憂鬱症合併重複自我傷害行為青少年的人際心理治療：正向改變及有效治療因子分析

Interpersonal Psychotherapy for Adolescents with Depression and Repeated Self-Injurious Behaviors: Positive Therapeutic Factors for Good Outcome

唐子俊(Tze-Chun Tang) ； 蔡瑞修(Jui-Hsiu Tsai) ； 王慧瑛(Huei-Ying Wang) ； 黃詩殷(Shih-Yin Huang) ； 林家興(Josh Chia Hsin Lin)

《中華心理衛生學刊》 19卷3期 (2006/09) Pp. 279-304

https://doi.org/10.30074/FJMH.200609_19(3).0004

摘要

本研究針對憂鬱症合併重複自我傷害的三個青少女案主，接受人際心理治療後症狀顯著改善者，經案主同意分次進行共三至五小時的深入訪談，經逐字稿分析心理治療中案主獲得改善相關內容，了解受訪者接受心理治療前後的差異以及治療中真正有效的治療因子。研究結果發現，人際心理治療前後差異有：從絕望的人際挫敗經驗中重燃希望；以其他情緒處理方法取代自我傷害；找到可暫時取代原先挫敗經驗的人際關係。而有效的治療因子則是：持續穩定的陪伴關係，不因仍有自傷行為就被放棄；不確定是否嘗試形成新的人際關係時，持續被提醒；情緒慌亂時，可以向人真實表達自己而不覺丟臉；不被強迫接受自己應該怎麼做，和自己家人不同。最後，依據研究結果提出相關實務工作建議。

關鍵字

青少年 ； 憂鬱症 ； 重複自我傷害行為 ； 人際心理治療 ； 有效治療因子

並列摘要

Goals: Adolescents' repeated self-injurious behaviors rise dramatically and have great impact on campus and community in past few years. Though lots of psycho-educational programs drew people' attention to this problem, there were no systematically effective suicide prevention models established. The purpose of this research is tried to find possible positive therapeutic factors from successfully treated adolescent patients.
Method: Research method was in-depth interviews. Subjects were with three depressed and repeated self-injurious adolescents. Inclusion criteria require patients who received full course of interpersonal psychotherapy (IPT). Data analyzed from their tapes and transcripts over 3 hours of interviews. The semi-structured probing questions were: 1. what was the difference after psychotherapy, and 2. what was the positive factor keeping clients from self-injurious behaviors.
Results: The differences after interpersonal psychotherapy were as follows: new therapeutic relations instilled new hope rather than hopelessness, clients developed alternative interpersonal ways of coping, clients established substitute peer relations to replace for frustrated relations. Positive therapeutic factors of interpersonal psychotherapy were: therapist's persistent and accompanying relationships, therapist's encouragement to actively establish new relationship, clients find their ways to express suppressed feelings, clients were not forced to do anything they don't want in therapy.
Suggestions: We suggested the mental health professionals to keep in mind that: 1. therapist should actively establish supportive relationship as soon as possible, 2. therapist should encourage clients to act on new relationship seeking and resolving interpersonal conflicts, 3. therapist should help the adolescent to confront their parent-child conflicts, 4. therapist should connect clients to school staffs, 5. therapist should not impose what clients don't want on them in order to prevent premature dropout, and 5, therapist should train clients to learn new ways of coping and early recognition of potential suicide risk.

並列關鍵字

adolescents ； depression ； repeated self injuries ； interpersonal psychotherapy ； positive therapeutic factors

參考文獻

Brent, D. A.,Holder, D.,Kolko, D.,Birmaher, B.,Baugher, M.,Roth, C.(1997).A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy.Archives of General Psychiatry.54(9),877-885.

Brent, D. A.,Kolko, D. J.,Birmaher, B.,Baugher, M.,Bridge, J.(1999).A clinical trial of adolescent depression: Predictors of additional treatment in the acute and follow-up phases of the trial.Journal of the American Academy of Child and Adolescent Psychiatry.38,263-270.

Diamond, G. S.,Reis, B. E.,Diamond, G. M.,Siqueland, L.,Isaacs, L.(2002).Attachment-based family therapy for depressed adolescents: A treatment development study.Journal of the American Academy of Child and Adolescent Psychiatry.41(10),1190-1196.

Goodman, S. H.,Schwab-Stone, M.,Lahey, B. B.,Shaffer, D.,Jensen, P. S.(2000).Major depression and dysthymia in children and adolescents: Discriminant validity and differential consequences in a community sample.Journal of the American Academy of Child and Adolescent Psychiatry.39,761-770.

Hammen, C.,Rudolph, K.,Weisz, J.,Rao, U.,Burge, D.(1999).The context of depression in clinic-referred youth: Neglected areas in treatment.Journal of the American Academy of Child and Adolescent Psychiatry.38(1),64-71.