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題名:厭食症患者觀點中家庭系統運作之探討
作者:翁樹澍
作者(外文):Wong.Shu-Shu
校院名稱:國立彰化師範大學
系所名稱:輔導與諮商學系
指導教授:郭麗安
程小蘋
學位類別:博士
出版日期:2004
主題關鍵詞:厭食症家庭系統結構取向家庭理論Anorexia NervosaFamily SystemStructural Family Theory
原始連結:連回原系統網址new window
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本研究目的在於瞭解厭食症患者觀點中家庭系統運作之特徵,以及症狀出現前後家庭系統運作之變化。研究者採質性研究現象學方法,以半結構式訪談大綱,訪談六位厭食症患者,搜集研究所需資料,再依質性研究現象學方法進行資料分析工作。
研究發現包括:一、厭食症患者家庭系統運作的特徵:(一)婚姻次系統疏離、(二)親職次系統功能過度、傾斜且缺乏協調、(三)婚姻次系統與手足次系統間界限不清,受訪者與父母形成「親子情緒黏結」、(四)手足次系統競爭家庭中有限的資源,手足競爭勝出的研究對象最難背離家規、(五)失功能的家庭結構加深親子情緒黏結,使研究對象難與家庭系統分化、(六)症狀在家庭脈絡下的意義—自我與家庭系統的分化:1.在糾結的家庭中,症狀是研究對象搖撼家規、脫離情緒糾結、退出情緒同盟、爭取為自己做生涯抉擇的權力的一項工具、掙脫不幸婚姻的方法,這都是研究對象將自我由家庭系統中分化出來、追尋自主性、自我認同的努力。2.在疏離的家庭中,症狀試圖引起家人的關注,重新凝聚疏離的家庭。
二、發展自我的困境—文化脈絡下的身體意象:在發展自我認同過程中,遭遇挫折、壓力的研究對象,順從文化對「纖瘦=美麗」的迷思,試圖以減肥獲取自尊。
三、食物對研究對象的特殊意涵:六位研究對象與食物之間皆有複雜的愛和情仇,所提及食物對他們的特殊意涵包括:(一)正向情緒經驗、(二)表達效忠、(三)展現控制力、(四)效忠與自主的掙扎。
四、研究對象症狀出現後家庭系統運作的改變:(一)家庭系統運作正向的變化、症狀緩解的原因有:1.婚姻次系統關係修復,親職次系統恢復功能;2.家人的支持與接納、家庭系統作恢復彈性;3.症狀的出現不能搖撼固著的原生家庭與結婚後的家庭,但卻給了研究對象脫離家庭系統尋求獨立的動力。(二)無法改變系統運作、症狀依舊維持的原因有:1.家庭系統對暴食-催吐的症狀的忽視與否認;2.被動等待對方改變的互動方式;3.症狀凝聚了已進入空巢期的原生家庭,但是症狀無法解除。
依據研究發現及省思,研究者對處理厭食症相關議題之家族治療、諮商輔導實務工作者及未來研究提出具體建議,以做為之參考。
The purpose of this study is to explore the characteristics and changes in Anorexia Nervosa Patients’ Family System. The researcher used the semi-structural guideline to interview six anorexia nervosa patients to obtain data and analyzed data by using a phenomenological method in qualitative research.
The main findings were as follows: first, the characteristics of anorexia nervosa patients’ family are: 1.the marital subsystem is distanced, 2.the function of parental subsystem is extended, slanted and lacking of cooperation, 3.the boundary between marital and sibling subsystem is vague, and patients develop “parent-child enmeshment” with their parents, 4.patients competing with siblings to get the limited resources from family and to obey the family rules are the most difficult ones to differentiate themselves from family, 5.dysfunctional family structure increases parent-child enmeshment, 6.the meaning of symptoms in the family context---differentiation between self and family system: 1. in enmeshed family, the symptoms are tools and methods for patients to break family rules, to get out of emotion enmeshment or alignment, to obtain the power to make career decision, and to be out of unhappy marriage. All these are the struggle-ness that patients try to differentiate from family system and look for self-autonomy and self-identity. 2. In distanced family, the patients try to use symptoms to get attentions of family members, and to polymerize distanced family.
Secondly, the plight of developing oneself under the culture context: for example, in order to comply with the culture myths ”thin=beauty”, participants try to lose weight to gain the self-esteem.
The third, the special meaning of the food to the participants is: 1.experience of positive emotion, 2.expression of the royalty, 3.display the ability of self-control, 4.strugglness of royalty and self-control.
Furthermore, the function of participants’ family changes positively because they support the patients and the family function is more flexible, and so on. On the other hand, the function of patients’ family system changes negatively because they ignore and deny the patients’ symptoms, the interaction style is passively waiting for others to change, and so on.
According to the above findings, this study serves as a springboard for further discussion, and can be proposed for family therapy, school counseling, social education, and future research.
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