طراحی مدل مفهومی برای تبیین روابط درمانی بین نوجوانان و درمانگران‌ ایرانی: نظریه داده بنیاد

نوع مقاله : مقاله پژوهشی

نویسندگان

1 کارشناسی ارشد روانشناسی بالینی،دانشکده روانشناسی و علوم تربیتی دانشگاه خاتم، تهران، ایران

2 استادیار گروه روان‌شناسی تربیتی و مشاوره، ،دانشکده روانشناسی و علوم تربیتی دانشگاه تهران، تهران، ایران

3 دکتری مشاوره، دانشکده روان‌شناسی و علوم تربیتی، دانشگاه اصفهان، اصفهان، ایران

چکیده

هدف: این پژوهش با هدف شناسایی تجارب نوجوانان و درمانگران ایرانی از رابطۀ درمانی و واکاوی راهبردها، شرایط علی، مداخله­گر، زمینه‌­ای و پیامدهای رابطۀ درمانی انجام شد.
روش‌ها: روش پژوهش حاضر کاربردی و از نوع کیفی نظریه داده­بنیاد می­باشد. جامعه این پژوهش شامل نوجوانان 15-18 ساله دارای سابقه مراجعه به روان­درمانی و درمانگران شهر تهران در سال 1400-1401 بود. نمونه­گیری به صورت هدفمند و تا مرز اشباع نظری و نهایتاً انتخاب 18 نوجوان و 7 درمانگر ادامه یافت. شرکت­کنندگان مورد مصاحبه­های نیمه ساختار یافته قرار گرفتند. به منظور تحلیل داده‌ها از روش تحلیل مضمون کوربین و اشتراوس (2014) استفاده شد.
یافته‌ها: تجزیه و تحلیل داده­ها منجر به تولید 6 مضمون اصلی شامل چالش­های رابطۀ درمانی درمانگر با نوجوان، عوامل علّی، عوامل زمینه­ای، عوامل مداخله‌گر، راهبردها و پیامدها شده است. همچنین 17 مضمون محوری شامل تجارب ناخوشایند انتقال داده شده در رابطۀ درمانی، رابطۀ درمانی در زیر سایه ترس­ها و نگرانی­های شخصی، عوامل درونی، عوامل بیرونی، صلاحیت­های شخصیتی، شاخص­های ظاهری، صلاحیت‌های اخلاقی و علمی، عوامل کلان، عوامل خانوادگی، عوامل فرهنگی، عوامل اجتماعی، راهبردهای سوق دهنده و انگیزشی، راهبردهای انفعالی، پیامدهای تحصیلی، هیجانی، شناختی، رفتاری و 89 مفهوم اولیه شد.
نتیجه‌گیری:  در مجموع نتایج این پژوهش نشان داد که میزان مطلوب بودن یا نبودن رابطۀ درمانی به نحوه بکارگیری راهبردهای درمانگران و صلاحیت‌های شخصیتی، شاخص‌های ظاهری و صلاحیت‌های اخلاقی و علمی بستگی دارد.

کلیدواژه‌ها

عنوان مقاله [English]

Designing a conceptual model to explain the therapeutic relationships between adolescents and Iranian therapists: Grounded theory

نویسندگان [English]

  • Farnaz Abbas Yazdian 1
  • Somayeh Shahmoradi 2
  • Fahimeh Bahonar 3
1 MSc, Clinical psychology, psychology and Educational Science Faculty, University of Khatam, Tehran, Iran.
2 Assistant Professor, Department of Educational Psychology and Counseling, Faculty of Psychology and Educational Sciences, University of Tehran
3 PhD Student, Department of Counseling, psychology and Educational Science Faculty, University of Isfahan, Isfahan, Iran.
چکیده [English]

Objective: This research was conducted with the aim of identifying the experiences of Iranian adolescents and therapists from the therapeutic relationship and analyzing the strategies, causal, intervening, contextual conditions and consequences of the therapeutic relationship.
Methods: The current research method is practical and qualitative type of grounded theory. The population of this research included adolescents aged 15-18 years who had a history of referral to psychotherapy and therapists in Tehran in 2021-2022. Sampling continued in a purposeful manner until the limit of theoretical saturation and finally 18 teenagers and 7 therapists were selected. The participants were subjected to semi-structured interviews. In order to analyze the data, Corbin and Strauss (2014) theme analysis method was used.
Results: Data analysis has led to the production of 6 main themes including the challenges of the therapeutic relationship between the therapist and the adolescent, causal factors, background factors, intervening factors, strategies and consequences. Also, 17 core themes including unpleasant experiences transmitted in the therapeutic relationship, therapeutic relationship under the shadow of personal fears and concerns, internal factors, external factors, personality qualifications, appearance indicators, moral and scientific qualifications, factors Macro, family factors, cultural factors, social factors, driving and motivational strategies, passive strategies, educational, emotional, cognitive, behavioral and 89 concepts were the primary concepts.
Conclusion: Overall, the results of this research showed that the degree of the therapeutic relationship being desirable or not depends on the way therapists use strategies and personality qualifications, appearance indicators and moral and scientific qualifications.

