促成團體心理治療中早退行為之脈絡因素

The Contextual Factors Clients' Process Dropout during Group Psychotherapy

蔣欣欣(Hsien-Hsien Chiang)

《Journal of Medical Sciences》 8卷3期 (1987/11) Pp. 169-179

摘要

本研究之目的為探求團體心理治療中，出現早退現象的脈絡結構（contextual structure），並找出形成早退的因素，及產生適應實際現象的概念模式。因此採用參與觀察（participant observation）的研究方法，以三軍總醫院精神科病房內進行的12次團體心理治療過程為對象，進行比較分析。結果發現早退行為主要有完成型及潛伏型兩種型態，影響早退行為的因素有（一）與個人所處狀態有關者，包括身體不適、動機不足、衝突形成，（二）與當時環境有關者，包括治療者的態度、團員關注程度、團體人數、新成員數。這些因素對早退者造成不同的拉力與驅力，其最後形成的總結合力決定早退者所處的生活空間（Life Space）。此外，結果亦顯示早退除了會破壞團體的穩定性，同時也是個機會，可促使團體成員認識自己感受，學習與人相處，產生建設性的治療效果。

關鍵字

早退現象 ； 團體心理治療 ； 提早離席 ； 參與觀察

並列摘要

The purpose of this study is to discover the contextal factors that affect the dropout phenomena of inpatient group psychotherapy and to form a conceptual model for dropout behaviors. For understanding the dropout in the contextual structure of group psychotherapy, a combined qualitative methodology was used. As a participant observer, I observed twelve sessions of group psychotherapy. There were forty-seven patients participating in the group psychotherapy sessions. The dropout rate of this study group was twenty-one percent. There is significant difference (P=0.0078) between the dropout rate of the group that have over four new members (≥4) with more than ten team members (≥10) and the group that have less than four new members (＜4) or less than ten team members (＜10). Furthermore, by using the constant comparative method, other factors that affect dropouts were detected. These factors are physical discomfort, insufficient motivation, and conflict formation. As I continued to analyze the situation, I found that the support and pressure from peer and the attitude of therapists also affect the dropouts. Besides these, I have found two different kinds of dropouts. One is latent type, and the other is a complete type. In summary, the contextal factors of dropping out from inpatient group include two parts. The one is related to the personal factors: physical discomfort, insufficient motivation, and conflict formation. The other is related to environmental factors; the number of team members and new members, pressure and support from peers, and the attitude of therapists. Thus, the interaction of these factors forms a changing force to induce two types of dropouts, which could be either destructive or productive for a group process. Based on these findings a conceptual model of dropouts in group therapy was formed.

並列關鍵字

Dropout ； Group Psychotherapy ； Premature Termination ； Participant Observation