心理咨询中来访者负面体验的质性探索

doi:10.3724/SP.J.1041.2025.1216

摘要/Abstract

摘要： 为了探索我国来访者在心理咨询中的负面体验, 本研究对42名被试进行半结构化一对一访谈, 并进行了现象学主题分析。结果表明心理咨询中来访者的负面体验包括4个主题：一是与心理咨询行业特质相关的负面体验, 包括与心理咨询本身的特点以及与行业发展阶段相关的负面体验; 二是咨访契合度不高, 包括风格不匹配、来访者难以敞开心扉、来访者反感咨询师; 三是与咨询师胜任力相关的负面体验, 包括来访者对咨询师能力与经验、态度、组织管理咨询的方式, 以及伦理方面的不满; 四是对咨询效果的不满意, 包括未能满足来访者的期待, 咨询引发的不良影响, 以及来访者对咨询失望或停止咨询。综上, 文化适应性、咨询中的权力关系不平等等问题对于来访者的体验有突出影响。来访者对咨询师胜任力的不满主要集中在胜任力的基本维度。咨询师应当对来访者的负面体验保持警觉。研究发现为改进本土心理咨询实践和提升咨询质量提供了有益的参考。

关键词: 心理咨询, 咨访关系, 咨询师胜任力, 文化适应性, 主题分析

Abstract:

In China, a significant proportion of individuals with psychological disorders rarely seek psychological counseling, indicating the limited reach of mental health interventions. Despite common beliefs in the positive impact of psychological counseling, negative experiences, often unrecognized by counselors, can occur. The negative experiences in counseling may be attributed to a lack of counselor competence, poor therapeutic alliance, and high client expectations. However, considering the cultural discrepancies between Chinese traditions and Western-imported counseling practices, coupled with the unique development trajectory of the mental health industry in China, these findings may not fully encapsulate the negative experiences encountered by Chinese clients. Additionally, the lack of evidence-based practice in China could further contribute to adverse treatment outcomes. Therefore, this research aims to delve into the subjective negative experiences of Chinese clients in counseling.

Adopting the sample size calculation method for qualitative research proposed by Fugard and Potts (2015), this study included 42 participants. Participant selection was designed to mirror the market demographics of clients, utilizing a combination of purposeful and quota sampling methods. Data were collected via semi-structured one-on-one telephone interviews, with an average length of 25 minutes. The interview question list was refined based on insights from the preliminary interviews. Following Braun and Clarke's (2006) six-step phenomenological thematic analysis, the study analyzed the transcripts to ensure a systematic and credible derivation of themes, with multiple validation processes throughout the coding and theme development phases.

The analysis revealed four main themes concerning clients' negative experiences in counseling: (1) constraints inherent to the industry, (2) poor matching between the counselor and the client, (3) negative experiences associated with poor competence, and (4) dissatisfaction with treatment outcomes. The four main themes are further delineated into twelve subthemes for a detailed examination of the challenges faced. The first theme highlights two subthemes: the intrinsic characteristics of counseling, such as theoretical orientations, fixed counseling settings, and unequal power dynamics, as well as the development stage of the counseling industry in China, marked by the difficulty in finding qualified counselors and issues of cultural fit. The theme of mismatch between counselors and clients encompasses three subthemes: a mismatch in personal styles, hardship in trusting the therapist, and disliking the therapist. The theme of counselor incompetence, which contains the most significant number of nodes, is characterized by counselors' lack of professionalism and experience, proper attitudes, the ability to arrange sessions, and ethical violations. The final theme encapsulates clients' dissatisfaction with treatment outcomes, encompassing three subthemes: unmet expectations, negative effects of counseling, and becoming disappointed or stopping counseling.

This study underscores the profound impact of industrial factors on clients' subjective experiences, particularly highlighting how issues such as cultural adaptability and the imbalance of power relations significantly influence these experiences. It also reveals deficiencies in the fundamental competencies of Chinese counselors. Furthermore, it acknowledges the potential for negative effects in psychological counseling and the significance of client expectations. These findings not only deepen and enrich our understanding of clients' negative experiences in the psychological counseling process but also highlight the complexity of the counseling process itself. The study emphasizes the interplay between clients, counselors, and the industrial environment. By identifying and understanding these negative experiences, the research offers insights for improving counselor training and contributes to the localization of counseling in China.

Key words: psychological counseling, therapeutic alliance, counselor competence, cultural adaptability, thematic analysis

中图分类号:

R395

李牧阳, 雷霆, 谢燮, 国泽宇, 刘可欣, 陈雯青, 孙沁怡, 董韫韬, 臧寅垠. (2025). 心理咨询中来访者负面体验的质性探索. 心理学报, 57(7), 1216-1230.

LI Muyang, LEI Ting, XIE Xie, GUO Zeyu, LIU Kexin, CHEN Wenqing, SUN Qinyi, DONG Yuntao, ZANG Yinyin. (2025). Qualitative exploration of negative experiences in counseling clients. Acta Psychologica Sinica, 57(7), 1216-1230.

