中国心理咨询与治疗中熟人双重关系的社会文化研究

发布时间：2018-05-20 04:52

本文选题：熟人双重关系 + 心理咨询与治疗　；参考：《南方医科大学》2014年硕士论文

【摘要】：研究意义与目的在民众巨大心理服务需求与国家重视的推动下,我国心理咨询与治疗的发展迈入职业化进程。专业伦理建设是心理咨询与治疗职业化深入推进的关键,其中熟人双重关系是我国专业伦理建设中面临的突出问题。2007年颁布的《临床与咨询心理学工作伦理守则(第一版)》中明确规定避免与寻求专业服务者发生双重关系,而国内已有研究数据显示我国心理咨询与治疗中熟人双重关系的发生率高,超过1/3的心理咨询与治疗师曾为亲戚、朋友、邻居、师生、同事、同学和同乡等熟人提供过咨询与治疗,这意味着他们所服务的来访者的权益和福祉很可能没有得到很好的保障。同时也有研究指出以西方伦理守则为参考依据的现有伦理规定与我国文化特征不符合,指导与评估我国心理咨询与治疗师的行为的作用不大。因此,需要对我国文化背景和现实环境下的熟人双重关系进行深入的研究,以期解决目前心理咨询与治疗师在熟人双重关系的实际行为和现有伦理规定冲突的困局。本研究旨在立足于我国文化背景及从业现实环境,对我国心理咨询与治疗实践中的熟人双重关系进行整体性探究,呈现当前我国心理咨询与治疗中的熟人双重关系现状及其影响,分析其存在的原因及影响因素,归纳我国心理咨询与治疗师对其的应对策略。基于本研究结果,从我国文化的视角对熟人双重关系的发生与发展过程进行解读,构建与我国文化相契合的熟人双重关系伦理文化适应决策模型,为现有伦理守则的修订提供具体的建议。对象与方法 1.研究方法由于熟人双重关系的复杂性和情境性,本研究采用了质性研究方法。 2.抽样方法和研究对象本研究采用质性研究中目的性抽样,选取综合医院心理科、精神病专科医院、大学和中学的心理咨询与治疗中心等机构的心理咨询与治疗师为研究对象,根据研究目的以及借鉴以往研究结果,将研究对象的纳入标准设定为：①获得国家心理咨询师三级资格证,或注册心理咨询师资格,或精神科医生从业资格；②从事心理咨询与治疗工作五年及以上。本研究采用质性研究中最常使用的基本标准——“信息饱和”来确定样本量,即在纳入新的样本时,不再有新的信息出现,即可停止抽样。本研究抽到10人时信息达到饱和,停止抽样。 3.研究工具本研究工具主要包括：一是在前期文献研究的基础上根据研究目的研制的访谈提纲,用于半结构化访谈中资料的收集；二是研究知情同意书,在访谈前让受访者签署；三是录音工具,事先征得受访者同意用于访谈全程录音；四是根据研究过程的心得与反思写成的研究札记,作为资料分析的参考。 4.资料分析将访谈资料逐字誊录,反复听录音与逐字誊录稿,对访谈资料进行类属分析与情境分析。结果 1.心理咨询与治疗师都接触过“双重关系”的基本伦理概念,他们对主张“避免熟人双重关系”伦理规定的态度存在很大分歧,从非常赞成到非常不赞成均有之,大多受访者对熟人双重关系的态度存在矛盾性,一方面认为原则上应该避免,另一方面认为实际上难以避免。 2.绝大部分心理咨询与治疗师都遇到过学生、领导、同事、朋友、同学、亲戚等熟人前来寻求专业心理帮助,也曾为这些熟人提过心理咨询与治疗。 3.心理咨询与治疗师对熟人双重关系之所以普遍存在的解读——咨访双方对“关系”的高度重视和心理咨询与治疗师肩负多重身份与角色是关键。 4.心理咨询与治疗师和来访者所建立的熟人双重关系中,熟人关系可分为直接型和间接型,专业关系可分为指导型、真实型以及移情型。除了直接型熟人关系和移情型专业关系是不匹配之外,其他的熟人关系和专业关系在一定条件下均有可能是匹配的。即心理咨询与治疗师为有频繁接触的直接熟人提供深入的潜意识层面的咨询与治疗(如心理动力学取向的心理咨询与治疗)是不恰当的,而为接触较少的间接熟人提供深入的潜意识层面的咨询与治疗(如心理动力学取向的心理咨询与治疗)在一定条件下是合适的,同时为间接或直接熟人提供首次诊断性访谈或较浅的意识层面的咨询与治疗(如认知与行为层面的指导、情绪层面的宣泄)也是合适的。 5.熟人双重关系的利弊影响主要存在两个特点：①从整体来看,熟人双重关系既存有益的影响,具体包括使熟人来访者获得一般咨询与治疗(即没有熟人双重关系的咨询与治疗)中有益的心理帮助和改变,以及对咨询与治疗的促进作用；也存在有害的影响,具体包括使来访者没有获得理想的心理帮助及存在被利用或威胁的可能性、使咨询与治疗师在精力和时间上的冲突加剧和容易产生情感上疲劳、使咨访双方的原有熟人关系遭到损害。②从单个个案来看,熟人双重关系的影响可分为有利无害、既有利也有害、有害无利这三种情况。 6.导致熟人双重产生不利影响的7个风险因素分别为：①角色冲突；②咨访双方角色定位模糊；③心理咨询与治疗界限设置的不规范；④心理咨询与治疗师对保密的重视程度不足；⑤心理咨询与治疗师专业伦理敏感性低；⑥专业伦理技能缺乏,⑦专业胜任力不足。 7.资深心理咨询与治疗师为熟人咨询与治疗中较常采用的7个应对策略：①为了关系的和谐,都会首先答应熟人来访者的请求；②为了保障来访者福祉,综合评估后再决定提供怎样的心理帮助；③清晰而明确地定位双方角色；④主动向来访者强调和说明保密原则,面对主动前来打探情况的熟人仅谈心理健康常识,不谈具体细节；⑤建立和维持有弹性的心理咨询与治疗界限设置；⑥在咨询与治疗过程中保持中立和判断的准确性：⑦普及心理咨询与治疗专业伦理,提前规避熟人双重关系中的风险因素,减少伦理困境的发生。