協助戒菸者改變之健康諮商模式與實務：心理諮商對職場員工健康行為之促進

Promoting Healthy Behaviors in Workplace by Counseling：Helping Smokers Quit Smoking with a Health Counseling Model

台灣約有400 萬的吸菸人口，而在2002 年的調查報告指出，約有70%的人希望戒菸，但真正行動並且成功的人卻是少之又少。從這例子中可以看出一個重要議題：何以一件攸關性命的重要事件，同時事件結果也是當事人所清楚認知的，而其本身也有改變的意願，但從認知到行動之間的落差卻是如此之大。由此可知，「知易行難」確為一普遍的現象，過去心理諮商常將焦點放在個人內在的覺察上，但了解不一定意味著改變，如何協助個案願意選擇健康行為並且真的行動，以促進大眾健康，實是心理諮商專業人員可努力投入之領域。戒菸專線服務中心自2003 年開辦以來，協助許多吸菸者戒菸，筆者從三年的實務工作中，逐漸發展出戒菸諮商的工作概念與模式。在五次的諮商架構裏，包含了認知行為學派、動機式晤談法、以及改變階段理論等原理原則所發展建構而成，從協助個案增加對本身行為的覺察、提升改變的動機，進而願意選擇戒菸此一健康行為後，緊跟著發展準備計畫、執行計畫，最後再討論如何維持成果以預防復發。雖然此一工作架構發展自戒菸工者實務，但其中的方法與原則事實上也是一種健康諮商的概念；願意選擇健康行為，同時發展自主控制力，進而維持健康行為，這樣的概念可應用於其它類似的問題，例如減重、糖尿病患之飲食控制、或者運動諮詢中。同樣的，它更可提供企業主參考，提供給有需要的員工做健康諮商，做為員工協助方案之一。此戒菸諮商工作模式由實務經驗出發，配合相關理論參考論述而得，未來擬以量化研究設計來評估此戒菸諮商架構之成效。

Taiwan Smokers’ Helpline has been established to assist smokers to be well aware of the hazards of tobacco, to motivate and to prepare them to quit smoking, and ultimately, to advocate healthier lifestyles. Since its establishment in 2003, TSH has contributed a lot in either providing smoking cessation counseling to attempted quitters or being the platform of exchanging tobacco control resources. In clinical experience, we construct the brief tobacco cessation counseling model to help smokers to quit. In the counseling process, the counselor helps client increased the self-awareness of behaviors, activates motivation of change, and willing to choose quit smoking. After making decision, counselor helps client to develop, implement, and maintain the smoking cessation plan. Although the model is applied on smokers, but essentially, the principles and methods originate from the concept of health counseling , of which we mean the willingness to choose healthy behaviors, to develop the ability of self-control, and furthermore, to maintain healthy behaviors. Such concept can be applied on other behaviors alike, such as weight control, diet control of diabetics and physical activity consultations. By the same token, it also provides business owners a model of providing Employee Assistance Programs.