图/表 2

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特征	N (%)
性别(女性占比)	35 (83%)
年龄(岁)
18~25	23 (55%)
26~35	16 (38%)
36~45	2 (5%)
≥46	1 (2%)
咨询场所¹
商业机构	38 (90%)
医院	11 (26%)
学校	19 (45%)
咨询费用(元)¹
免费	18 (43%)
1~199	11 (26%)
200~399	12 (29%)
400~599	12 (29%)
600~799	5 (12%)
800~999	2 (5%)
1000及以上	2 (5%)
未知²	4 (10%)
心理咨询流派¹
人本主义	16 (38%)
认知行为	14 (33%)
精神分析或心理动力	30 (71%)
沙盘治疗	2 (5%)
家庭治疗	4 (10%)
理性情绪疗法	1 (2%)
催眠	1 (2%)
其他流派³	9 (21%)
不清楚流派²	13 (31%)
接受过几段咨询
1段咨询	14 (33%)
2段咨询	13 (31%)
3段咨询	9 (21%)
4段咨询	2 (5%)
5段咨询及以上	4 (10%)
咨询状态	35 (83%)
正在进行咨询, 尚无已完结的咨询	6 (14%)
正在进行咨询, 有已完结的咨询	16 (38%)
全部咨询已完结	20 (48%)

特征	N (%)
性别(女性占比)	35 (83%)
年龄(岁)
18~25	23 (55%)
26~35	16 (38%)
36~45	2 (5%)
≥46	1 (2%)
咨询场所¹
商业机构	38 (90%)
医院	11 (26%)
学校	19 (45%)
咨询费用(元)¹
免费	18 (43%)
1~199	11 (26%)
200~399	12 (29%)
400~599	12 (29%)
600~799	5 (12%)
800~999	2 (5%)
1000及以上	2 (5%)
未知²	4 (10%)
心理咨询流派¹
人本主义	16 (38%)
认知行为	14 (33%)
精神分析或心理动力	30 (71%)
沙盘治疗	2 (5%)
家庭治疗	4 (10%)
理性情绪疗法	1 (2%)
催眠	1 (2%)
其他流派³	9 (21%)
不清楚流派²	13 (31%)
接受过几段咨询
1段咨询	14 (33%)
2段咨询	13 (31%)
3段咨询	9 (21%)
4段咨询	2 (5%)
5段咨询及以上	4 (10%)
咨询状态	35 (83%)
正在进行咨询, 尚无已完结的咨询	6 (14%)
正在进行咨询, 有已完结的咨询	16 (38%)
全部咨询已完结	20 (48%)

本研究主题结构		参考点个数	被试个数	西方被试负面体验主题结构¹
主题	子主题	参考点个数	被试个数	主题	子主题
与心理咨询行业特质相关的负面体验				治疗不适配	对咨询设置不满意
	心理咨询本身特点所造成的负面体验	188	39		与干预方案不适配
	行业在国内发展不足所造成的困难	174	37		对咨询结束不满意
					未满足期待
咨访契合度不高	咨询师的特点和来访者的偏好不契合	70	23	阻碍咨访关系	感到与咨询师个人风格不匹配
	来访者难以对咨询师敞开心扉	16	8		咨询师冷漠
	来访者反感咨询师	26	14		来访感到不安全或不信任
					来访感到困惑或不确定
与咨询师胜任力相关的负面体验				咨询师的不当操作	咨询师胜任力不足
	来访者感觉咨询师能力或经验不足	91	35		咨询师不倾听、不理解
	来访者感觉咨询师态度有问题	267	39		咨询师否定来访者价值
	咨询的组织管理让来访者不舒服	7	5		咨询师评判来访者
	咨询师违反伦理	113	35		咨询师利用来访者
					其他不合适的言语回应
咨询效果不满意				咨询的负面影响	没有改变或改变不充足
	未能满足期待	123	35		咨询后问题增加
	咨询的坏效果	76	30		对咨询进程感到恐惧
	对咨询失望或停止咨询	22	14		缺少动力或希望
					咨询过程感到不愉悦
					咨询过程唤起负面认知

本研究主题结构		参考点个数	被试个数	西方被试负面体验主题结构¹
主题	子主题	参考点个数	被试个数	主题	子主题
与心理咨询行业特质相关的负面体验				治疗不适配	对咨询设置不满意
	心理咨询本身特点所造成的负面体验	188	39		与干预方案不适配
	行业在国内发展不足所造成的困难	174	37		对咨询结束不满意
					未满足期待
咨访契合度不高	咨询师的特点和来访者的偏好不契合	70	23	阻碍咨访关系	感到与咨询师个人风格不匹配
	来访者难以对咨询师敞开心扉	16	8		咨询师冷漠
	来访者反感咨询师	26	14		来访感到不安全或不信任
					来访感到困惑或不确定
与咨询师胜任力相关的负面体验				咨询师的不当操作	咨询师胜任力不足
	来访者感觉咨询师能力或经验不足	91	35		咨询师不倾听、不理解
	来访者感觉咨询师态度有问题	267	39		咨询师否定来访者价值
	咨询的组织管理让来访者不舒服	7	5		咨询师评判来访者
	咨询师违反伦理	113	35		咨询师利用来访者
					其他不合适的言语回应
咨询效果不满意				咨询的负面影响	没有改变或改变不充足
	未能满足期待	123	35		咨询后问题增加
	咨询的坏效果	76	30		对咨询进程感到恐惧
	对咨询失望或停止咨询	22	14		缺少动力或希望
					咨询过程感到不愉悦
					咨询过程唤起负面认知