结论 1.心理咨询与治疗师对熟人双重关系的态度存在争议。 2.熟人双重关系的发生很普遍。 3.熟人双重关系普遍发生与我国传统儒家文化和现实从业环境有关。 4.既存在有利的熟人双重关系,也存在有害的熟人双重关系。熟人双重关系性质的好坏取决于心理咨询与治疗师能否有效地应对熟人双重关系发展过程的风险因素。 5.本研究基于我国文化和本土心理咨询与治疗师实践经验所构建的熟人双重关系伦理文化适应决策模型,可助于心理咨询与治疗师更为合理地应对熟人双重关系中的风险因素。 6.中国心理学会临床与咨询心理学工作伦理守则中关于熟人双重关系的规定具有修订的必要性,具体修订建议为： ①心理咨询与治疗师为熟人来访者(例如学生、同事、领导、同学、朋友、邻居、亲戚等)可提供的专业心理帮助包括：一是诊断性访谈,进行心理问题评估,提供导诊服务；二是若需要进一步处理,则可提供意识层面的咨询与治疗(如认知与行为层面的指导、情绪层面的宣泄),但必须在“尊重和促进熟人来访者的福祉”这个最高伦理原则以及“善行”和“无伤害”两个基本伦理价值观的指导下进行,并借助我国熟人双重关系伦理文化适应决策模型来应对熟人双重关系发展过程中的可能风险因素。 ②心理咨询与治疗师不能为有频繁交往的直接熟人提供深入的潜意识层面的咨询与治疗(如心理动力学取向的心理咨询与治疗)。研究的特色与创新之处 1.研究视角的特色与创新。过往国内心理咨询与治疗中的双重关系研究主要是借助于国外概念术语及问卷调查工具而进行的研究,这实际是从外部视角来考察我国熟人双重关系议题。本研究从内部视角出发,立足于我国社会文化环境,基于本土心理咨询与治疗师的实践经验,提炼出了具有我国特色的“熟人双重关系”术语,并对熟人双重关系现状与性质进行深入研究,扩充我国现有双重关系的研究视角。 2.研究内容的特色与创新。以往关于熟人双重关系的研究,主要是零散地见于双重关系或整体心理咨询与治疗专业伦理研究中,甚少专门针对熟人双重关系的研究。本研究专门针对我国心理咨询与治疗中熟人双重关系进行了较全面而深入的探究,通过访谈收集了我国心理咨询与治疗师为熟人咨询与治疗的实践经验,通过类属分析法和情境分析法对所收集的素材进行了细致的分析,呈现了熟人双重关系现状,归纳了熟人双重关系的影响、风险因素、发生的原因及其应对策略。并将熟人双重关系置于我国文化背景进行了解读,从而使我国社会文化环境下的心理咨询与治疗熟人双重关系的性质逐步得到澄清。最后还构建了与我国文化相契合的熟人双重关系伦理文化适应决策模型,为现有伦理守则的修订提供了具体的建议,极大地丰富了我国熟人双重关系的研究内容。 3.研究方法的特色与创新。本研究引入质性研究方法,是对国内目前心理咨询与治疗双重关系实证类研究中研究方法较为单一局面(绝大多数是从宏观层面进行的问卷调查类量化研究)的突破。相对于以往的量化研究,本研究通过深度访谈收集心理咨询与治疗中熟人双重关系的一手素材,结合情境分析法和类属分析法在微观层面对熟人双重关系进行细致、动态的描述和分析,更能贴近我国心理咨询与治疗中熟人双重关系真实现状,也更能呈现出该议题的复杂性与情境性,弥补了过往量化研究只能提供心理咨询与治疗师在脱离具体情境下熟人双重关系的伦理意识或行为信息的不足。本研究需改进和深入的方面 1.本研究心理咨询与治疗师样本数量只有10名,因此本研究所得到的结论,要外推到其他心理咨询与治疗师,存在一定的局限性。因此,本研究结论需要后续研究在更大的心理咨询与治疗师样本中加以验证与修正。 2.本研究只从咨询与治疗师的视角对熟人双重关系进行了研究,然而来访者也是熟人双重关系的重要构建者、参与者以及受影响者,因此未来的研究有必要以来访者为研究对象,以便从多个视角更全面地反映熟人双重关系现状与性质。
[Abstract]:Research significance and purpose
The development of psychological consultation and treatment in China has entered the process of Professionalization under the impetus of people's great psychological service demand and national attention. Professional ethics construction is the key to the deepening of psychological consultation and treatment professionalization, in which the double relationship between acquaintances is a prominent issue in the construction of professional ethics in China in.2007. The ethical code for psychological work (First Edition) clearly stipulates that there is a double relationship between avoiding and