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Journal of the Korean Academy of Family Medicine 1997;18(2):126-135.
Published online February 1, 1997.
Usefulness of Family Counseling.
Yeong Sik Kim, Hyo Soon Kim, Young Sun Pahk, Sung Seonwoo, Hye Soon Park
가족상담의 유용성
김영식, 김효순, 박영선, 선우성, 박혜순
울산대학교 외과대학,서울중앙병원 가정의학교실, 사회사업실
Abstract
Background
: Family counseling is an essential part of family practice in which patients are cared in psychosocial dimension as will as in physical dimension and the family is dealt with as a whole unit. However, it is little applied in practice. The department of family medicine has made efforts to activate family counseling. This study was done to estimate the patient's response on the effect of family counseling that we have performed, and to investigate what clinical problems counseling was held and in what situations the counseling was perceived to be useful by the patients. We hope this study will be useful to establish some useful data and ideas for the development of family counseling in family practice in Korea.

Methods : The subjects of this study are 53 households who received family counseling at the department of family medicine from Oct. 1, 1994 to May 31, 1995. 64 households receive counseling during this peroid, but 11 persons who could not be reached by the phone were excluded. Patient's demographic charateristics, patients' chief complaints, physicians' assessment on the complaints and major problems presented in the counseling sessions were identified from the medical records. Patient' own estimation of the effect of counseling and the reasons for termination of counseling were inquired through the telephone interview. Finally the association between the usefulness of counseling and some factors was statistically analyzed.

Results : Subjects were predominently women(84.9%), especially middle aged. The most common chief complaint was headache complained by 10 subjects (18.9%), and the second and the third were abdominal pain complained by 8 (15.1%) and chest discomfort complained by 7(13.2%), respectively. The list of physicians' assessment included depression(34.0%), physical symptom per se without any assessment(20.8%), family problem(15.1%), somatization(13.2%), and anxiety(9.45). More than half of the subjects(60.4%) had only one session, 26.4% two sessions and 7.5% more than 4 sessions. The most common problem presented in the counseling was marital conflict(28.3%), the second was trouble with in-laws(15.1%), and the third was chronic illness in the family(9.4%). 32.1% replied that the counseling was very helpful, 28.3% somewhat helpful, 17% little helpful, 20.8% never helpful, and 1.9% not sure. The session was experienced to be more useful in the group of duration of symptom less than 6 months, than in the group of longer duration(p<0.05), and in the group with motivation for counseling than in the group without motivation(p<0.05).

Conclusion : About 60% of subjects replied the counseling was useful to them. Symptom duration and patient's motivation to participate in counseling showed significant association with the effect of family counseling.
초록
연구배경 : 가족상담은 가족중심적 진료를 추구하는 가정의학의 필수적인 부분이다. 그러나 한국 가정의학의 현실상 실제 진료에서 적절히 시행되지 못하고 있다. 이 연구는 환자들이 느끼는 가족상담의 효용성을 평가하며, 어떤상황에서 상담이 시행되었고 어떤 경우에 효과적이었지 알아봄으로써 향후 가족상담의 발전에 도움을 주려는 목적으로 수행되었다.

방법 : 1994년 10월 1일부터 1995년 5월 31일까지 8개월간 서울j병원 가정의학과에서 가족상담을 받은 64가구 중 전화연락이 가능했던 53가구를 대상으로 의무기록을 검토하고 전화설문을 하였다.

결과 : 대상 중에는 여성이 많았으며(84.9%) 연령별로는 40대가 가장 많았다. 환자들의 주소로는 두통, 복통, 흉부 불편감, 소화불량, 우울 등이 있었으며, 환자들의 증상이나 내원동기에 대한 의사의 진단으로는 우울증, 가족문제, 신체화 장애, 불안증 등이 포함되어 있었다. 상담 중에 환자들이 드러낸 주요 문제로는 부부 갈등이 가장 많았고 시댁과의 불화, 가족내의 만성 질환, 자녀 양육상의 문제 등이 있었다. 전체 환자 중 상담이 도움이 되었다고 응답한 환자는 60%정도였다. 그리고 증상의 기간이 짧았던 군과 상담에 대한 자발적인 동기가 있었던 군에서 상담이 유용했다고 응답한 비율이 유의하게 높았다(각각 p<0.05)

결론 : 가족상담을 받았던 환자 중 60% 정도가 상담이 도움이 되었다고 대답했으며, 환자의 상담에 대한 동기와 증상의 기간이 상담 효과와 유의한 연관을 보였다.


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