焦點解決短期諮商對青少年身體意象之輔導效果

本研究旨在探討焦點解決短期諮商（Solution Focused Brief Counseling,SFBC）用於青少年身體意象的輔導效果。研究目的包含：（1）了解SFBC對青少年身體意象之輔導效果；（2）探討SFBC對青少年身體意象提升之主觀調適經驗結果；以及（3）SFBC對青少年身體意象提升之影響因素。以南部某國中有負向身體意象的五位國中青少年為研究對象，分別進行四到六次、每次四十五分鐘的焦點解決短期諮商個別晤談。採用「不等組前後測與追蹤測之前實驗設計」，並於個別諮商結束後及諮商一個月後，進行半結構式訪談及填寫「身體意象量表」，藉此蒐集量化與質性資料：量化資料採無母數統計法之Wilcoxon配對組符號等級檢定與描述統計進行考驗分析；質性資料則於個別諮商後，立即進行半結構訪談，質性資料則分為兩部分，一部分配合MBSRQ進行八向度之討論，另一部分運用主題分析法加以歸納探討個案經過SFBC介入後之立即及追蹤的輔導效果。研究結果共分為以下三部分：一、SFBC提升青少年身體意象之輔導成效，有以下兩點發現：（一）實驗組之青少年身體意象在MBSRQ之前測-後測與前測-追蹤測之提升未達顯著水準。就各分量表來看，「外表自我評估」同時具立即與追蹤輔導效果的提升有顯著差異，而「體能重視程度」僅在立即輔導效果上達顯著；（二）青少年身體意象在MBSRQ之後測-追蹤測之分量表在實驗組之「健康重視程度」與對照組之「健康自我評估」之提升上有顯著差異。二、SFBC對青少年身體意象提升之主觀經驗結果，分為「諮商後立即效果」及「一個月後追蹤效果」等兩部分來呈現青少年身體意象在MBSRQ的八大向度變化，其發現如下：（一）諮商後立即效果：（1）外表關注程度無明顯變化，但多數個案外表變瘦；（2）因個案外表變瘦，因而對外表滿意度提升；（3）體重關注程度無明顯變化，但個案會想開始注意自己的體重變化；（4）多數個案體重下降，即便未達理想體重也能接受現況並有信心達標，滿意度亦有提升；（5）個案不僅提升體能狀態亦提升體能關注程度；（6）多數個案均滿意目前自己的體能狀況；（7）健康狀況因著身體意象之改變計畫而有所提升；以及（8）個案均滿意目前健康狀態。（二）一個月後追蹤效果：（1）個案外表持續變瘦並開始接納自己的外貌；（2）因外表持續變瘦且外表滿意度亦有正向變化；（3）個案欲了解計畫成效會提升體重關注度；（4）體重減輕的個案對身體意象未來持續正向改變更有信心；（5）體能漸佳，對自我體能狀況也較能掌控；（6）因體能狀況維持，同時對滿意度亦持正向肯定；（7）健康狀態良好，並不會特別關注健康狀況；以及（8）對目前健康狀態滿意，不想改變健康部分。三、SFBC對身體意象提升之影響因素，包含：諮商合作同盟、正向自我激勵、有效能的目標、自主評估與督促、問題解決策略、建構未來圖像以及增進自我覺察等七項影響因子。　　研究討論針對先前研究結果進行三部分的討論：一、SFBC對提升青少年身體意象雖無顯著立即與追蹤輔導效果，但在分量表上，「體能重視程度」具立即輔導效果，而「外表自我評估」同時具立即與追蹤效果。而追蹤階段之健康向度在實驗組與對照組內均有顯著變化，其中實驗組在健康重視程度具顯著差異，對照組則是在健康自我評估向度上，有明顯變化。二、SFBC對青少年身體意象主觀輔導效果則有七項發現：（1）「外表自我評估」最容易在短期內有顯著變化，且會隨關注焦點而有其正向改變；（2）負向身體意象者於諮商前已有嘗試過一些方法提升身體意象，且容易受學校課程與他人建議方式而影響；（3）「飲食調整」與「體能活動」乃提升身體意象之主要方式，且具性別差異，其中男性偏重增加肌肉量，女性以減輕體重為主；（4）獨特的生命經驗帶來多元身體意象提升方式，且受到諮商影響而更有動力去實踐改變；（5）定期檢核、動機強弱與生活重大事件深深影響身體意象提升之效果；（6）看見身體意象客觀具體的改變，帶來主觀經驗持續之正向改變；（7）身體意象參照對象對個體評估身體意象滿意度影響程度大。三、SFBC提升青少年身體意象之成效因素與SFBTA（2013）提出的六項SFBC特定有效因素媒合，其中包含以下七個有效因子：（1）諮商合作同盟：諮商中與個案一同尋求身體意象改變之可能，並找出具體解決策略；（2）正向自我激勵：賦能個案並透過身體意象之成功經驗，激發其自我改變動機；（3）有效能的目標：定錨具體適切之改變目標，建構身體意象提升方法；（4）自主評估與督促：引導個案看見身體意象具體而微的變化，並拓展更多改變之可能；（5）問題解決策略：從個案本身資源與身體上之優勢，發掘提升身體意象之道；（6）建構未來圖像：貼近個案對身體意象提升之想像，合作協同建構未來願景；以及（7）增進自我覺察：藉由對身體意象之「再看見」，接納與理解並重新建構身體意象新觀點。最後，研究者依據研究結果與討論，提出對焦點解決短期諮商與從事身體意象議題之實務工作者與未來研究者相關建議。