کلیدواژه‌ها [English]

  • Therapeutic relationships
  • therapist
  • teenagers
  • grounded theory

مراجع

بازرگان، عباس (1402). مقدمه­ای بر روش­های تحقیق کیفی و آمیخته: رویکردهای متداول در علوم رفتاری. تهران: نشر دیدار.
https://www.adinehbook.com/gp/product/6001040320
بنی­اسد، علی و صالحی، کیوان (۱۳۹۸). مقدمه­ای بر اصول و فرایند ساخت و رواسازی  پروتکل مصاحبه، مجله نامه آموزش عالی، ۱۲(۴۶)، ۲۰۳-۱۷۷. https://journal.sanjesh.org/article_36128.html
تدین چهارسوقی، بتول؛ ایزدی، نقوی. (1400). اتحاد درمانی در مشاوره از راه دور: تجارب افراد مبتلا به اختلال وسواس فکری‌ـ‌عملی و مشاوران. پژوهش های علوم شناختی و رفتاری، ۱۱(۲)، ۷۳-۱۰۶.  [Doi:10.22108/cbs.2022.132192.1616]
خاک پور، رضا؛ و شفیع ابادی، عبدالله (۱۳۸۹)،اثر بخشی گروه درمانی آموزش حساسیت و تعلیمی بر کاهش اشتباهات مشاوران و روان درمانگران، نشریه دانشگاه آزاد اسلامی رودهن، ۱۵(4)، ۱۹ تا ۲۳. https://www.sid.ir/paper/172100/fa
دشتی، محمد (1392). سنگ صبور بچه ها باشیم. فصلنامه رشد آموزش مشاوره مدرسه، 8(4)، 19-15
رضایی، لیبا؛ حیدری، شیما؛ رضایی، فرزین و خزایی، حبیب‌الله (۱۴۰۰)، چالش‌ها و فرصت‌های پیش روی روان درمانی در ایران: یک مطالعه کیفی، مجله روان‌شناسی و روانپزشکی شناخت، ۸(۲)، ۱-۱۳  [Doi:10.32598/shenakht.8.2.1]
شفیع آبادی، عبدالله (1394). روش ها و فنون مشاوره، چاپ پانزدهم، تهران: کتاب فکرنو.
Baniasadi, A., & Salehi, K. (2019). Introduction on the Principles and Process of Construction and Validation of the Interview Protocol. Higher Education Letter, 12(46), 177-203. (Persian). https://journal.sanjesh.org/article_36128.html?lang=en
Bazargan, A. (2023). An introduction to qualitative and mixed research methods: common approaches in behavioral sciences. Fifth edition, Tehran: Didar publishing. (Persian). https://www.adinehbook.com/gp/product/6001040320.
Beck, A. T. (1979). Cognitive therapy and the emotional disorders. Penguin.‏ https://www.amazon.com/Cognitive-Therapy-Emotional-Disorders-Aaron/dp/0452009286
Blackmore S., Burnett S. & Dahl R. (2010). The role of puberty in the developing adolescent brain. Hum Brain Mapp. 31(6) 926–933. [Doi:10.1002/hbm.21052]
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychother. Theory Res. Pract. 16, 252–260. [Doi:10.1037/h0085885]
Charmaz, K., & Thornberg, R. (2021). The pursuit of quality in grounded theory. Qualitative research in psychology, 18(3), 305-327.‏ [Doi:10.1080/14780887.2020.1780357]
Corbin, J., & Strauss, A. (2014). Basics of qualitative research: Techniques and procedures for developing grounded theory. Sage publications. [Doi:10.20696/jagn.11.1_12]
Daniel SI. (2006). Adult attachment patterns and individual psychotherapy: a review. Clin Psychol Rev, 26(8):968-984. [Doi:10.1016/j.cpr.2006.02.001]
Dashti, M. (2012). Let's be patient children. School Counseling Education Growth Quarterly, 8(4), 15-19. (Persian(
Davison, K.K., Charles, J.N., Khandpur, N. & Nelson, T.J. (2017). Fathers’ perceived reasons for their underrepresentation in child health research and strategies to increase their involvement. Maternal and child health journal, 21 (2), 267– 274. [Doi:10.1007%2Fs10995-016-2157-z]
De Haan, A., Boon, A., De Jong, J., Hoeve, M., and Vermeiren, R. (2013). A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clin. Psychol. Rev. 33, 698–711. [Doi:10.1016/j.cpr.2013.04.005]
Devlin, A.S. (1992). Psychiatric Ward Renovation. Environment and Behavior, 24(1), 66-84.
Ellis, A. (1962). Reason and emotion in psychotherapy.‏ Secaucus, NJ: Citadel Press.
Evans GL. (2013).A novice researcher’s first walk through the maze of grounded theory. Grounded Theory Review. 12(1), 100-120.
Flückiger C., Del Re A., Wlodasch D., Horvath A., Solomonov N., & Wampold B. (2020). Assessing the alliance-outcome association adjusted for patient characteristics and treatment processes: A meta-analytic summary of direct comparisons. J Couns Psychol, 1(5), 122-145. [Doi:10.1037/cou0000424]
