電話諮商的協助歷程：戒菸個案的觀點

The Helping Process of Quitline Counseling: Clients' Viewpoints

10.7040/JGC.200705.0047

張景然(Ching-Jan Chang o)；王珮蘭(Pei-Lan Wang)

戒菸 ； 戒菸電話 ； 質性研究 ； 電話諮商 ； 協助歷程 ； helping process ； qualitative research ； quitline ； smoking cessation ； telephone counseling

輔導與諮商學報

29卷1期（2007 / 05 / 01）

47 - 66

繁體中文

本研究旨在探討個案在戒菸電話諮商中所出現戒菸前的心理衝突及面對與處理戒菸不同階段的體驗與歷程，藉由個案回溯諮商歷程中改變的契機，作為將來建立戒菸電話諮商中個案的改變模式。研究者採取質性研究中的文件分析法與深度訪談法進行資料收集與分析，藉此進行兩者相互資料比對，俾便以更為客觀的角度探討吸菸者在戒菸電話諮商中的歷程。透過三角校正工作進行分析、歸類與概念化，期使研究結果更具可信度。 研究結果發現十六名參與研究訪談的個案過去經歷數次戒菸失敗經驗，故一開始對於戒菸電話諮商抱著姑且一試的心態，在諮商員提供真誠、支持、關懷的態度中，個案才逐漸正視戒菸電話諮商，同時開始體驗戒菸歷程中出現種種生理不適應與心理掙扎，期間更面臨復發挑戰，甚至興起隱瞞諮商員的念頭，但在諮商員無條件的關懷與接納下坦承接受復發的困境，並重新設定戒菸目標，藉由短期諮商尋找個案正向資源，並且搭配認知與行為上的調整逐漸戒菸成功。 本研究建議戒菸個案除了在戒菸行為上可以搭配多種戒菸方法，心理上也可以透過自我內在語言改變戒除心理依賴，並且提前做好自我認同角色的改變。諮商工作者也可以嘗試運用家庭系統觀詮釋個案戒菸歷程，並在初期仔細評估個案的期待以作為後續諮商計畫的參考。

The purpose of the present study was to understand the junior high school dropout-at-risk students' dropout intention and related factors. The present study randomly surveyed 327 junior high school dropout-at-risk students. There were eight instruments applied in this study: ”academic performance” scale, ”school relationship” scale, ”others way” scale, ”dropout intention” scale, ”external commitment” scale, ”joining out-school deviant peer group” scale, ”academic self-esteem” scale and ”behavior” scale. The data were analyzed with a number of descriptive statistic methods, Person correlation t-test and structured equation model. The results of this study were listed as follows. 1. The junior high school dropout-at-risk students had lower performance than the general junior high school students on the academic performance and academic self-esteem, rather than on deviant behaviors. 2. There was no significant difference in the school relationship between the junior high school dropout-at-risk students and the general junior high school students. 3. The academic performance and deviant behaviors of junior high school dropout-at-risk students were highly related to the school relationship. 4. The deviant behavior of junior high school dropout-at-risk students was highly related to joining out-school deviant peer group. 5. The academic performance, the school relationship, the deviant behaviors, and other behaviors of the junior high school dropout-at-risk students were highly related to the academic self-esteem. 6. The deviant behavior, joining out-school deviant peer group of the junior high school dropout-at-risk students were highly related to the external commitments. 7. The other behaviors and the external commitments of the junior high school dropout-at-risk students were highly related to the dropout intention. 8. The junior high school dropout-at-risk students' dropout intention and its related factors model were supported. According to the results, a number of specific suggestions for clinical workers and future researches were provided.

