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題名:臨床心理師心理治療中非性雙重關係倫理決策歷程之研究
作者:張馥媛
校院名稱:國立彰化師範大學
系所名稱:輔導與諮商學系所
指導教授:王智弘
學位類別:博士
出版日期:2015
主題關鍵詞:臨床心理師心理治療雙重關係倫理決策clinical psychologistpsychotherapydual relationshipethical decision making
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本研究旨在探討臨床心理師心理治療中非性雙重關係之經驗,及其倫理決策歷程的決定因素、行動與結果。本研究採深度訪談法,對九位臨床心理師進行個別訪談,並以內容分析法進行質性資料分析。研究結果發現:臨床心理師治療中的非性雙重關係包含治療前社交關係、同時發生的雙重關係以及結案後雙重關係;其中同時發生的雙重關係可分跨越界線及治療中的社交關係;跨越界線還可分為非治療性的跨越界線如收受禮物及提供治療外的協助,以及延伸治療的跨越界線如跨越空間界線、跨越時間界線及非性的身體接觸。臨床心理師在面對非性雙重關係時的決定因素包括當事人福祉、關係界線風險、倫理法規、治療者、人情、情境等;其行動可分為維持專業角色界線、調整專業角色界線、跨越專業角色界線、專業與社交角色並重、以及社交角色為主專業角色次之等;其結果包括對治療、治療者及社交關係之正負影響;當參與者堅持專業角色界線時,對治療有益但也可能有損害,若調整專業角色界線或跨越專業角色界線會增加助益但也有風險,而若是專業與社交角色並重或社交角色為主專業角色次之時,其影響主要都是負面的。此外,參與者的人格特質、治療取向、個人與專業成長及執業環境也會影響其決策歷程。本研究最後依所得結果提出對臨床實務、倫理守則修訂、倫理教育規劃及未來研究之建議。
The goal of the study is to investigate the clinical psychologists’ nonsexual dual relationships experiences in psychotherapy and their decision-making process including determinants, actions and consequences. Four male and five female clinical psychologists were interviewed individually and intensively. All interviews were audio taped. Content analysis was used to analyze the data. The nonsexual dual relationships clinical psychologists involved in Taiwan include the social relationships before the therapy, the dual relationships during therapy sessions, and the social relationships after the therapy ends. The dual relationships during therapy sessions can be divided to boundary crossing and in-therapy social relationships with clients. Boundary crossing includes non-therapy boundary crossing, such as acceptance of clients' gifts and offering help not related to the treatment, and extra-therapy boundary crossing such as providing therapy outside the therapy room, providing counseling by phone or other ways between two sessions, and nonsexual physical contact. The clinical psychologists’major concerns when facing nonsexual dual relationships include the well-being of the clients, the risk of violating boundary, ethic rules, the warmness of the clients and circumstances, etc. Actions can be classified into maintaining the boundary, adjusting the boundary, crossing the boundary, paying equal attention to professional and social roles, and especially emphasizing the social roles. The consequences include positive and negative impact on the treatment, therapists and social relationships between therapists and clients. When the participants persist to maintain professional boundaries, the outcome may be helpful to treatment but may also be harmful to treatment. If the participants adjust professional boundaries or cross professional boundaries, the outcome may increase the positive consequences but may also has risk. And if the participants pay equal attention to professional and social roles, or especially emphasize the social roles, the outcome is often negative. Participants' personality traits, theoretical orientation, personal and professional maturity, and practice environment will affect their decision-making process. Implications of these findings and recommendations for clinical practices, revising of ethics code, planning for ethics education and the possible research in the future were discussed.
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