Fox C. L., & Butler I. (2007). “If you don’t want to tell anyone else you can tell her”: Young people’s views on school counselling. British Journal of Guidance & Counselling, 35(1), 97–114. [Doi:10.1080/03069880601106831]
Freud, J. (1912). The dynamics of transference The standard edition of the complete psychological works of Sigmund Freud ed. Strachey, J. London: Hogarth Press98-108
Gelso, C. J. (2011). The real relationship in psychotherapy: The hidden foundation of change.
Gesler, W., Bell, M., Curtis, S., Hubbard, P., & Francis, S. (2004). Therapy by design: Evaluating the UK hospital building program. Health & Place, 10(2), 117–128. [Doi:10.1016/S1353-8292(03)00052-2]
Goodwin J., Savage E., Horgan A. (2016). Adolescents’ and young adults’ beliefs about mental health services and care: A systematic review. Archives of PsychiatricNursing,30(5),636–644. [Doi:10.1016/j.apnu.2016.04.004]
Geranmayeh, S., & Azadfallah, P. (2020). The relationship between countertransference and self-regulation process in Iranian psychotherapists. Clinical Psychology Studies, 10(39), 1-17. (Persian( [Doi: 10.22054/jcps.2020.20719.1611]
Green, H., McGinnity, Á, Meltzer, H., Ford, T. & Goodman, R. (2005). Mental health of children and young people in Great Britain, 2004. (1403986371). Basingstoke: Palgrave Macmillan. https://sp.ukdataservice.ac.uk/doc/5269/mrdoc/pdf/5269technicalreport.pdf
Green, J. (2009). The therapeutic alliance. Child: Care, Health and Development, 35 (3), 298–301. [Doi:10.1111/j.1365-2214.2009.00970.x]
Greenberg, L. S. (2004). Emotion–focused therapy. Clinical Psychology & Psychotherapy, An International Journal of Theory & Practice, 11(1), 3-16.‏ [Doi:10.1002/cpp.388]
Greenson, R.R. (1965). The working alliance of shame social anxiety and depression. psychoanalytic quarterly, 34, 155 – 181
Gross V., & Goldin J. (2008). Dynamics and dilemmas in working with families in inpatient CAMH services. Clin Child Psychol Psychiatry. 13(3), 449–461. [Doi:10.1177/1359104507088350]
Guba, E. G., & Lincoln, Y. S. (1994). Competing paradigms in qualitative research. Handbook of qualitative research, 2(163), 105 -118. [Doi: 1994-98625-005]
Hackett C. L., Mulvale G., Miatello A. (2018). Co-designing for quality: Creating a user-driven tool to improve quality in youth mental health services. Health Expectations, 21(6), 1013–1023. [Doi:10.1111/hex.12694]
Hartley, S., Redmond, T., & Berry, K. (2022). Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff. Plosone, 17(1),e0262070.‏‏ [Doi:10.1371/journal.pone.0262070]
Hauber, K., Boon, A., and Vermeiren, R. R. (2017). Examining changes in personality disorder and symptomology in an adolescent sample receiving intensive mentalization based treatment - a pilot study. Child Adolesc. Psychiatry Ment. Health 11:58. [Doi:10.1186/s13034-017-0197-9]
Huggett, C., Gooding, P., Haddock, G., Quigley, J., & Pratt, D. (2022). The relationship between the therapeutic alliance in psychotherapy and suicidal experiences: A systematic review. Clinical Psychology & Psychotherapy, 29(4), 1203-1235.‏ [Doi:10.1002/cpp.2726]
Jones S., Hassett A., Sclare I. (2017). Experiences of engaging with mental health services in 16- to 18-year-olds: An interpretative phenomenological analysis. SAGEOpen,7(3).https://organizers-congress.org/frontend/index.php?page_id=2411&v
Karver, M. S., Handelsman, J. B., Fields, S., and Bickman, L. (2006). Meta-analysis of therapeutic relationship vairables in youth and family therapy: the evidence for different relationship variables in the child and adolescent outcomeliterature. Clin.Psychol. Rev. 26,50–65. [Doi:10.1016/j.cpr.2005.09.001]
