مطالعهٔ كيفي: عوامل مرتبط با نقش مشاوره‌اي درمانگر توانبخشي

Factors Related to the Role of the Therapist as a Rehabilitation Consultant: a Qualitative Study

هدف: يكي از خدمات موردنياز افراد داراي ناتواني و خانواده‌هاي آن‌ها، راهنمايي و مشاورۀ تخصصي است. هم‌چنين مشاوره يكي از نقش‌هاي درمانگران توانبخشي، هنگام ارائهٔ خدمات توانبخشي محسوب مي‌شود. هدف از انجام اين پژوهش، بررسي عوامل مرتبط با نقش مشاوره‌اي درمانگر توانبخشي بود. روش بررسي: اين مطالعهٔ كيفي با روش تحليل محتوا اجرا شد. 19 مشاركت‌ كننده با حداكثر تنوّع، از طريق نمونه‌گيري هدفمند با رويكرد نظري، به‌روش متوالي و تدريجي تا رسيدن به اشباع اطلاعات از ميان استادان و متخصصين حوزهٔ توانبخشي و حوزهٔ مشاوره و افراد داراي معلوليت انتخاب شدند. داده‌ها از طريق مصاحبهٔ نيمه‌ساختار يافتهٔ عميق و تحليل داده‌ها (با رويكرد قراردادي) براساس مدل گرانهايم و لاندمن (2004) انجام شد. اطمينان از صحّت و استحكام پژوهش با استفاده از معيارهاي لينكلن و گوبا انجام گرفت. يافته‌ها: از يافته‌هاي اصلي اين پژوهش، ادراك مشاركت‌كنندگان دربارهٔ عوامل مرتبط با نقش درمانگر بود كه همراه با چهار زيرمضمون نگرش و اعتقاد درمانگر، ويژگي‌هاي فردي، منافع درمانگر و آگاهي درمانگر شكل گرفت. نتيجه‌گيري: نتايج اين مطالعه، بر تأثير عميق نقش درمانگر و عملكرد وي به‌عنوان مشاور توانبخشي تأييد كرد؛ بنابراين ضروريست كه مديران و تعيين كنندگان خط‌مشي‌هاي سلامت با به‌كارگيري راهبردهاي صحيح، به ترميم ساختارهاي ذهني و عملكردي نامناسب درمانگران توانبخشي در حيطهٔ مشاوره بپردازند.

Objective: As a specialized service, counseling is required by people with disabilities and their families. Moreover, counseling is one of the tasks assigned to a rehabilitation therapist when providing rehabilitation services. The aim of this study was to investigate factors related to the role of the therapist as a rehabilitation counselor. Methods: This qualitative study was carried out through content analysis Qualitative content analysis is a method for analyzing written, spoken or visual messages. It is known as a systematic research method to describe a phenomenon. This study involved a total of 19 participants with maximum diversity selected through purposive sampling from among professors and specialists in the field of rehabilitation and counseling people with disabilities. Sampling was gradually achieved until information was saturated. Data were collected through semi-structured, open and in-depth individual interviews. Each interview lasted between 45 and 120 minutes. Data analysis involved content analysis with a conventional approach based on Graneheim and Lundman’s model (2004). The trustworthiness and dependability of the research were taken care of through criteria proposed by Guba (1985) by through Lincoln. Results: One of the major emerging themes was the participants’ perception of the factors associated with the role of therapist, developed through 4 subthemes: therapist's attitude and belief, individual characteristics, therapist's interests and therapist’s awareness as well as 15 codes. The findings under therapist's attitude and belief indicated that therapists emphasized the effectiveness of counseling on how referrals think about counselors. Counseling is underappreciated due to lack of positive attitude adopted by specialists toward the physical aspect of counseling, adopting a medical viewpoint and focusing on reducing physical symptoms and pain. The findings under therapist's individual characteristics, including self-orientation, misconception about versatility, application of personal desires in treatment and referral as well as fear of illiteracy in the eyes of referrals, are all key obstacles against building an appropriate status for a rehabilitation counselor. The therapist’s collaborative spirit in providing services, good behavior and avoidance from harsh treatment with referrals and the art of careful listening were considered highly effective. Under the therapist's interests, the participants' experiences demonstrated that therapist’s concern about economic interests and losing the referral hinder client visits to the counselor. Appropriate communication skills to provide information to patients, necessary familiarity with tasks and counseling capabilities will help counselors ensure how to react in case the treatment process fails. Conclusions: The results of this study confirmed the profound effect of therapist’s role and performance as a rehabilitation counselor. Considering that the structure of rehabilitation counseling is undesirable due to poor development of essential mental constructs, rehabilitation therapists can, as one of the key players throughout the rehabilitation treatment process, greatly contribute to building a desirable status for the profession of rehabilitation counseling. Therefore, it is imperative that managers and decision-makers devise health policies by adopting correct strategies in an effort to repair the inappropriate mental and functional constructs of rehabilitation therapists involved in the counseling field.