臨床晤談與心理接觸

為著學習如何適切地與病患及家屬作心理接觸，本文擬將臨床晤談之「建立關系的原則」，「基本技巧」與「進階技巧」作一些回顧與整理。臨床晤談技巧中最根本的部分是與患者建立和諧、共鳴的關系；要建立這樣的關系，需要在三方面努力。首先，是「減低患者的困惑與不安」、「有限度、合適地自我揭露」、「無條件地接納與尊重，并觀察其效果」。基本技巧是進行晤談的基礎，以下要回顧的議題包括：專注行為(attending behavior)、專注與傾聽的關系、超越專注(moving beyond attending)、非指導性的傾聽(nondirective listening)以及再保證(reassurance)。進階技巧中有許多技巧是指導性的，這些技巧將晤談者置於指導者、專家、權威者的角色上。使用這些技巧需要晤談者對於人際與臨床的敏感度，以及基礎的心理病理學知識與診斷技巧。使用這些技巧是為了在晤談情境中，提供患者指引或方向(guidance or direction)，以便聚焦於與患者問題相關的重要議題上。這些技巧可分為三類，第一類是「指導性的傾聽(directive listening responses)」，第二類是「問問題(using questions)」，第三類是「指導性的行動(directive action response)」。患者在面臨整體生活的衝擊時，需要時間以自己的步伐來調適；他的尊嚴與隱私，他的個人與經驗應受到尊敬與保護。從事晤談工作會與患者有深入直接的接觸，幫晤談者就要有謙沖嚴謹的態度，并認真養成專業純熟的技巧，才能真正對患者產生助益。

關鍵字

臨床晤談；心理接觸；融洽關系；晤談技巧

並列摘要

For the purpose of learning how to making psychological encounter with patients and family, we reviewed and summarized principles of building rapport, basic skills and advanced skills in this article. Building rapport and empathetic relationship are the foundation of clinical interview. While trying to establish this kind of relationship, ”reducing the confusion and anxiety of client”, ” making limited and appropriate self-disclosure and expressing” , ” unconditioned acceptance and respect and monitoring the effect” are the directions we may need to be in. Basic skills include ”attending behavior”, ”moving beyond attending ”, ”nondirective listening” and ”reassurance”. The relation between attending and listening has been reviewed, too. Comparatively speaking, advanced skills are more directive than basic skills in general, which put interviewer in a directive, expert or authoritative position. They provide client guidance or direction in the interview context; facilitate focusing on the relevant issues. These skills require interviewer s interpersonal and clinical sensitivity, basic psychopathological knowledge and diagnostic skills. We categorize these skills into three parts: first is ”directive listening responses”, second is ”using questions”, third is ”directive action response”. While facing impact of life, each and every client needs time to set his pace for shaking down. His dignity, privacy and individual experiences should be respected and protected. Engaging in interview often has opportunity to have deep encounters with clients, so the interviewer should be modest, conscientious and skillful, then can really benefit clients.

並列關鍵字

clinical interview ； psychological encounter ； rapport ； interview skill

國際替代計量

臨床晤談與心理接觸

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