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題名:以結構─策略學派的觀點建構一個家族治療的改變歷程
作者:賈紅鶯 引用關係
校院名稱:國立臺灣師範大學
系所名稱:教育心理與輔導研究所
指導教授:陳秉華
學位類別:博士
出版日期:2000
主題關鍵詞:結構─策略家族治療詮釋性研究的微觀分析家庭互動結構治療介入
原始連結:連回原系統網址new window
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本研究係以結構─策略家族治療的觀點,對某市立醫院家族治療門診中一個睡眠障礙、酗酒大學生家庭的家族治療歷程進行觀察及詮釋。研究者以詮釋性研究的微觀分析法對二十次的治療過程錄影帶與治療者、評判員共同進行分析,得到以下幾方面的重要發現。
一、 結構─策略家庭治療者對〝問題〞的建構:
家庭對問題的看法是找出〝病因〞的「癥狀」架構,治療者則是提出互動、多元因果的「系統」架構。
二、 治療者的介入
包含「順應家庭結構」、「挑戰家庭結構」、「挑戰家庭的問題架構」、「治療關
係的介入」、「策略性的介入」、「挑戰個人內在」、「其他」等七大部分的介入。治療者最經常出現的為「挑戰家庭結構」,另一面又同時在「順應家庭結構」的治療介入。
三 、家庭互動結構的發展歷程
家庭的互動結構隨著IP癥狀的變化,歷經以下六個階段的轉變歷程:(A)家庭為IP癥狀求助(B)IP癥狀改善而家庭關係的衝突浮現(A’)IP癥狀發作與家庭結構被挑戰(B’)IP癥狀改善與家庭結構回穩的抗衡 (A”)IP癥狀再復發與家庭結構改變(B”)癥狀消失與家庭結構的改變。家庭的互動結構隨著癥狀的「復發─改善」的螺旋曲線而循環進展。
四、 治療介入發展階段的歷程
伴隨家庭結構的改變歷程,治療介入也形成六個階段的發展歷程如下:(A)使家庭參與治療 (B)建立信任與合作的關係(A’)順應癥狀發作對家庭結構挑戰(B’)治療第二階段的系統架構(A”)對夫妻結構的挑戰(B”)改變與結束。本研究發現癥狀除了對家庭系統有癥狀功能之外,對治療介入的發展也同樣具有正面功能。
五、治療者介入遇見的阻抗
治療者在進行家族治療介入時會遇到的阻抗包括:(一)治療過程出現的阻抗(二)治療技術介入的阻抗(三)治療者的系統架構面對家庭癥狀架構的阻抗(四)來自家庭內部的權力衝突的阻抗。治療者對阻抗的轉化的介入包括:重新框架家庭的問題觀; 尊重父親的癥狀架構;刻意忽略或淡化家庭出現的阻抗的訊息;順應家庭的權力與階層來進行挑戰。
研究者進一步就這個家族治療過程所反應的社會意義,包括:(一)家庭對問題「病」的建構所反應的社會意義(二)家庭結構反應的社會文化(三)治療介入反應的社會文化進行討論,進而對進行一個詮釋性研究的歷程提出結論與建議,作為未來家庭治療理論、實務及研究的參考。
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