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題名:身體受虐兒童團體遊戲治療歷程之分析研究
作者:孫幸慈 引用關係
作者(外文):HSing-Tzu Sun
校院名稱:國立高雄師範大學
系所名稱:輔導與諮商研究所
指導教授:黃正鵠
學位類別:博士
出版日期:2006
主題關鍵詞:團體遊戲治療身體受虐兒童團體歷程abused childrengroup play therapy
原始連結:連回原系統網址new window
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身體受虐兒童團體遊戲治療歷程之分析研究
中文摘要
本研究旨在探討身體受虐兒童在團體遊戲治療中的互動行為與遊戲主題之變化情形,以歷程研究中的發現取向研究法,針對四位身體受虐兒童在為期兩週、共計三天十九小時,以結構性-自由遊戲-結構性活動為架構的整合取向的團體遊戲治療之互動行為與遊戲主題進行開放式編碼,且進行歸類、分析和統整。研究發現如下:
在互動行為方面,本研究發現,身體受虐兒童團體在第一個暖身(結構性)活動出現的主要互動行為是「衝突」、「抗拒」和「普同感」,第二個自由遊戲主要是「衝突」、「替代學習」和「合作」,第三個結構性活動則是「替代學習」、「合作」、「同盟」和「普同感」。團體出現「干擾」-「衝突」、「普同感」-「同盟」、「同盟」-「替代學習」-「合作」的行為組型。「替代學習」會隨著關係之建立而逐漸增加,在對象上可能先一人、兩人,最後才擴展至四人皆產生替代學習;在學習類型上,則從外在行為逐漸延伸至內在主題。「合作」行為隨著團體的進行而有逐漸攀升的現象,兒童之間的合作對象,從團體初期的「兩人一組、無固定對象」、「兩人一組、有固定對象」,最後為四人共同合作。「衝突」行為類型發現,團體初期以肢體衝突為主,到了團體中期和後期則逐漸由肢體衝突轉變為口語衝突。當觸及有關家庭、受虐事件等敏感主題,「抗拒」行為次數增加,「抗拒」行為組型主要有「排拒參與團體活動-單獨遊戲」、「排拒參與團體活動-否定回應」、「拒絕諮商師引導-曖昧不明動作」、「拒絕諮商師引導-否定-主動」、「涉及敏感主題-否定回應」、「拒絕諮商師引導-矛盾回應」、「涉及敏感主題-曖昧不明動作」及「拒絕諮商師引導-疑問反問」等八種不同的反應組型。前三次團體的「同盟」行為大部份都是由諮商師帶領結構化的儀式產生,第四次團體之後,「同盟」行為則由兒童之間自然產生。「普同感」主要有第二次團體的爸爸外遇、害怕孤單、自責,以及第四次團體的照顧弟妹。「干擾」與「衝突」行為次數互為正比,「干擾」的行為組型為「無關發言-不理會」、「觸碰他人-衝突」、「替他人回答-不理會」、「無關遊戲-提醒」與「抑制他人發言-順從」五類,以「替他人回答-不理會」行為組型出現次數最多。
遊戲主題方面,本研究團體在三個段落的重要遊戲主題不同,在暖身(結構性)活動為「匱乏」、「秘密」、「防衛」、「難過」、「虐待」與「掌控」,第二個自由遊戲段落為「撫育」、「清潔」、「建構」、「保護」、「虐待」、「秘密」與「修理」,最後一個結構性活動為「自主」、「撫育」、「成就」、「挑戰」與「滋養」。遊戲主題組型為「掌控」-「保護」、「秘密」、「匱乏」和「自責」後都會出現「替代父母」,「難過」-「滋養」,「保護」和「修理」後出現「滋養」,「撫育」-「對抗」重要組型。遊戲主題會因「替代學習」而互相影響,各次團體之間的主題也具有連貫性,或是前次團體出現的主題會影響下一次團體的主題。團體中遊戲主題有時會呈現共同的主題,如諮商師引導的結構性活動的「安全」和「對抗」主題,或是某個兒童引出的主題而使其他兒童產生「普同感」,如「自責」、「秘密」主題。並非每個兒童都因為身體受虐而出現同樣的情緒或行為反應,若對照四位兒童的家庭背景與受虐情形,與其所出現的主題相應證。「撫育」主題隨著團體進行而增加,「撫育」行為從想像遊戲,逐漸擴展至團體內的相互照顧,以及團體外的連結。「防衛」機制也是身體受虐兒童經常採用的方式,「防衛」主題發生時機主要是在暖身(結構性)活動段落,團體間隔時間愈長,愈是揭露跟家庭、受虐事件相關的主題時,防衛次數愈增加。「保護」主題隨著團體進展逐漸減少,「保護」主題相關的遊戲行為是掌控諮商師、穿上醫生服、認同自己是醫生和警察的角色、帶小嬰兒看病等。「匱乏」主題可以分為心靈「匱乏」與物質「匱乏」,心靈「匱乏」主要是兒童覺得自己沒有爸爸、沒有媽媽、失去家或感到孤單,物質「匱乏」則是兒童覺得缺少東西或是物品不夠。「修理」為處理對家的「掌控」和「保護」之後所產生相對應的遊戲主題,在處理「匱乏」、「虐待」和「自責」的主題後,才開始出現「修理」的主題。「秘密」為身體受虐兒童重要的遊戲主題,若諮商師能適時運用「普同感」或帶領一些儀式來建立「同盟」,對於消弭爾後的繼續保有「秘密」的現象極有助益。
研究者並針對上述研究結果加以討論,並據此分別對實務工作者及未來研究兩方面提出具體建議。
關鍵詞:身體受虐兒童、團體遊戲治療
The process research of the physical abused children in the group play therapy
Hsing-Tzu Sun
ABSTRACT
The purpose of this research was to investigate the change of interpersonal behaviors and game themes during group play therapy with physical abused children. The four physical abused children received three days 3- stages- activity of group play therapy in two weeks. The whole process of the group interpersonal behaviors and game themes was videotaped, and the discovery -oriented research were employed .
The finding were as follow:
The physical abused children, through 3- stages- activity, there were structural activity (the warm- ups), free game and structural activity , developed their main interpersonal behaviors, the first stages is” conflict” “resistance” and ” universality”, the second stages is “conflict” “substitute learning” and “cooperation”, the final stage is “substitute learning” “cooperation” “alliance” and ” universality” . The interpersonal behavior pattern in the group consisted of interfere – conflict, universality – alliance, and alliance – substitute learning –cooperation. Substitute learning was an important interpersonal behavior, which provided others with a change of observational learning, and which also developed in advance and deepened slowly. For the physical