心理治療師在心理治療歷程之反移情經驗研究

A Study on a Psychotherapist’s Countertransference during the Process of Psychotherapy

謝珮玲(Pey-Ling Shieh)

指導教授 ： 王麗斐

國立臺灣師範大學/教育學院/教育心理與輔導學系/博士(2002年)

摘要

本研究跟隨一名心理治療師的治療歷程，以現象學取向藉由每次治療後30小時內的訪談，與結案後回顧療程的訪談，探索其在十次治療中的反移情經驗。研究焦點涵括反移情經驗的背景因素、內涵以及轉變，並以提取自訪談資料的架構進行分析。
研究結果共整理出22個反移情經驗，與背景因素對照下，受訪者對特定案主之反移情經驗，比其對反移情之界定與既有經驗更多樣化且具有雙面的意涵。反移情經驗的相關因素同時包括治療師之固定背景與治療師--案主互動之獨特成份，可依經驗性質區分為「對個案的感受或觀點」、「治療師與治療的角色及地位」、「治療關係與治療維繫」、「分心與聯想」四個主軸。
「對個案的感受或觀點」在療程中佔最多數，治療師對案主有多樣的感受，其中部分感受會進一步產生對案主的觀點。「治療師及治療的角色與地位」主軸的反移情出現情形居次，治療師在其中的經驗環繞著「治療師究竟是什麼角色」與「治療的地位是什麼」兩個問題，被利用、不被尊重的感受強度可能會影響治療的維繫。在「治療關係與治療維繫」主軸中，治療師對關係的評估直接關乎治療維繫。「分心與聯想」的反移情經驗在本研究出現最少，治療師在其中經歷到隨案主的描述，而有不同聯想內容與認同立場的經驗。
在經驗轉變的整體趨勢方面，隨著治療的進展，受訪者對個案由不熟悉到熟悉，了解個案之依據由自己的刻板印象和經驗架構，轉變為依據個案故事的特異性。注意焦點由分心於自身議題而專注在「對個案的情緒」、「突兀的反應」和「故事」上。假設驗證的主題由「個案故事與治療師經驗是否一致」，轉為驗證「個案故事內的一致性」、「個案故事與假設的一致性」。在治療之間較細微的轉變上，反移情經驗的轉變是起起伏伏、來來回回的過程，四個反移情經驗主軸出現在療程初期，與其他經驗有著延續與互為因果的關係。
依據反移情經驗在療程中展現多樣性質，以及由多重因素共同形成與影響其發展狀況的發現，本研究提出在實務訓練與未來研究上的的努力方向。
關鍵詞：反移情、治療歷程、現象學

關鍵字

反移情 ； 心理治療歷程 ； 現象學

並列摘要

A Study on a Psychotherapist’s Countertransference during the Process of Psychotherapy
Pey-Ling Shieh
Abstract
The purpose of this study is to explore the countertransference during an ongoing process of psychotherapy. The study is conducted by the phenomenology approach. As a ten-session psychotherapy progressed, the psychotherapist was interviewed within 30 hours after each session. The data were analyzed by a framework retrieved from the data itself. The contextual factors, natures and transformation of the countertransference were all described.
The result yielded 22 units of countertransference experience. When compared with contextual factors, the psychotherapist’s countertransference to the specific client was found to have dual implications and to be more various than her original definition of and previous experiences of countertransference. The related factors of countertransference consisted of the fixed background of the therapist as well as the unique portion of the therapist-client interaction. The four domains of countertransference were classified as ‘feelings or cognitions toward the client’, ‘the role and position of the therapist and psychotherapy’, ’relationship and therapy maintenance’ and ‘distraction with associations’.
Most units of countertransference fall into the category of ‘Feelings or cognitions toward the client’. The therapist had various feelings toward the client and some of those feeling led to cognitions about the client. ‘Role and position of the therapist and psychotherapy’ is the second most frequent category of the countertransference, which happened when the therapist wondered about ‘what is the role of a therapist’ and ’what is the position of psychotherapy’. The feeling of being used and of not being respected would contribute to the discontinuity of therapy. As for the countertransference of ’relationship and therapy maintenance’, therapist’s assessment of the relationship was directly related to the maintenance of therapy. On ‘distraction with associations’, the therapist experienced various association and identification.
During the process of the psychotherapy, the familiarity of the therapist with the client increased. The global trend of understanding moved from stereotype-based and experience-based toward specific issues of the client. The focus of hypotheses-testing moved from ‘content consistency between client’s story and therapist’s experience’ toward ’internal consistency within client’s aspects of story’ or ’consistency between client’s story and hypotheses’. The transformation between sessions fluctuated and was recurrent. All four domains occurred at the initial stage and were intertwined with each other throughout the psychotherapy. process.
Given the findings that the countertransference displayed various natures and was formed by multiple factors, the author suggests some directions about future training and research.
Keywords: countertransference, process of psychotherapy, phenomenology

並列關鍵字

countertransference ； process of psychotherapy ； phenomenology

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