내담자의 상담 기대와 실제 상담 성과와의 관계에서 치료동맹의 매개효과 = Mediating Effect of Working Alliance in the relationship of Client’s Counseling Expectation and Counseling Outcome

다국어 초록 (Multilingual Abstract)

The purpose of the present study was to examine the mediating effect of working alliance on the relation of client’s counseling expectation and counseling outcome using counseling longitudinal data from 284 clients and 44 counselors in Korea. Client’s counseling expectation was measured at pre-treatment, working alliance at the third session and the counseling outcome at pre- and post-treatment. Result of structural equation modeling analysis supported a complete mediating effect of working alliance on the relation of client's counseling expectation and counseling outcome. Furthermore, results showed the importance of collaborative counseling relationship in the early phase of counseling process as a therapeutic context leading counseling expectation into positive counseling outcome. The implication for future studies and counseling practice are discussed based on the result of the present study.

국문 초록 (Abstract)

본 연구는 내담자의 상담에 대한 기대와 실제 상담 성과와의 관계에서 치료적 동맹이 어떤 역할을 하는지 검증하였다. 이를 위해 자발적으로 연구에 참여한 내담자 284명을 대상으로 접수 면접 시에 초기심각도와 상담성과에 대한 기대, 3회기에 치료적 동맹, 종결회기에 상담성과를 측정하였다. 상담기대와 상담성과의 관계에서 치료적 동맹이 매개하는 모형을 구조방정식모형분석을 사용하여 검증한 결과, 내담자의 상담에 대한 기대는 상담성과에 직접적인 영향을 주지 않고 상담 초기의 치료적 동맹을 통해서만 영향을 미치는 완전 매개 모형이 유의한 모형으로 선택되었다. 이러한 결과는 내담자의 상담에 대한 기대가 실제 상담 성과에 기여하기 위해서는 상담 초기 단계에 강한 치료동맹을 형성하는 것이 필수적임을 보여주어 상담관계의 중요성을 다시 한 번 확인해 주었다. 본 연구는 실제 국내 상담 종단 자료를 분석하여 내담자의 상담 직전, 과정, 종결의 전체 상담 과정 동안의 경험을 구조적으로 분석하였다는 점에서 주요한 의의를 지닌다. 연구 결과에 기초하여 상담실제 및 추후 연구에 대한 시사점을 논의하였다.

참고문헌 (Reference)

1 신희천, "핵심 갈등관계에 대한 해석의 적절성과 회기평가의 변화과정- 작업동맹이 높은 사례와 낮은 사례의 비교 -" 한국상담학회 3 (3): 529-548, 2002

2 이정화, "치료 동맹의 발달 유형과 상담 성과" 한국상담심리학회 21 (21): 1-24, 2009

3 오충광, "초기 작업동맹과 상담 불만족에 대한 개입이 후기 작업동맹에 미치는 영향" 한국상담학회 10 (10): 1471-1486, 2009

4 금명자, "상담자에 대한 내담자의 기대" 3 : 23-43, 1990

5 조성호, "내담자 저항과 내담자 반발성, 상담자 개입 측성 및 작업동맹과의 관계" 9 : 101-127, 1997

6 Noble, L. M., "What do patients expect of psychiatric services? A systematic and critical review of empirical studies" 52 : 985-998, 2001

7 Meyer, B., "Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program" 70 : 1051-1055, 2002

8 Goldstein, A. P., "Therapist-patient expectancies in psychotherapy" Macmillan 1962

9 Hatfield, D. R., "The use of outcome measures by psychologists in clinical practice" 35 : 485-491, 2004

10 Horvath, A. O., "The therapeutic relationship: From transference to alliance" 56 : 163-173, 2000

11 Horvath, A. O., "The role of the therapeutic alliance in psychotherapy" 61 : 561-573, 1993

12 Baron, R. M., "The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations" 51 : 1173-1182, 1986

13 Duncan, B. L., "The heart and soul of change (2nded.)" American Psychological Association 2010

14 Wampold, B. E., "The great psychotherapy debate: Models, method, and findings" Lawrence Erlbaum 2001

15 Bordin, E. S., "The generalizability of the psychoanalytic concept of the working alliance" 16 : 252-260, 1979

16 Asay, T. P., "The empirical case for the common factors in therapy: Quantitative findings. in: The heart and soul of change: What works in therapy" American Psychological association 33-56, 1999

