一段治療，兩種經驗：初探治療改變機制

「治療改變機制」這個術語被用來說明治療改變的原則，不同的研究者以不同的隱喻敘說著。本研究的目的是藉由質性研究取向，對於個案與治療師的治療經驗提供一個厚實的治療現象理解，建構性地再現出個案與治療師於治療中的互動，探討個案與治療師治療經驗的異同，以及建構出治療改變機制模式。研究樣本採立意取樣六組曾經一同完成治療的個案與治療師，以回溯性深度訪談方式對兩方收集個別獨特的治療經驗敘說資料；資料分析方法為敘說分析，以多樣的敘說故事，來鋪陳個案與治療師具體治療經驗和對此經驗意義的建構。研究結果主要有二部分，第一：個案與治療師的治療經驗有差別，個案與治療師會用不同的框架來找尋問題現象的原因，個案以其自我與世界接觸的整全經驗為架構，在生命經驗之流中尋找問題現象原因，相對地治療師則著重於治療理論，而透過兩人對話方式，個案找到屬於自己意義的答案。第二：以較偏重個案視野所建構出的「關聯性改變機制」來說明改變現象，其主要內涵是個案透過循環性建構自我與問題間關聯性的行動，將自我與世界接觸時有問題的現象回復到沒有問題的現象，更了解自我怎麼活在生活世界中，關聯性改變機制模式運作下的改變歷程可區分為六個階段：求助階段、問題標定階段、承載問題階段、建構自我與問題間關聯性階段、問題解決階段、承載自我階段。上述研究結果建議，若治療師能充分運用自身所偏好之治療理論與知識，建構出一個可說明個案問題現象中之外在事件、內在想法、情緒與情緒功能三者間關聯性的答案，來與個案對話，將有助於個案建構出屬於自己意義問題現象原因的答案，也對自己有更多的了解，並進一步採取行動解決問題。

關鍵字

個案與治療師；治療改變機制；治療經驗；敘說分析

並列摘要

The term “Mechanism of Therapeutic Change” was used to elucidate the principle of therapeutic change, and different researchers asserted different metaphors. The purposes of this study were to employ a qualitative research approach (1) to provide a solid therapeutic phenomenon understanding of clients’ and therapists’ experiences in therapy, (2) to constructively represent the interactions between client and therapist during therapy sessions, (3) to explore the differences between clients’ and therapists’ experiences of therapy, and (4) to construct a model of mechanism of therapeutic change. As a purposive sample, six pairs of clients and therapists who had finished psychotherapy together participated in the study. Both parties’ unique narrative data were collected separately via retrospective depth-interviews. With narrative analysis method, the meaning of therapeutic experiences was constructed through various narrating stories describing and elaborating clients’ and therapists’ concrete experiences in therapy. There are two significant results of this study. First, the experiences of clients and therapists are distinct. Clients and therapists used different frames-of-reference to formulate reasons for the problem phenomenon. For clients, they generally focused on the experiential gestalts of self-world exchange, when searching from the stream of life reasons for the problem phenomenon; in contrast, therapists focused on therapeutic theories. Through therapeutic dialogue, clients discovered reasons meaningful to self. Second, aligning more with clients’ perspective, a model of “Mechanism of Change with Relatedness” was proposed to illuminates the phenomenon of change. The model mainly showed that through constructing self-problem relatedness circularly and repeatedly, clients restored the problem phenomenon of self when exchanging with the world to no problem phenomenon, and gained more understanding of how oneself can live in the life-world. The change process under the model consists of six phrases: help-searching phrase, problem clarification and definition phrase, problem-acceptance phrase, self-problem relatedness construction phrase, problem-solving phrase, and self-acceptance phrase. The results of this study suggested that while working with clients via therapeutic dialogs, if therapists could use their own preferred therapeutic approach and knowledge to construct an answer able to explain the relatedness among external events, internal thoughts, and emotions and emotional functions of clients’ problem phenomenon, it is useful to help clients construct their own meaningful reasons for problem phenomenon, understand one selves more, and take actions to problem solving.