abused children, the conflict was an important factor of promoting group's relations of the children, and personal inner anxiety and theme as well. The physical abused children, which being touched with the relevant families and abused theme, were apt to produce” resistance “, the group acceptance was an important index to their dealing with the themes in the group. There are eight categories of response in children’s resistance. There are “reject attempt group-alone play”, “reject attempt group-discontent deny”, “reject counselor’s guidance- unidentified movements”, “reject counselor’s guidance- ambiguous”, “reject counselor’s guidance- deny-active”, “reject counselor’s guidance- ask in reply”, “involve the sensitive theme- unidentified movements”, “involve the sensitive theme- discontent deny”. Most alliance behaviors are produced by the ceremony in initial stage, after the fourth group session, alliance behaviors are produced naturally. There are five categories of response in children’s interfere. There are “no relevant speech- pay no attention”, “touch others- conflict”, “answer for others - pay no attention”, “no relevant game-warning”, “forbid others to answer-submit” .
The physical abused children, through 3- stages- activity, there were structural activity (the warm- ups), free game and structural activity , developed their main game themes , the first stages is” control ” “keeping secret” “ protecting” “sadness ” and ” maltreating ”, the second stages is “fostering” ” cleaning” “ constructing to act” “protecting” “ maltreating” “ keeping secret” and “repairing”, the final stage is “fostering” “achievement” “challenge” and “nourishment” .The themes of the game were regarded as children’s dealing with individual’s inner course struggling in group play therapy. Not every child presented the same mood or behavior, but had her own specific theme to be dealt with, depending on her abused family background. Though 3-stages-activity in the group ,the children developed some main game themes in each stage. The treatment of the theme, and the timing of treatment were determined by the children. The themes of group were interacted through substitute learning, and the was a continue in series of group, or former theme influenced the later. There was an order in theme appearance: secrecy, deficient and feeling guilty came first, then parent surrogate, sadness, protection, and reparation. After that, nourishment, and control, and at last protection. These theme patterns had much meanings in dealing with children’s inner conflict and improving their energy. The defense mechanism was used by the children at the stage of structural activity (the warm-ups). When the longer intervals between the groups took and the more the themes contacted with the family and abused events, the more frequency the defense mechanism would present. During the three stages of group play therapy applied to physical abused children, there were different but important interactive behaviors and game themes, and also patterns for behaviors and themes . Meanwhile, there were different process for individual child to deal with her inner strugglers and grieves as well.
Based on the above finding, discussions, suggestions and applications were provided for counselor and future research.
Key words: abused children, group play therapy, group process.
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