장기상담에서의 내담자 변화 과정과 치료적 촉진 요인에 대한 다중사례연구: 상담자와 내담자의 관점을 중심으로

초록

This study aimed to explore the psychological change processes experienced by clients in long-term psychotherapy and the therapeutic factors that facilitated these changes. In-depth semi-structured interviews were conducted with three clients who had experienced long-term psychotherapy (more than 40 sessions or over one year), and three therapists who had conducted more than 30 cases of long-term psychotherapy. The collected data were analyzed using a multiple case study method, incorporating both within-case and cross-case analysis. As a result, seven categories were identified under the domain of "clients’ psychological change processes": cognitive insight and behavioral change, deep emotional experiences and gradual affect integration, restoration of the sense of self and identity, reconstruction and transformation of relational patterns, repetitive experiences of change and stagnation, therapist internalization through repeated relationship experiences, and settlement and maintenance of change. Additionally, nine categories emerged under the domain of "therapeutic facilitative factors": psychological nurturing experiences, formation of trust based on consistent attitude and sustained relationship, fine-tuned coordination and therapeutic use of transference and countertransference, ongoing emotional containing and facilitation of affective experience, exploration of underlying emotions and meanings beyond defenses, integrative case understanding and macroscopic perspective, awareness and patience for the long-term change process, clinical expertise for long-term psychotherapy, and deep respect for the client’s unique individuality. Based on the findings, implications and limitations of the study and suggestions for future research were discussed.

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