················································································87
• 참 고 문 헌 ····································································································89
• - iii -
• 부 록 ·································································································103
• 1. 연구 대상자를 위한 설명서 ···········································································104
• 2. 연구 대상자 동의서 ·························································································108
• 3. 면담 질문지 ·········································································································110
• - iv -
• 표 목 차
• <표 1> 비자살적 자해의 진단기준(DSM-5) ·························································11
• <표 2> 현상학 질적 연구 ··························································································26
• <표 3> 연구 참여자 정보 ··························································································28
• <표 4> 면담 흐름표(interview schedules) 내용 ··················································30
• <표 5> 자료 분석 절차 ······························································································31
• <표 6> 자해 상담 경험 ······························································································36
• <표 7> 자료 상담으로 인한 영향 ············································································67