心理治療個案：自我改變歷程之敘事分析

研究目的：本研究之目的藉由具有時序性的訪談探討心理治療個案如何看待其困擾處境，而個案在說故事中如何地做選擇與建構意義來成就自我；期待看到隱沒主體的說出轉變，及個案於心理治療裡其自我抒困的身心轉化歷程，和此歷程與心理治療的關係。試圖使心理治療過程中自我的改變現象與歷程更為彰顯。研究方法：本研究採質化研究方法，以敘事分析的取向深入呈現經驗現象。本研究對象為心理治療進行中的個案，從接受治療之初即開始訪談，每四次治療進行一次約一小時的訪談，過程中全程錄音，其逐字稿即為本研究主要的分析資料。並依據呂格爾「三層次再現論」及透過研究者對自我的預設視框進行分析。研究者的「自我」預設視框係指包含主體我，敘說我及處境我，以及其各自的敘說，以此預設視框試圖看到自我在心理治療歷程中所呈現的改變，並進而試圖勾勒出其改變歷程。本研究共呈現了四位心理治療個案的改變故事。研究結論：本研究以自我的預設視框作為呂格爾三層次再現論中的再構分析方式，試圖看到自我各元素間的互動及改變的可能路徑，結果意外地發現某些自我意義的建構與處境息息相關，也就是處境我的敘說不斷地在處境中建構意義，進而影響主體我；另外，結果也發現個案在治療裡的發現與理解所展現的改變，仍需要生活中重要他人的認可，改變在生活裡才有義理之路可走，所以意義也需在處境中被建構，那麼心理治療的重點也可能需要轉入至一種人際倫理契入的作為，以促啟更多改變的可能。其次，本研究也發現主體我會經由處境我做選擇、採取行動，而處境我的行動會再度肯定主體我。最後，本研究發現心理治療中自我改變歷程有兩個時期：一為接近理解時期，二為自我回憶時期。第一個時期為治療初期個案的等待被心理師理解承接的過程，理解承接意指個案一直隱而未明的感受被指認出，在治療中成形，且可被談論。而進入第二個時期的關鍵就在於一旦被承接之後，個案在心理治療裡有一個能被理解的說話位置，進而再度回到困擾處境，進行經驗的回憶，在其中處境我及主體我之間產生對話，進而展開自我改變。由於本研究其中三位個案的治療次數約在7∼12次之間，所以改變歷程的分析所呈現的只是治療初期的樣貌，無法全然概括至心理治療之全貌，但仍能提供個案於心理治療初期的自我改變樣貌。

關鍵字

自我；敘事分析；改變歷程；心理治療

並列摘要

Purposive : The aim of the research is with a processing interview way to investigate how the clients in the psychotherapy view their problem situation, made choices in the situation and construct meaning for attending a realization of the Self. The second aim is to find how the implicit Self to become explicit. Otherwise expect to find the change process that how the clients get through the discomfort between mind and body, and the relation that the change process with psychotherapy. This research attempts to make the Self change phenomena and process of psychotherapy clients more apparent and provide more insights to the readers. Method : To provide a more in-depth representaion of the clients’ experience phenomenon, this research adopted the qualitative approach and the narrative analysis. The research objects are the clients in the psychotherapy, the researcher interview the clients from the treatment onset, and then interview them every four treatments after that. Each interview took approximately one hour and was recorded for transcribing into text to provide the main source for data analysis. We analyze texts further in accordance with the Ricoeur ‘s discourse, la triple mimesis, and a frame of reference “the Self”. ”the Self ” is composed of I, narrator, and Mes, and each component has a location in the Self to narrate, all of them are some ways to represent the one’s Self. We try to find the Self change of the clients in the psychotherapy with these two perspectives, and attempt to draw the change process. Four clients were represented in this research. Result and Discussion: The research attempts to illustrate and discuss the interactive phenomena in the Self and the possible routes of changes. The unexpected result discovers sorts of the self meaning constructions are in relation closely with one’s situate. We find Mes constantly construct the meaning from the situation, and then influence the I. Otherwise, the other result discovers that the changes, some discovers and realization from the psychotherapy, must carry out in the life. The changes need significant other’s affirmation, and just can go on. Therefore, the key point of psychotherapy might turn intervention into a interpersonal ethical action, and then promote more changes. Besides, the I would make choices and do actions through the Mes, and in the other way, these actions might further affirm the I. The other result concludes there are two period in the Self change process: 1. accessing get realize period, 2. get into the self historical memory stream period. The first period is the process that the waiting for be realized by the therapist of the client in the psychotherapy onset. The therapist action is a way to figure the felt sense of the client. If the felt sense was figured out, the I and the Mes were received and carried on, and can be narrated in the afterward psychotherapy. The key point of getting into the second period is the client can be realized, and then get the voicing location. The voicing location lets one get back to the discomfort situation, and memorized the past discomfort experience, and Mes and the I dialog with each other , and might develop changes further. As a result of the total treatment sessions between 7~12 in three clients of the research, the result presented is only one kind of change phenomena and process of treatment initial stage. It is unable to completely summarize to the overall picture of the psychotherapy, but still can offer some meaningful pictures of change process in the initial stage of psychotherapy .