關鍵字

身體意象；焦點解決短期諮商；青少年；輔導效果

並列摘要

The aim of this study was to explore the effectiveness of Solution-Focused Brief Counseling (SFBC) with regard to negative body images of adolescents. The purpose of the study included: (a) understanding the effectiveness of immediate and follow-up SFBC counseling on the body image of adolescents; (b) exploring the subjective perception results of body image enhancement in adolescents; and (c) understanding the effective factors of SFBC on body image enhancement in adolescents. Utilizing a single-group pretest-posttest and follow-up test pre-experimental design, this study selected as participants from a junior high school in the south (of Taiwan) five students with negative body images. They participated in individual 45-minute SFBC counseling sessions four to six times. The participants completed both semi-structured interviews and a body image scale inventory immediately after termination and one month later, yielding both qualitative and quantitative data. Quantitative data were analyzed using nonparametric statistics Wilcoxon matched-pair signed-rank test, as well as descriptive statistics. Qualitative data were collected through semi-structured interviews immediately after and one-month after individual counseling sessions, and data were evaluated by Multidimensional Body-Self Relations Questionnaire (MBSRQ) and analyzed using thematic analysis of the effectiveness of SFBC interventions through immediate and follow-up counseling. The study results are divided into the following three parts: First, the determination that SFBC has enhanced counseling effectiveness for addressing negative body images on adolescent population, with the following two specific findings: (a) there is no statistically significance on the pretest-posttest and pretest-follow-up test results of MBSRQ on the experimental group. However, there are significant differences on immediate counseling effectiveness of enhancing the dimensions of self-assessment in terms of appearance and level of emphasis on physical fitness, and there is also significant difference on follow-up counseling effectiveness of appearance self-assessment; (b) there are significant differences on the MBSRQ post- and follow-up test subscales results of experimental group indicating enhancement of health emphasis and health self-assessment on body image of adolescents. Second, the subjective perception results of SFBC on body image enhancement, including the findings of immediate counseling effectiveness and one-month follow-up effectiveness, which indicate the changes on the eight dimensions of MBSRQ on body image of adolescents, were as follows: 1. Immediate counseling effectiveness: (a) no significant changes with regard to attention to appearance, though most participants lost weight; (b) participants experienced improved levels of satisfaction due to weight loss; (c) no significant changes with regard to concerns about weight, though participants began to pay attention to changes in weigh; (d) most of the participants lost weight, they did not attain their ideal body weights but were accepting of the results and expressed confidence about eventually reaching their goals, and their satisfaction has increased; (e) participants not only enhanced physical condition but also improved level of emphasis with regard to physical fitness; (f) the majority of participants expressed satisfaction with their current physical condition; (g) health was improved as a result of the plan for enhancement of body image; and (h) participants expressing satisfaction with their current health status. 2. One-month follow-up effectiveness: participants (a) lost weight and therefore became more accepting of their appearances; (b) had positive changes in terms of self-satisfaction due to their lean appearances; (c) enhanced their level of concern about weight, for understanding treatment effectiveness; (d) who had weight loss experienced positive feelings about ongoing body image change in the future; (e) experienced improved physical fitness and better control over personal physical fitness; (f) had improved physical fitness and more positive levels of self-satisfaction; (g) had good health, and not particularly concerned about the health status; and (h) expressed satisfaction with their current health situation, and not wanting to change. Third, the seven affect factors of SFBC on body image enhancement include counseling alliance, positive self-motivation, effective goals, self-assessment and supervision, problem-solving strategy, construction of future image, and self-awareness enhancement. Finally, based on the study results and discussion, the researcher proposed suggestions regarding SFBC intervention for future practitioners and researchers on body image issues.