過動兒童在系統中的哀礙愛-實習心理師的關係介入與系統整合經驗

本研究旨在研究小學三年級經確診為ADHD過動症兒童的個案（代稱為大雄），經過一學期的諮商晤談與系統合作（主要對象為導師與案母），探討個案以系統合作的工作模式下，探討在諮商晤談前、後，包括個案與系統重要成員的影響與變化。研究方法是個案研究，採用關係介入，其內容有兩大部分，包括研究者對整個歷程的再建構與反思，以及事後與系統重要他人（導師與案母）的半結構訪談，試圖探討在這個過程中的有效與有限因子分別為何，包括像諮商師、導師、案母等各自的效能與限制各為何，各自會面對的挑戰與困難，試圖從各自的拼圖，勾勒出如何促進系統合作的藍圖。研究發現有以下幾點：一：「個案工作」方面：在人際方面，信任關係的建立與正確的理解，是促進改變與適應的關鍵有效因素，在學習方面，要能針對與滿足個別需求的彈性作法。二：「家長與導師工作」方面，唯有多同理、多賦能，才能讓對方感到有能力參與，降低愧疚或不足帶來的種種矛盾與抗拒，以增進合作的有效因素。主要技巧為「人際歷程回饋」，應用多提問與多對話的技巧，以降低各自不同帶來的壓力與抗拒。三：「學校工作」方面，家長團體與親職諮詢是很重要的，前者可帶給家長「希望感」、「普同感」，後者可促進親職功能的提升與調整。四：「心理諮商師」方面，扮演促進彼此理解的媒介與轉譯者是晤談與合作工作的有效因素。這部分有賴於對他人的同理，即將心比心，以及對人我之間的人際歷程與適當界線具有一定的觀察力。五：「系統合作工作」方面，本身是充滿挑戰的，可說大不易。有效關鍵在於能看見每一個人的需要與困難何在，且關係的建立著重在平等、互惠與尊重上。六：「未來展望」方面，在校可以組成「行動聯盟」，將導師、家長與諮商師定期開會與討論，能更即時地調整以貼近兒童需求的可能，以達到防患於未然的目的，並可以此建立志工種子，建立友善的人力循環，成為未來過動兒童的守護者。

關鍵字

ADHD ；過動兒童；系統合作；生態系統；人際歷程；合作對話

並列摘要

The purpose of this research was to study a single case of a child with ADHD in the third year of elementary school who was designated as David. The counseling sessions and interviews within the system (mainly focusing on the class teacher and the mother of David) has cooperated lasted for a semester in order to observe the influence and change, before and after the interviews in important members of the system and David under a model of systemic cooperation. Case study was adopted as the research method with the relationship intervention was offered by the intern psychologist as well. Two main parts of this study included the researcher’s reconstitution and introspection of the entire process as well as the semi-structured interview of post-event with important members (the class teacher and the mother of David). The research was intended to discover the effective factors and limited factors during the entire process, including the performance and restrictions of consultant, the teacher and the mother of David. Each role has faced its own challenges and difficulties, with the information, the blueprint of systemic cooperation will be developed. The findings of this study were listed as follows. A. Case Work: Regarding the interpersonal aspect, the establishment of a trustful relationship and the correct understanding were both the key effective factors for the individuals in the system to make a change and adaptation to the situation. About the learning aspect, the flexible approach should be used to satisfy the needs of each individual. B. Work of Parents and Teachers: Only being more empathetic and skilful could possibly make people feel that they were able to participate, reducing the contradictions and resistance brought by guilt or insufficiency and increasing the effective factors for cooperation. The main skill found here was called interpersonal process feedback. By asking more questions and having more conversation, the stress and resistance from different reasons can thus be decreased. C. School Work: Parent groups and parenthood consultation were extremely important. The former would bring hope and universality to the parents, and the latter would improve to adjust the parental generativity. D. Intern Psychologists: As an intern psychologist, I had played a role as a medium and translator to understand each other that was the effective factor for interviews and cooperative work. It could rely upon the empathy for others, which means putting oneself in someone else’s shoes, as well as having a certain degree of observation about the interpersonal process and proper boundaries between people and myself. E. Work of Systematic Cooperation: It was challenging and difficult to work within a system with individuals with different perspectives of the case. The key was to discover each individual’s needs and difficulties and built the relationship based on the principles of equality, reciprocity, and respect. F. Vision in the Future: As suggested from the abovementioned findings, a mobile alliance can be formed in the school with the teachers, parents and counsellors gather together regularly for meetings and sessions of discussion. In this way, the needs of children will be possible to be adjusted instantly to achieve the goal of nipping in the bud, and to form the volunteering groups in order to establish a cycle of human friendly resources for protecting the children with ADHD in the future.