seeking professional service providers, while domestic research data shows that the incidence of dual relations between psychological consultation and treatment in our country is high, and the psychological counseling and therapists over 1/3 have been related to relatives, friends, neighbors, teachers and students, colleagues, classmates, and fellow townsmen. The acquaintances have provided consultation and treatment, which means that the rights and welfare of the visitors they serve may not be well protected. At the same time, there are also studies pointing out that the existing ethical regulations based on the Western code of ethics do not conform to the cultural characteristics of our country and guide and evaluate the behavior of our psychological counseling and therapists in China. Therefore, it is necessary to make a thorough study of the dual relations of acquaintances under the cultural background of our country and the realistic environment, in order to solve the dilemma of the conflict between the actual behavior of the current psychological consultation and the therapist in the practice of the acquaintances and the existing ethical regulations.
The purpose of this study is to explore the dual relationship of acquaintances in the psychological consultation and treatment practice in our country based on the cultural background and practical environment of our country, and to present the current situation and influence of the dual relationship of the acquaintances in the psychological consultation and treatment of our country, analyze the causes and influencing factors of its existence, and sum up the psychological consultation and treatment of our country. Based on the results of this study, the author interprets the occurrence and development process of the dual relations of acquaintances from the cultural perspective of our country, and constructs a decision-making model of the dual relationship ethics and culture of acquaintances with the culture of our country, and provides specific suggestions for the revision of the existing ethical code.
Object and method
1. research methods
Due to the complexity and situational nature of acquaintances' dual relationship, qualitative research is adopted in this study.