Kelly, G. (1955). Personal construct psychology. Nueva York: Norton.‏ https://www.researchgate.net/profile/Joan-Medina
Khakpour, R., & Shafi Abadi, A. (2008), The effectiveness of sensitivity training and educational group therapy on reducing the mistakes of counselors and psychotherapists, Roudhan Islamic Azad University Journal, 15(4), 19-23. (Persian( https://www.sid.ir/paper/172100/fa
Kim-Cohen, J, Caspi, A, Moffitt, T.E &et al (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry,  60, 709–717. [Doi:10.1001/archpsyc.60.7.709]
Knutzen, M. (2020). A Phenomenological Inquiry Into the Client Experience of the Psychotherapy Relationship (Doctoral dissertation, Antioch University).‏ http://rave.ohiolink.edu/etdc/view?acc_num=antioch1608325158481581
Kramer, U., Fisher, S., & Zilcha‐Mano, S. (2022). How Plan Analysis can inform the construction of a therapeutic relationship. Journal of Clinical Psychology, 78(3), 422-435.‏ [Doi:10.1002/jclp.23300]
Lambert M. J. (2013). Bergin and Garfield’s handbook of psychotherapy and behavior change. Hoboken, NJ, US: John Wiley & Sons Inc Lawrence ErlbaumAssociates. https://books.google.com/books?hl=fa&lr=&id=7VsGNYd5PqsC&oi=fnd&pg=PR9&dq=Lambert+M.+J 
Lear, J. (2003). Therapeutic Action: An Earnest Plea for Irony. New York: Other Press. https://books.google.com/books?id=3dnLLMGpbJoC
Lynch, L., Moorhead, A., Long, M., & Hawthorne-Steele, I. (2021). What Type of Helping Relationship Do Young People Need? Engaging and Maintaining Young People in Mental Health Care—A Narrative Review. Youth & Society, 53(8), 1376–1399. [Doi:10.1177/0044118X20902786]
Moeini, B, Bashirian, S, Soltanian, AR, Ghaleiha, A, & Taheri, M. (2019). Prevalence of depression and its associated sociodemographic factors among Iranian female adolescents in secondary schools. BMC Psychol. 7(1):1-10.[Doi:10.1186/s40359-019-0298-8]
Muran JC. (2019). Confessions of a New York rupture researcher: An insider's guide and critique. Psychother Res, 29(1):1-14. [Doi:10.1080/10503307.2017.1413261]
Muran, J. C., Safran, J. D., Gorman, B. S., Samstag, L. W., Eubanks-Carter, C., & Winston, A. (2009). The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders. Psychotherapy, 46(2), 233–248. https://psycnet.apa.org/doi/10.1037/a0016085
Noble, Lilly, & Ann Sloan Devlin. (2021). Perceptions of psychotherapy waiting rooms: design recommendations." HERD: Health Environments Research & Design Journal, 140-154.‏ [Doi:10.1177/19375867211001885]
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303 315. [Doi:10.1037/pst0000193]
Núñez, L., Fernández, S., Alamo, N., Midgley, N., Capella, C., & Krause, M. (2022). The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(1).‏ [Doi:10.4081/ripppo.2022.556]
O’Connor, K., Jr., Hill, C. E., & Gelso, C. J. (2019). Therapist-client aggreement about their working alliance: Associations with attachment styles. Journal of Counseling Psychology, 66(1), 83–93. https://psycnet.apa.org/doi/10.1037/cou0000303
O'Keeffe, S., Martin, P. & Midgley, N. (2020). When adolescents stop psychological therapy: Rupture–repair in the therapeutic alliance and association with therapy ending. Psychotherapy, 57 (4), 471–490. [Doi:10.1037/pst0000279]
Ormhaug, S. M., Shirk, S. R., and Wentzel-Larsen, T. (2015). Therapist and client perspectives on the alliance in the treatment of traumatized adolescents. Eur. J. Psychotraumatol. 6:27705. [Doi:10.3402/ejpt.v6.27705]
Owen, J., Miller, S. D., Seidel, J., and Chow, D. (2016). The working alliance in treatment of military adolescents. J. Consult. Clin. Psychol. 84, 200–210. [Doi:10.1037/ccp0000035]