17 Constantino, M. J., "The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa" 73 : 203-211, 2005

18 Horvath, A. O., "The alliance. in: Psychotherapy relationships that work: Therapists contributions and responsiveness to patients" Oxford University Press 37-69, 2002

19 Joyce, A. S., "The alliance as mediator of expectancy effects in short-term individual therapy" 71 : 672-679, 2003

20 Frazier, P. A., "Testing moderator and mediator effects in counseling psychology research" 51 : 115-134, 2004

21 West, S. G., "Structural equation models with non-normal variables: problems and remedies. in: Structural equation modeling: Concepts, issues and application" Sage 56-75, 1995

22 Anderson, J. C., "Structural equation modeling in practice: A review and recommended two-step approach" 103 : 411-423, 1988

23 Martin, D. J., "Relation of the therapeutic alliance with outcome and other variables: A meta- analytic review" 68 : 438-450, 2000

24 Horvath, A. O., "Relation between working alliance and outcome in psychotherapy: A meta-analysis" 38 : 139-149, 1991

25 Fisher, A. R., "Reconceptualizing multicultural counseling: Universal healing conditions in a culturally specific context" 25 : 525-588, 1998

26 Connolly Gibbons, M. B., "Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive expressive psychotherapy and cognitive therapy" 13 : 59-76, 2003

27 Frank, J. D., "Persuasion and healing: A comparative study of psychotherapy (3rded.)" Johns Hopkins University Press 1991

28 Vermeersch, D. A., "Outcome Questionnaire 45: Item sensitivity to change" 74 : 242-261, 2000

29 Safran, J. D., "Negotiating the therapeutic alliance: A relational treatment guide" The Guildford Press 2000

30 Ægisdóttir, S., "Methodological issues in cross-cultural counseling research: Equivalence, bias, and translations" 36 : 188-219, 2008

31 Shrout, P. E., "Mediation in experimental and nonexperimental studies: New procedures and recommendations" 7 : 422-445, 2002

32 Busseri, M. A., "Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form" 15 : 193-197, 2003

33 Dearing, R. L., "Indicators of client engagement: Influences on alcohol treatment satisfaction and outcomes" 19 : 71-78, 2005

34 Orlinsky, D. E., "Fifty years of psychotherapy process-outcome research: Continuity and change. in: Bergin and Garfield's handbook of psychotherapy and behavior change (5th ed.)" Wiley 307-390, 2004

35 Tracey, T. J., "Factor structure of the Working Alliance Inventory" 1 : 207-210, 1989

36 Arnkoff, D. B., "Expectations and preferences. in: Psychotherapy relationships that work" Oxford University Press 335-356, 2002

37 Joyce, A S., "Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy" 7 : 236-248, 1998

38 Kim, B. S. K., "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" 52 : 67-76, 2005

39 Horvath, A. O., "Development and validation of the Working Alliance Inventory" 36 : 223-232, 1989

40 Hu, L. T., "Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives" 6 : 1-55, 1999

41 Al-Darmaki, F., "Congruence in client-counselor expectations for relationship and the working alliance" 40 : 379-384, 1993

42 Patterson, C. L., "Clients’ pretreatment counseling expectations as predictors of the working alliance" 55 : 528-534, 2008

43 Bohart, A.C., "Clients: The neglected common factor in Psychology. in: The heart and soul of change: Delievering what works in therpy" American Psychological association 33-56, 2010

44 Schlomer, G. L., "Best practices for missing data management in counseling psychology" 57 : 1-10, 2010

45 Greenberg, R. P., "Are patient expectations still relevant for psychotherapy process and outcome?" 26 : 657-678, 2006

46 Abouguendia, M., "Alliance as a mediator of expectancy effects in short-term group psychotherapy" 8 : 3-12, 2004

47 Lambert, M. J., "Administration and scoring manual for the Life Status Questionnaire" American Professional Credentialing Services LLC 2001

48 Bagozzi, R. P., "A general approach for representing constructs in organizational research" 1 : 45-87, 1998

49 Ellsworth, J. R., "A comparison of the Outcome Questionnaire- 45 and Outcome Questionnaire- 30 in classification and prediction of treatment outcome" 13 : 380-391, 2006