心理治療中成年初顯期個案的中途流失現象之調查研究

Abstract

本研究旨在探討成年初顯期的個案自行決定中止心理諮商或心理治療的經驗，藉由研 究者自編的調查問卷，了解哪些因素與此決定有關。在問卷中，研究者以 18 歲至 29 歲的 成年人為研究對象，且近兩年內曾在大專院校、社區諮商所、身心科診所或醫院接受至少 一次的心理諮商或心理治療，最後自行中止晤談者。研究者透過問卷了解個案之背景因素、 個案決定中止心理治療之內外因素、個案當時接受的心理諮商治療之形式、提供服務的心 理專業人員之特徵，並請個案針對晤談提供質性回饋。本研究共收回 207 份有效樣本，研 究結果顯示:(1)個案中止心理諮商/治療的原因比率，從比率最高的原因，依序排列為 晤談感受不佳;對心理師不滿;身心狀況變好;生活的變動;身心狀況變差;擔心他人看 法;非自願前往，行政流程感受不佳(1.54%)。(2)除了上述原因外，在質性回饋中，個 案也曾提及因對心理師的討好感到不真誠、對晤談感到抗拒以及對於結束的複雜感受而選 擇中止晤談。(3)接受心理諮商/治療超過兩次的個案，選擇身心狀況變好的比率顯著多 於諮商兩次內的個案。研究結果則顯示兩者具有顯著差異。(4)心理師的工作年資與個案 的中途流失原因兩者並無顯著關聯。(5)個案付費與否與個案的中途流失原因並無顯著關 聯。(6)個案在是否仍願意再次回到晤談的考量上，與中途流失的原因有顯著關聯。(7) 願意再次尋求心理諮商/治療的比率有高達 86.5%。(8)多數的個案皆在 1 至 6 次晤談間 中止心理諮商/治療。(9)若不計個案中止晤談的原因，晤談超過兩次的個案相較晤談兩 次內的個案的來談困擾程度皆顯著下降。最後，本研究就上述結果進行討論，提出諮商實 務工作及未來研究方向建議。

This research aimed to explore the experiences of emerging adult clients who have decided to terminate their psychotherapy without discussing with their therapists. Through a researcher- developed survey, we aimed to understand the factors associated with such decisions. The study focused on adults aged 18 to 29 years who have received psychotherapy at least once in the past two years from universities, community counseling centers, mental health clinics, or hospitals, and have subsequently terminated the treatment without discussing with their therapists. The survey gathered information on background factors, internal and external factors leading to the decision to terminate psychotherapy, the psychotherapy setting and modality, bacgrounds of therapists providing the service, and qualitative feedback from clients regarding their counseling experience. The study collected a total of 207 valid samples, and the results are as follows: (1) Reasons for clients’ dropout of psychotherapy, ranked in descending order of frequency: Experiencing negative feelings about the sessions; dissatisfaction with the therapist; improvement in mental and physical condition; changes in life circumstances/external factors; deterioration in mental and physical condition; concern about others’ opinions; attending counseling involuntarily; and dissatisfaction with administrative procedures. (2) In addition to the reasons mentioned above, the qualitative feedback also revealed other factors contributing to their decision to dropout. In certain cases, clients mentioned feeling their therapists aren’t genuine, experiencing resistance towards the counseling process, and experiencing complex emotions surrounding the termination of psychotherapy. (3) The proportion of clients who chose “improvement in mental and physical condition” as the reason for dropout was significantly higher among those who had received psychotherapy more than twice compared to those who terminated within the first two sessions. The research findings demonstrated a significant difference between the two groups. (4) There was no significant association between the seniority of the therapist and the reasons for dropout. (5) There was no significant association between the payment status (whether the client paid for the psychotherapy or received it free of charge) and the reasons for dropout. (6) There was a significant association between clients’ willingness to return psychotherapy and the reasons for dropout. (7) The proportion of clients willing to seek psychotherapy again is as high as 86.5%. (8) The majority of clients terminated psychotherapy within 1 to 6 sessions. (9) If disregarding the reasons for dropout, clients who attended more than two sessions showed a significant decrease in the level of distress compared to those who terminated within the first two sessions. In the last sections of the study, the results were discussed, along with suggestions for psychotherapy practice and future research directions.