家庭治療四步模式的治療歷程與療效研究

許皓宜

指導教授 ： 田秀蘭

國立臺灣師範大學/教育學院/教育心理與輔導學系/博士(2010年)

摘要

本研究主要目的在探究家庭治療四步模式的治療要素，並瞭解其療效所在，以及如何藉由一些特定的介入技巧促進家庭治療的進展。
在研究方法上，本研究分為兩階段進行。階段一為「建構要素階段」，研究者藉由文獻與經驗整理，根據家庭治療四步模式的四個步驟整理出初步的治療要素，接著蒐集實際治療行為的錄影帶、治療歷程逐字稿、治療師記錄，透過假設與實際行為的不斷比對，分析家庭治療四步模式的歷程要素，以建構更細部的「家庭治療四步模式之要素與細項」。階段一的研究參與者為醫療院所轉介的5個家庭，由研究者自行擔任治療師，對家庭提供5到9次的家庭治療。在此過程中，研究者以質性取向之方式進行資料蒐集與分析，在協同研究者、受過家庭治療四步模式訓練的資深督導之合作下，逐步澄清模式中的相關要素，最後並由受過家庭治療四步模式訓練的資深治療者進行專家效度檢核。
階段二為「療效分析階段」，研究者採準實驗研究設計、以多重檢證的方法，同時蒐集質性與量化資料；並整合治療師與案家的角度，一方面探討家庭治療四步模式的療效內涵，以及影響療效或阻礙療效發生之因素，另一方面也瞭解該模式對不同家庭類型及不同家庭成員在家庭互動、家庭和諧感受、心理需求滿足感、個人生活滿意度，以及不同療效層面之影響。階段二的研究參與者為研究者透過公開招募的方式前來報名的12組家庭，由6位受過家庭治療四步模式訓練的治療師提供6到8次的家庭治療。研究最後除了分別呈現質性與量化結果之外，研究者亦將所蒐集之資料以對偶分析的方式整合呈現各個家庭成員在接受會談後的改變。
最後，研究者根據上述研究結果，與國內相關研究相互呼應，並提出在實務研究中的反思，以及對家庭治療實務工作與家庭治療師的訓練提出建議。

關鍵字

家庭治療 ； 治療歷程 ； 療效研究

並列摘要

The purposes of this study is to explore the therapy elements in the four-step model of family therapy, to find out what the curative effects are, and to facilitate the development of therapy by adopting certain techniques.
In the aspect of research methods, this study was conducted in two stages. Stage one is the stage of “constructing elements”. Through organizing documentations and experience, the researcher summarized the initial therapy elements according to the four steps from the four-step model of family therapy, and then collected videos of actually behaviors in therapies, verbatim transcriptions of theory processes, and therapists’ records. Through continuous comparison with hypotheses and actual behaviors, the elements in the process of the four-step model of family therapy was analyzed to construct more specific “elements and details of the four-step model of family therapy”. The research subjects in stage one were five families introduced by hospitals. The researcher served as their therapist to offer them five to nine family therapies. During these processes, the researcher collected qualitative data for data analysis. By cooperating with other researchers and senior superintendent who had received trainings for the four-step model of family therapy, the related elements in the model were clarified one by one. Finally, the senior therapists who had received trainings for the four-step model of family therapy verified the expert validity.
　　Stage two is the stage of “analyzing curative effects”. In this stage, quasi-experimental design and triangulation method were adopted by the researcher. Both quantitative and qualitative data were collected to, on the one hand, explore the content of the curative effects and the factors influencing or blocking the curative effects, and on the other hand, find out the influences of the model on family interactions, family harmony, fulfillment of psychological demands, and satisfaction in personal life with different types of families and different family members. The research subjects in stage two were 12 families signing up in the public recruitment activity conducted by the researcher. Six to eight family therapies were provided by six therapists who had received trainings for the four-step model of family therapy. Besides the qualitative and quantitative results of this study, the researcher also presented the collected data in an integrated way through dyadic analysis.
　　Finally, the researcher offered the suggestions for practice of family therapy and family therapist training according to the above-mentioned research results.

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