處理自殺個案的倫理衝突－以一位軍中諮商心理師的經驗為例

軍中諮商心理師因場域的特殊性，以及組織對諮商師的角色期待，使得諮商師在面對自殺個案時容易產生倫理衝突事件與議題“而軍中的特殊情境，特別讓新手諮商師在面對自殺個案衍生的倫理議題時，感到衝突與兩難。本研究目的在探討諮商師於軍中情境脈絡下面對自殺個案的倫理衝突經驗，依研究目的衍生兩個研究問題：1．諮商師在軍中情境脈絡下面對自殺個案的倫理衝突事件為何？2．諮商師在軍中情境脈絡下面對自殺個案引發的倫理衝突議題為何？本研究透過研究綱要的設計，邀請一位軍中諮商心理師進行四次一到兩個小時的訪談，訪談資料以敘說研究中的「敘說分析」法進行分析，研究結果分為『故事敘寫－倫理衝突事件』與『故事意義建構－倫理衝突議題』兩個部分。研究結果發現：本研究受訪者在面對自殺個案與軍中文化體制的角色期待過程中，其所經歷的倫理衝突事件包括：1．給電話－糾結的承諾。2．自殺送軍法？對諮商師想法的衝擊。3．保密的限制與信任關係的挑戰；而研究者如何建構故事與軍中諮商面對自殺個案倫理衝突的議題則包括：1．與當事人建立信任關係與遵守專業倫理問的掙扎；2．面對當事人與組織間的角色兩難；3．兼顧尊重案主意願與面對組織責任的挑戰。

關鍵字

自殺個案；倫理衝突；敘說分析

並列摘要

Given the character and expectations of military organizations, counselors in the military have to face many ethical and professional conflicts and dilemmas, often involving suicidal clients. New counselors face numerous and unique ethical and professional issues and dilemmas, particularly when suicidal clients are involved. This study investigated the ethical conflicts experiences by military counselors treating suicidal clients. Two questions were addressed by this study. 1. What kind events of the ethical conflicts a military counselor has to face when treating suicidal clients under the military circumstances? 2. What kind issues of the ethical conflicts a military counselor has to face when dealing with suicidal clients under the military circumstances? The study population was one military counselor in this study. Based on the study design, a military counselor was interviewed four times total with one to two hours each. The interview data was analyzed by ”narrative analysis”, and was presented in one of two formats of ”narration-conflict events” and ”construct story meaning/conflict issues”. The narrative analysis results indicate that, given the unique ethical and legal context of the military, the counselor treating suicidal clients face the following events of ethical conflicts: 1. Should the counselor giving out privileged phone number?/Providing personal information to suicidal clients or not? 2. A suicidal client should have the treatment or have a punishment in the martial court?/A conflict thought on the counselor, 3. The counselor have the limit of confidentiality and the challenge of trustful relationship. The way for the counselor to interpret the narrative story meaning and the issues of the ethical conflicts experienced by the counselor include: 1. Balancing professional ethics with the practical need to establish a trusting relationship with the client, 2. The dilemma of a role when the military counselor has to play the client's counselor and a employee of the organization, 3. The conflict between the professional responsibility to treat the client and the responsibility to the military organization.