2. sampling method and research object
In this study, the purpose of this study was to select the purpose sampling in the qualitative study, select the psychological consultation and therapist of the psychological consultation and treatment center of the general hospital, psychiatry hospital, college and middle school and other institutions. According to the purpose of the study and the previous research results, the inclusion criteria of the subjects were set as: (1) obtaining the country Psychologist three qualification certificate, or registered psychologist qualification, or psychiatrist's qualification; (2) engaged in psychological counseling and treatment for five years or more. This study uses the most common basic standard in qualitative research - "information saturation" to determine the sample size, that is, when new samples are included, there is no new information. We can stop sampling now. The information reached saturation at 10 people and stopped sampling.
3. research tools
The research tools include: first, the interview outline developed on the basis of previous literature research based on research purposes, used for the collection of data in semi structured interviews; two is the study of the informed consent, the interviewee signed before the interview; the three is the recording tool, prior to the consent of the respondents to the interview full recording; four is the root. According to the experience and reflection of the research process, the research notes are used as reference for data analysis.
4. data analysis
The interview materials were transcribed verbatim, repeated listening and recording and word for word transcript.
Result
1. the psychological consultation and therapist all have contact with the basic ethical concept of "double relations". They have great disagreement about the attitude of "avoiding the double relationship of acquaintances", from very favorable to very disapproving. Most of the respondents are contradictory to the state of the double relationship of acquaintances. On the one hand, it should be in principle. On the other hand, on the other hand, it is hard to avoid.
2. most of the psychological counseling and therapists have encountered students, leaders, colleagues, friends, classmates, relatives and other acquaintances to seek professional psychological help, and have also mentioned psychological counseling and treatment for these acquaintances.
3. the common understanding of the dual relationship between psychological counseling and therapists on acquaintances - the key to the attention of the two parties to the "relationship" and the psychological consultation and the therapist to shoulder multiple identities and roles.
4. in the dual relationship between psychological consultation and therapists and visitors, the relationship of acquaintances can be divided into direct and indirect types, and professional relationships can be divided into guidance, real and empathy. In addition to the mismatch between direct acquaintances and empathy specialties, other acquaintances and professional relationships are all under certain conditions. It is possible to match. It is not appropriate for psychological counseling and therapists to provide in-depth subconscious counseling and treatment (such as psychological counseling and treatment) for direct acquaintances with frequent contacts (such as psychological counseling and treatment), and to provide in-depth subconscious counseling and treatment for less exposed acquaintances (such as psychological dynamics). Psychological counseling and treatment is appropriate under certain conditions, and it is also appropriate to provide an indirect or direct acquaintance with the first diagnostic interview or a superficial awareness level of consultation and treatment (such as the guidance of cognitive and behavioral level and emotional level).
The advantages and disadvantages of the double relationship between 5. acquaintances have two main characteristics: (1) as a whole, the double relationship of the acquaintances not only has a beneficial effect, but also the beneficial psychological help and change in the general consultation and treatment of the acquaintances, that is, the consultation and treatment of the double relationship without acquaintances, as well as the promotion of consultation and treatment. It also has harmful effects, including the lack of ideal psychological help and the possibility of being used or threatened by the visitors, which makes the conflict between the consultant and therapist in the energy and time intensifies and easily produces emotional fatigue, so that the relationship between the former acquaintances of the two parties is damaged. The influence of relationship can be divided into three situations, which are beneficial, harmless, beneficial and harmful, and harmful.
6. the 7 risk factors that resulted in the adverse effects of the acquaintances were: (1) the role conflict; (2) the role orientation of the consultative and visiting parties was vague; (3) the unstandard setting of psychological counseling and treatment boundaries; (4) the lack of attention to the confidentiality of psychological counseling and therapists; and (5) the low ethical sensitivity of psychological counseling and therapists; Lack of ethical skills, inadequate professional competence.
7. senior psychological counseling and therapists have often adopted 7 coping strategies in consultation and treatment of acquaintances: (1) for the harmony of the relationship, the requesting of the acquaintances will be first agreed; (2) what kind of psychological help is provided to ensure the well-being of the visitors and how to provide the psychological help after comprehensive evaluation; and (3) the initiative to define the roles of the two parties clearly and clearly; (4) initiative To emphasize and explain the principle of confidentiality to the visitors, the acquaintances who come to explore the situation voluntarily only talk about the mental health knowledge, and do not talk about the specific details; 5. Establish and maintain a flexible psychological consultation and treatment boundary setting; (6) to maintain the neutrality and the accuracy of judgment in the process of consultation and treatment: (7) popularize the ethics of psychological consultation and treatment professional ethics We should avoid the risk factors in the relationship between acquaintances in advance and reduce the occurrence of ethical dilemmas.
conclusion
1. the attitude of psychological counselling and therapists to the dual relationship between acquaintances is controversial.