1. 張景然、王珮蘭(2004)。吸菸行為的形成、持續、戒斷與復發歷程。中華心理衛生學刊，17(4)，29-66。
   連結：
2. 張德聰、潘瑞香、張景然(2006)。單次與多次電話諮商戒菸成效之比較：以戒菸專線服務中心爲例。中華心理衛生學刊，19(3)，213-230。
   連結：
3. American Psychiatric Association(1994).Diagnostic and statistical manual of mental disorders DSM-IV.Washington, DC:American Psychiatric Association.
4. Psychological research offers reasons for smoking behavior craving cigarettes not necessarily associated with abstience heigh self-esteem impedes effort to quit
5. Baer, J. S.,Holt, C. S.,Lichtenstein, E.(1986).Self-efficacy and smoking reexamined: Construct validity and clinical utility.Journal of Consulting and Clinical Psychology,6,846-852.
6. Brownell, K. D.,Marlatt, G. A.,Lichtenstein, E.,Wilson, G. T.(1986).Understanding and preventing relapse.American Psychologist,41,765-782.
7. Cinciripini, P. M.,Lapitsky, L.,Seay S.,Wallfish, N.,Kitchens, K.,Vunakis, H. V.(1995).The effects of smoking schedules on cessation outcome: Can we improve on common methods of gradual and abrupt nicotine withdrawal.Journal of Consulting and Clinical Psychology,63,388-399.
8. Hellman, R.,Cummings, K. M.,Hanghey, B. P.,Zielezny, M. A.(1991).Predictors of attempting and succeeding at smoking cessation.Health Education Research,6(1),77-86.
9. Krogh, D.著、潘震澤譯(2000)。幹嘛要吸菸？。台北:天下遠見。
10. Lichtenstein, E.,Glasgow, R. E.,Abrams, D.(1986).Social support in smoking cessation: In search of effective interventions.Behavior Therapy,17,607-619.
11. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Newbury Park, CA:Sage.
12. Marlatt, G.A.,Gordon, J.R. (Eds.)(1985).Relapse prevention: maintenance strategies in the treatment of addictive behaviors.New York:The Guilford Press.
13. McAlister, A.,A.M. Enelow,J.B. Henderson (Eds.)(1975).Applying behavioral science to cardiovascular risk.New York:American Heart Association.
14. Mermelstein, R.,Lichtenstein, E.,McIntyre, K.(1983).Partner support and relapse in smoking cessation programs.Journal of Consulting and Clinical Psychology,51,465-466.
15. Miller, W.R.,Rollnick S.(1991).Motivational interviewing-preparing people to change addictive behavior.New York:The Guilford Press.
16. Ney, T.,Gale, A.(1989).Smoking and human behavior.New York:John Wiley & Sons.
17. Orford J.(1985).Excessive appetites: A psychological view of addictions.New York:Wiley & Sons.
18. Patton, M. Q.(1990).Qualitative evaluation and research methods.Newbury Park, CA:Sage.
19. Prochaska, J. O.,DiClemente C. C.,Norcross J. C.(1992).In search of how people change: Application to addictive behaviors.American Psychology,47(9),1102-1114.
20. Schwartz(1992).Methods of smoking cessation.Medical Clinics of North America,76(2),451-476.
21. Strauss, A.、Corbin, J.著、徐宗國譯(1997)。質性研究概論。台北:巨流。
22. Zhu S.-H, Tedeschi G. J.,Anderson, C. M.,Pierce J. P.(1996).Telephone counseling for smoking cessation: What`s in a call.Journal of Counseling & Development,75,93-102.
23. Zhu S.-H.,Rosbrook, B.,Anderson, C. M.,Gilpin, E.,Sadler, G.,Pierce, J. P.(1995).The demographics of help-seeking for smoking cessation in California and the role of the California Smokers` Helpine.Tobacco Control,4(1),9-15.
24. Zhu, S. -H.,Stretch, V.,Balabnis, M.,Rosbrook, B.,Sadler, G..,Pierce, J. P.(1996).Telephone counseling for smoking cessation: Effects of single-session and multiple-session interventions.Journal of Consulting and Clinical Psychology,64,202-211.
25. 李燕鳴(2001)。戒菸諮詢。台灣醫界，41(5)，401-403。
26. 邱南英(1999)。非藥物的戒菸方法。大豐醫療資訊，166，5-6。
27. 洪莉竹、許維素、樊雪春、賈紅鶯、李玉嬋、張德聰、陳秉華編(1998)。焦點解決短期心理諮商。台北:張老師文化。
28. 郭許智、謝文斌(1997)。菸害危險性與戒菸研究之進展。當代醫學，24(11)，16-19。
29. 台大醫網
30. 陳惠珍(1994)。碩士論文(碩士論文)。台灣大學公共衛生研究所。
31. 陳晶瑩(2000)。如何幫助病人戒菸。當代醫學，27(1)，49-56。
32. 台大醫網
33. 廖秀珠(1995)。碩士論文(碩士論文)。台灣大學醫學院護理學研究所。
34. 劉玉菁(1999)。碩士論文(碩士論文)。台灣大學護理研究。
35. 潘怜燕、李蘭(1999)。台灣地區成年人吸菸盛行率及與教育和職業之關係：菸害防治法實施前的狀況(1993-1996)。中華公共衛生雜誌，18，199-208。
36. 蔡幸蓉(2002)。碩士論文(碩士論文)。台灣師範大學大眾傳播研究所。
37. 衛生署國民健康局和國家衛生研究院(2002)。台灣臨床戒菸指南。台北:衛生署國民健康局和國家衛生研究院。
38. 謝淑卿(1993)。碩士論文(碩士論文)。國防醫學院護理學研究所。
39. 蘇陳端、張景然(2007)。立即戒斷法與漸進減量法之復發狀況研究：以戒菸專線服務中心爲例立即戒斷法與漸進減量法之復發狀況研究：以戒菸專線服務中心爲例,未出版

1. 陳貴凰、洪文發、吳菊(2012)。廚藝戲曲定期展演─文本中臺灣廚師奮鬥故事解讀。島嶼觀光研究，4(4)，74-108。
2. 張景然、吳仙琦(2013)。電話戒菸諮商未完成個案之追蹤效果研究。諮商心理與復健諮商學報，25，89-111。