臺灣大學生共依附諮商團體之團體氣氛與成效關聯性研究

Group Climate and Its Association with Effects of Counseling Groups for Taiwanese College Students with Codependency

本研究旨在探討共依附人際歷程取向（IP團體）與Bowen家庭系統理論（Bowen團體）、二種不同理論取向諮商團體的氣氛發展和差異，以及團體氣氛與成效之關聯性。本研究採混合研究之聚斂平行設計，同時蒐集量化與質性資料，研究參與者為14位具有共依附特質傾向與人際困擾之大學生。本研究結果主要為：（一）在團體氣氛的發展和差異上，量化資料以廣義估計方程式的分析結果發現，兩團體在投入氣氛的變化量上有顯著差異，在逃避與衝突氣氛上則無顯著變化和差異；質性資料以主題分析結果發現，兩團體在團體氣氛發展上的共同主題內容有所不同。（二）在團體氣氛與成效之關聯性上，多元階層迴歸分析結果顯示，IP團體的整體衝突氣氛越高，成員的自我立場分數越低，而Bowen團體則反之；質性資料分析結果發現兩團體的共同主題為「團體中的距離感與擔心減少成員的表達」，IP團體另有「團體經驗引發自我反思與調整」及「團體正向環境和情感連結促進相互分享與理解」兩個主題，Bowen團體則為「團體經驗引發自我和關係系統的觀察、思考與調整」與「團體中的連結與差異促進自我觀察與區分」兩個主題。本研究綜合討論量化與質性研究結果與發現，並對共依附團體諮商實務與教育訓練和未來相關研究提出若干建議。

The concept of codependency refers to excessive caretaking traits and behaviors stemming from a stressful or dysfunctional family environment (Chang, 2012; Fuller & Warner, 2000). Dear et al. (2005) conducted a thematic analysis of 11 definitions of codependency and identified four core defining elements: external focusing, self-sacrificing, controlling others, and suppressing one’s emotions. They also found additional factors associated with codependency, such as relationship problems, low self-esteem, and substance use disorders, but these were separated from the four defining elements. Recent research and clinical observations have found high levels of codependency and related symptoms among college student populations. Codependency was consistently found to be related to low self-esteem, relationship difficulties, and other problems with psychological adjustment—including anxiety, depression, somatic complaints, and social dysfunction (Chang, 2016–2017, 2017–2018; M. Wells et al., 1998; M. C. Wells et al., 2006) . According to M. C. Wells et al. (2006), college students with codependency and related symptoms may need tertiary prevention to resolve family-of-origin and relationship issues in addition to the primary and secondary prevention issues.
Group counseling is a clinically efficacious and cost-effective approach for treating individuals with codependency (Byrne et al., 2005; Chang & Bhat, 2023; Edmundson et al., 2000; Liu & Chang, 2017). According to Byrne et al. (2005) and Edmundson et al. (2000), interpersonal learning in group counseling can help members learn about their relational patterns and reduce codependency traits and related symptoms, such as anxiety and depression; however, their groups did not have a sound theoretical framework and were guided by more than one goal for adult participants. Few studies have been conducted to further compare and examine the efficacy and its related factors of group counseling models based on different theoretical frameworks and approaches for college students with codependency and related symptoms. Small group research (Chang, 2016–2017, 2017–2018; Chang & Bhat, 2023; Liu & Chang, 2017) conducted in Taiwan on adolescents and college students with codependency have identified key factors in group counseling models using Bowen family systems theory and the interpersonal process (IP) approach; however, their results have been inconsistent. In addition to therapeutic factors, group climate is a crucial common factor related to group outcomes. Recent research suggests that the relationship between group climate and group outcomes may vary depending on factors such as the length and type of group, theoretical framework and approach, and group member characteristics (Bakali et al., 2013; Bonsaksen et al., 2013; Bonsaksen et al., 2011; Tasca et al., 2006; Thorgeirsdottir et al., 2015).
Accordingly, this study explored group climate and how it affected outcomes in two counseling groups based on Bowen family systems theory (Bowen group) and the IP approach (IP group) for college students with codependency in Taiwan. Participants were 14 Taiwanese college students with codependency and interpersonal problems. The IP group comprised six participants with a mean age of 19.5 years. This group had an average score of 63 on the Chinese version of the Codependency Assessment Tool (CODAT). The Bowen group comprised eight participants with a mean age of 20.5 years. This group had an average score of 76.75 on the Chinese version of the CODAT. Both groups underwent eight 2.5-hour sessions, with a total of 20 hours over eight successive weeks. The IP group aimed to gain awareness of and change their interpersonal styles through hereand- now interactions and exchanges of feedback in the group. The Bowen group aimed to gain awareness of the anxiety and self in their relationship systems and enhance their ability to observe and define themselves through learning and applying concepts of Bowen theory.
A mixed-methods convergent parallel design was used. Both quantitative and qualitative data were collected. Generalized estimating equation and multiple hierarchical regression were used to analyze quantitative data; thematic analysis was used to code and analyze qualitative data. To show the change and development of group climate, data were analyzed according to the early, middle, and final stages of the two groups. As for the development and differences of group climate, results of the study indicated that engagement in the Bowen group increased significantly throughout the group stages and that a significant difference in the change of engagement was found between the two groups. Qualitative findings revealed that four similar major themes emerged in the early stage of both the IP and Bowen groups. These four themes were“cohesive and positive environment,”“progression in group work,”“explicit group guidance,”and“anxiety and tension in the group.”Three similar major themes emerged in the middle and final stages of the two groups. These three themes were“cohesive and positive environment,”“progression in group work,”and“anxiety and tension in group.”Differences in subthemes were noted. As for the association between group climate and group effects, this study observed a significant interaction between level of conflict and group approach with level of differentiation in terms of an ability to take an I position. That is, greater conflict in the IP group was associated with a poorer ability to take an I position. By contrast, greater conflict in the Bowen group was associated with a stronger ability to take an I position. Qualitative findings revealed one major theme for both the IP and Bowen groups:“Members’expressing themselves less because of distances and worries in the group.”In addition, two other major themes (“self-reflection and adjustment induced by group experience”and“positive environment and emotional connection promoting sharing and mutual understanding”) emerged in the IP group. Two other major themes (“observation, reflection, and adjustment of self and relationship systems induced by group experience”and“observation and differentiation of self-promotion by group connections and differences”) emerged in the Bowen group.
In conclusion, slight differences were observed in the development of group climate and the association between group climate and group effects in the IP and Bowen groups. Counselors and therapists who intend to use the two group models for college students with codependency and related symptoms are encouraged to pay attention to the development of group climate. Particularly, leaders in the IP group must pay attention to high levels of tension and conflict and at the same time encourage members to further disclose themselves and make a change on the basis of emotional connection and support. Leaders in the Bowen group must pay attention to members’anxiety and emotional reactivity while examining their relationship systems and how they define themselves. These leaders should help members manage their anxiety through mindfulness and relaxation activities. Furthermore, counselors and therapists should extend the duration of both groups to 10–12 sessions to promote the development of group climate and enhance the effectiveness of the groups. The implications of the findings for group counseling based on different approaches for college students with codependency and suggestions for future research are further discussed.