The occurrence of the double relationship between 2. acquaintances is very common.
3. the relationship between acquaintances is generally related to our traditional Confucian culture and practical working environment.
4. there is a double relationship between favorable acquaintances and harmful acquaintances. The quality of the double relationship between the acquaintances depends on whether the psychological consultation and therapist can effectively cope with the risk factors of the development of the acquaintances' dual relationship.
5. this study is based on the practice of Chinese culture and local psychological counseling and therapists' practical experience, which can help the psychological consultation and therapist to deal with the risk factors in the relationship of acquaintances more reasonably.
6. there is a need to revise the regulations on the relationship between acquaintances in the code of ethics of clinical and consulting psychology of the Chinese Psychological Association.
Psychological counseling and therapists can provide professional psychological help for acquaintances, such as students, colleagues, leaders, classmates, friends, neighbors, relatives, etc.
First, diagnostic interviews are conducted to assess psychological problems and provide guidance services.
Two, if further treatment is needed, a conscious level of consultation and treatment (such as the guidance of cognitive and behavioral level, emotional level) is provided, but it must be guided by the supreme ethical principles of "respecting and promoting the well-being of the acquaintances of acquaintances", as well as the two basic ethical values of "good" and "no harm". With the help of our acquaintances' dual relationship ethics and acculturation decision-making model, we can deal with the possible risk factors in the development of acquaintances' dual relations.
(2) psychological counseling and therapists can not provide deep subconscious counseling and treatment for direct acquaintances with frequent contacts (psychological counseling and treatment, such as psychological dynamics).
The characteristics and innovation of the research
1. the characteristics and innovation of the research perspective. The research on the double relationship in the past domestic psychological counseling and treatment is mainly by the use of foreign conceptual terms and questionnaire survey tools. This is actually an external perspective to investigate the dual relationship issues of Chinese acquaintances. This study is based on the internal perspective and is based on the social and cultural environment in China, Based on the practical experience of local psychological counseling and therapists, the terminology of "double relations of acquaintances" with Chinese characteristics is extracted, and the current situation and nature of the double relations of acquaintances are deeply studied, and the research perspective of the existing dual relations in China is expanded.
2. the characteristics and innovation of the research content. The previous research on the double relationship of acquaintances is mainly in the study of the dual relationship or the ethical study of the overall psychological consultation and treatment, and little specifically aimed at the study of the double relationship between the acquaintances. This study is aimed at the more comprehensive relationship between the acquaintances and the acquaintances in the psychological consultation and treatment in our country. Through the interview, we collect the practical experience of consultation and treatment for acquaintances and therapists in our country through interviews. Through the analysis of category and situation analysis, this paper makes a detailed analysis of the collected materials, presents the status of the double relations of acquaintances, sums up the influence of the acquaintances, the risk factors, the causes of the occurrence and the reasons for it. In order to clarify the dual relationship between psychological consultation and treatment acquaintances in our social and cultural environment, the dual relations of acquaintances in China's social and cultural environment are gradually clarified. The amendment provides concrete suggestions and greatly enriches the research contents of the dual relationship between acquaintances in China.
3. the characteristics and innovation of the research method. The qualitative research method introduced in this study is a breakthrough in the single situation in the empirical study of the dual relationship of psychological consultation and treatment in China (the vast majority of them are quantitative research on the questionnaire survey from the macro level). On the basis of the detailed and dynamic description and analysis of the double relations between the acquaintances and the acquaintances in the microcosmic layer, the one hand material for collecting the double relations between psychological consultation and the treatment of the acquaintances in the treatment of the acquaintances can be closer to the reality of the double relations of the acquaintances in the psychological consultation and treatment of our country and the complexity and feeling of the issue. In the past, quantitative research can only provide psychological counselling and therapists familiar with the situation.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：B849

【参考文献】