邁入諮商新視界：從心理師角度探究通訊諮商之準備與實施經驗
Authors: 宋呈澔 宋呈澔 , 陳婉真 陳婉真 , Wan-Chen Chen 黃俐瑀 , 陳柏霖 陳柏霖 , Po-Lin Chen 洪雅鳳 
Published: October 2024

<p>以視訊為本的通訊諮商於新冠肺炎疫情期間在國內快速發展。鑑此，本研究奠基在建構主義觀點進行質性研究，以深入探究心理師對於通訊諮商之準備與實施經驗。透過立意取樣與滾雪球取樣，共18位心理師參與以線上視訊形式進行之半結構式個別訪談（5男、13女；年齡為30至55歲；從事通訊諮商時數範圍為6至380小時）。資料分析上採用分析抽象階層化概念（the ladder of analytical abstraction）進行。分析結果有二。（1）通訊諮商的準備包括三層面：（a）政策規範層面。現今存有申請流程繁瑣、實施細則不明確，以及規範與實務之落差等議題，增添準備困難，如何促進法規與實務間的契合誠為重點；（b）機構與心理師層面。因經驗缺乏，心理師在準備中且戰且走，目前強調以個案福祉與諮商倫理為經緯預先建構通訊諮商流程，並妥善設置設備及熟稔操作；（c）個案層面。心理師認為要積極催化個案對通訊諮商的準備與投入，進而共構治療同盟並維持諮商架構。（2）通訊諮商的實施經驗分為助益與限制。心理師大多表示通訊諮商與實體諮商具有共通性，可發揮諮商的基礎效益，且一定程度可打破空間與距離限制，以服務特定個案；然而通訊諮商可能出現三類型限制。首先，個案評估的精準性較低、諮商歷程較難掌握；再者，通訊諮商存有形式限制，包括進行體驗型諮商或多人諮商較為困難；最後，通訊諮商的服務對象有所限制，如危機個案或未成年個案。</p>
<p>&nbsp;</p><p>The COVID-19 pandemic has impacted the public and society as a whole and has triggered a transformation of mental health services. Tele-counseling has become a feasible alternative to face-to-face counseling for maintaining safe social distancing practices while addressing the public’s mental health issues. The term &quot;&quot;telecounseling&quot;&quot; refers to methods of counseling through video, telephone, Internet calls, and other types of telecommunication that can be conducted over long distances. Features of tele-counseling include confidentiality and flexibility, which could help the public access mental health services by overcoming obstacles such as geographical and time constraints. Notably, Taiwan legalized tele-counseling in 2019, and it developed rapidly during the pandemic, especially video call tele-counseling; however, few studies thus far have explored this. To make Taiwan a tele-counseling-friendly environment, the present study, grounded in a constructivist perspective, employed a qualitative approach to deeply explore psychologists’ views on tele-counseling, thereby elucidating their preparation for tele-counseling and relevant practical experience. Through purposive and snowball sampling, licensed psychologists participated in semi-structured individual interviews via online video conferencing (5 males, 13 females; aged between 30 and 55 years, with a range of 6 to 380 hours of experience in tele-counseling). Data were analyzed using the ladder of analytical abstraction. As a result, two factors were highlighted. First, in terms of preparation for tele-counseling, the results revealed the following. (1) When it comes to policy and regulation, some problems still exist, including a cumbersome application process, unclear enforcement rules for tele-counseling applications and implementation, and differences between regulation and practice. These issues make preparation for tele-counseling more difficult; therefore, a way to facilitate alignment between regulations and practice (as well as investment in tele-counseling) is important for optimizing the preparation and implementation of tele-counseling. (2) Due to a lack of experience, institutions’ and psychologists’ preparation for tele-counseling still depends on how it progresses. They primarily emphasized that preparation should focus more on pre-developing the tele-counseling procedure based on clients’ well-being and professional ethics, as well as setting up tele-counseling equipment and becoming familiar with its operation. Moreover, psychologists should regularly engage in professional training for tele-counseling. This is a useful means of preparing for telecounseling. (3) It is necessary to facilitate clients’ attention and investment in tele-counseling sessions, thereby developing a therapeutic alliance and maintaining the framework of counseling together. This is important for the implementation of tele-counseling. Second, in terms of the practical experience of tele-counseling, the results revealed the following: (1) Some commonalities between tele-counseling and face-to-face counseling help maintain the efficiency of tele-counseling. (2) Tele-counseling can overcome the limitation of distance and space, thereby serving needs of specific clients. (3) The features of tele-counseling result in some potential restrictions. For example, psychologists often find it difficult to assess clients’ situations and grasp the entire counseling process, which drives them to put in more effort. Some forms and methods of counseling are restricted in telecounseling, so psychologists need to put more effort into preparing for counseling, or even adjusting the ways they counsel. In addition, potential candidates suitable for tele-counseling are limited; therefore, psychologists need to provide more follow-up services based on clients’ situations and needs. To summarize, the present study not only broadens the horizon of psychologists’ experiences of tele-counseling, but also proposes some useful practical suggestions for preparing for and implementing tele-counseling. This has important implications for the development of tele-counseling in Taiwan. However, this research is still limited, and further investigation is necessary to boost this development.</p>
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