社會工作人員悲憫疲憊之初探-以大台北地區從事老人日間照顧與居家服務領域為例

藉由社會工作實習經驗的反思，察覺到自己對於服務對象情緒上反應所表現的狀態，與指導教授討論後，引發我對悲憫疲憊的注意及認識，也觸動了研究者想研究此議題的旅程。在尋找文獻的過程中，發現國外已有一些研究指出悲憫疲憊對專業助人工作者的影響，而目前國內針對專業助人工作者在服務的過程中，產生的工作壓力或是產生的情緒反應之相關文獻，包含情感反轉移、專業耗竭、替代性創傷的文獻雖多，但是對於只針對社會工作人員產生悲憫疲憊之現象、概念和因應的文獻卻相當地有限。因著Smullens於2015年在美國社會工作專業人員協會（NASW NEWS）出版的<社會工作中專業耗竭與自我照顧>一書中提到，造成專業耗竭的三個主要因素包括悲憫疲憊、情感反轉移及替代性創傷，而在這些因素中，悲憫疲憊是造成耗竭中發生範圍最廣泛的一種。因此採用Smullens對悲憫疲憊的界定，也就是悲憫疲憊是專業耗竭的伴隨症狀之一。本研究以大台北地區從事老人日間照顧與居家服務領域之社會工作人員為研究對象，以深度訪談法訪談6位，皆為女性社會工作者。研究發現不適當地使用同理容易造成悲憫疲憊，且悲憫疲憊的產生來自於與人互動關係的直接關聯，包括個人過去的工作經歷、工作本身的風險與工作環境外在的因素的間接關聯，且悲憫疲憊如果未適當地被覺察及處理，會影響到社工員其個人生理、心理、社會等層面及其工作和私人生活的狀態。在因應悲憫疲憊的方式，了解身為社工員的限制與責任，有適當地敏銳度和判斷力，拉起實際的專業界線並自我照顧，透過從內心探尋或向外尋求力量等，都能減少其悲憫的壓力。最後，根據前面描述的研究結果，提出針對組織層面、社工員本身，以及社會工作教育等三個方面的建議。

關鍵字

悲憫疲憊；情感反轉移；替代性創傷；專業耗竭；老人日間照顧服務；居家照顧服務；社會工作人員

並列摘要

Through my practical and research experiences in social work, I became aware of my inner emotional response to my clients. During my discussion with my professor, I was informed regarding the phenomenon of “ compassion fatigue”. I became intrigued about this condition and decided to conduct a study to explore it in greater depths. Through my review of the current literature about this topic, I found that previous international studies have already identified the impact of compassion fatigue on professional carers. As I analysed the local data, I realised that the majority of them focused on the areas of counter-transference, burnout and vicarious traumatisation. There were limited studies done on the phenomenon or concept of compassion fatigue or counter-measure in the social work field. As Smullens mentioned in his book, " Burnout and Self-Care in Social Work," published in 2015 in NASW NEWS, the United States. The three major root causes of burnout stemmed from: compassion fatigue, countertransference, and vicarious trauma. Among these causes, compassion fatigue is the most widespread and common one. Therefore, the researcher adopts Smullens’s definition of compassion fatigue as one of the attendant symptoms of burnout. This study enrolled the social workers in daycare and home helper severices for elders in Taipei area as the research objects and used in-depth interviews to 6 workers.The study found that inappropriate use of empathy will easily lead to compassion fatigue. This condition arises from direct interaction with clients, previous work experiences, the risks associated with the work tasks and also external factors. If the symptoms of compassion fatigue are not detected and addressed, this condition will significantly influence the social worker's physical, psychological and social status as well as her job performance and personal life. One can reduce the level of carer stress by a greater understanding of compassion fatigue, knowing the limitations and responsibilities of being a social worker and exercising proper sensitivity and judgment. Maintaining professional boundaries and good self-care, also knowing when to seek support will ease the pressure for social work professionals. Finally, based on the results of aforementioned research, this study offers suggestions on three major dimensions: organizational level, social workers themselves, and the educational process of social work.