精神科職能治療治療關係的探討：治療師與個案觀點之比較

The study of therapeutic relationship in psychiatric occupational therapy: different perspective from therapists and clients

劉德昌(De-Chang Liu)

指導教授 ： 潘璦琬

國立臺灣大學/醫學院/職能治療研究所/碩士(2021年)

https://doi.org/10.6342/NTU202100448

摘要

前言：為了瞭解個案需求，建立治療關係是治療過程中重要且必須的程序。過去文獻顯示治療關係與治療成效有中度相關，且治療師與個案間的治療關係有差異，因此，評估治療關係的品質並區分治療雙方治療關係的差異是必要的。本研究目的為驗證治療關係短版問卷的信效度，並探討治療師與個案雙方對治療關係的觀點是否有所差異。
研究方法：本研究收取醫學中心精神科日間病房以及社區康復之家中符合收案標準之個案與治療師，在進行知情同意之後，使用網路問卷量測兩種情境的治療關係，分別包含團體活動中治療師與個案的治療關係，以及在一般情境中個案與主要治療師的治療關係，並收取個案症狀資訊、活動參與度與人口學資料。資料分析部份，透過羅序分析驗證治療關係短版問卷的適切性，並透過成對樣本T檢定檢驗治療師與個案關係的差異。
研究結果：本研究共收取一般情境30位個案、4位治療師，團體活動情境20位個案、4位治療師。羅序分析顯示，短版治療關係問卷可調整為三分量表，較符合評分量表適切性與單向度假設。成對樣本T檢定顯示，在一般情境中的治療關係問卷總分、目標次領域分數以及任務次領域分數上，個案與治療師有顯著差異。而在活動情境中的治療關係問卷總分、目標次領域分數以及任務次領域分數上，個案與治療師有顯著差異。
結論：個案與治療師雙方在治療關係上的觀點有所差異，特別是在目標以及任務領域部分，治療師在帶領活動、與個案討論目標時，需特別注意到彼此的觀點差異，並透過相關問卷測量治療關係的品質，可增進雙方治療關係觀點的一致性，進而促進治療成效。

關鍵字

職能治療 ； 治療關係 ； 羅序分析

並列摘要

Introduction: It is important to establish good therapeutic relationship with our clients so that we can collaborate with them to achieve better treatment outcome. Literature shows that there were moderate correlations between therapeutic relationship and treatment outcome, and there was different level of therapeutic relationship perceived by clients and therapists. Therefore, it is necessary to evaluate the quality of therapeutic relationship from both sides. The aim of this study is to validate the therapeutic relationship questionnaire- short form and to examine the different perspective of therapeutic relationship from both sides.
Methods: The subjects of the study were recruited from the psychiatric day care ward of medical center and a community mental health setting. Clients and therapists who met the inclusion criteria will be invited to participate. We applied online questionnaire to measure the therapeutic relationship on two situations. The first one is to look at the therapeutic relationship in the group activity therapy occasion; and the other one is to look at the the therapeutic relationship which each client was assingned a caring therapist after admission. The validity of the therapeutic relationship questionnaire (short form) was analyzed by Rasch measurement model. The therapeutic relationship between both sides were analyzed using paied-t test.
Results: A total of 50 clients and 8 therapists participate in the study. Among them, 20 clients and 4 therapists chose to fill out therapeutic relationship on group activity therapy; 30 clients and 4 therapists chose to fill out therapeutic relationship on assigned case care system. The result of the Rasch analysis showed that the therapeutic relationship questionnaire (SF) can be adjusted to a three-point rating scale, which met criteria for unidimensionality. The result of pair-t test showed that there are significant differences between the client and therapist on total scores and subdomain of goal and task in assigned case care system. There are significant differences between the client and therapist on total scores and subdomains of goal and task in group activity therapy.
Conclusion: Our findings support the validity and reliability of the SF-therapeutic relationship questionnaire. The results also confirm that there are significant differences of the level of therapeutic relationship as perceived by the clients and the therapists, especially on the domain of goal and task. Therapists tended to rate higher than their counterpart. We strongly suggest that the therapists should be aware of the differences and take actions to promote therapeutic relationship.

並列關鍵字

Occupational therapy ； Therapeutic relationship ； Rasch analysis

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