Pearson, M., & Wilson, H. (2012). Soothing spaces and healing places: Is there an ideal counselling room design? Psychotherapy in Australia, 18(3), 46-53. http://search.informit.com.au/documentSummary;dn
Persson S., Hagquist C., Michelson D. (2017). Young voices in mental health care: Exploring children’s and adolescents’ service experiences and preferences. Clinical Child Psychology and Psychiatry, 22(1), 140–151. [Doi:10.1177/1359104516656722]
Petre, D. A. (2022). The role of decor and clothing in psychotherapeutic practice and research. Counselling and Psychotherapy Research.‏ [Doi:10.1002/capr.12598]
Post, Brian C., and Nathaniel G. Wade. (2009). Religion and spirituality in psychotherapy: A practice‐friendly review of research. Journal of clinical psychology, 131-146.‏ [Doi:10.1002/jclp.20563]
Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European child & adolescent psychiatry, 30(2), 183-211.‏ [Doi:10.1007/s00787-019-01469-4]
Rezaie, L., Heydari, S, Rezaei, F., & Khazaie, H. (2021). The challenges and opportunities for psychotherapy in Iran: a qualitative study. Shenakht Journal of Psychology and Psychiatry, 8 (2), 1-13. (Persian( [Doi:10.32598/shenakht.8.2.1]
Rickwood D., Deane F. P., Wilson C. J. (2007). When and how do young people seek professional help for mental health problems? The Medical Journal of Australia, 187, S35–S39. [Doi:10.5694/j.1326-5377.2007.tb01334.x]
Robin D. Everall & Barbara L. Paulson (2002). The therapeutic alliance: Adolescent perspectives, Counselling and Psychotherapy Research, 2(2), 78-87. [Doi:10.1080/14733140212331384857]
Rogers, C.R. (1951). Client-centered therapy: Its current practice, implications and theory. Boston: Houghton Mifflin.
Rosenberg, H., Ophir, Y., & Billig, M. (2021). OMG, RU OK? Therapeutic relationships between caregivers and youth at risk on social media. Children and youth services review, 120, 105365.‏ [Doi:10.1016/j.childyouth.2020.105365]
Ryan, R., Berry, K., Law, H., & Hartley, S. (2021). Therapeutic relationships in child and adolescent mental health services: A Delphi study with young people, carers and clinicians. International Journal of Mental Health Nursing, 30(4), 1010-1021.‏ [Doi:10.1111/inm.12857]
Shafi Abadi, A. (2022). Counseling methods and techniques (clinical interview). 39th edition, Fekrno Publishing, Tehran. (Persian( https://www.roshdpress.ir/product-2361D8%B1%D9%88%D8%B4_%D9%87%D8html
Tadayon Chaharshughi, B., Izadi, R., & Naghavi, A. (2021). Therapeutic Alliance in Tele-Counseling: The Experiences of Patients with Obsessive-Compulsive Disorder and Counselors. Research in Cognitive and Behavioral Sciences, 11(2), 73-106. (Persian( [Doi: 10.22108/cbs.2022.132192.1616]
Tschuschke, V., Koemeda-Lutz, M., von Wyl, A., Crameri, A., & Schulthess, P. (2022). The impact of clients’ and therapists’ characteristics on Therapeutic Alliance and Outcome. Journal of Contemporary Psychotherapy, 52(2), 145-154.‏ [Doi:10.1007/s10879-021-09527-2]
Williams D. J. (2012). Where do Jamaican adolescents turn for psychological help? Child & Youth Care Forum, 41(5), 461–477. [Doi:10.1007/s10566-012-9177-7]
Wilson C. J., Deane F. P. (2001). Adolescent opinions about reducing help-seeking barriers and increasing appropriate help engagement. Journal of Educational and Psychological Consultation, 12(4), 345–364. [Doi:10.1007%2Fs10566-012-9177-7]
Wolberg, L.R., (2013). The technique of psychotherapy. 4th ed. New York: Grune &Stratton. http://hdl.handle.net/123456789/6481
World Health Organization (2018). Child and adolescent mental health. Retrieved from
Zilcha-Mano, S. (2017). Is the alliance really therapeutic? Revisiting this question in light of recent methodological advances. American Psychologist, 72(4), 311–325. [Doi:10.1037/a0040435]

فایل ها

هم رسانی

ارجاع به این مقاله

آمار