喪親成人之悲傷調適與復原力增長之研究-以參與社區大學體驗式生死教育活動者為例

A Study on Grief Adjustment and Resilience Growth of Bereaved Adults - The Example for Participation in Experiential Life-Death Educational Activities at a Community College

羅耀明(Lo Yao-Ming)

指導教授 ： 黃明月

國立臺灣師範大學/教育學院/社會教育學系/博士(2018年)

https://doi.org/10.6345/DIS.NTNU.DACE.011.2018.F02

摘要

我國高齡人口逐年增加，死亡數亦隨之提高，需尋找積極因應喪親悲傷的調適策略。悲傷理論學者認為，表達與經驗悲傷有助於悲傷調適。然而，華人多壓抑悲傷，且家庭較不公開表達悲傷與討論逝者。對於喪親多年仍持續悲傷的喪親者來說，可考慮往社會系統尋求資源以調適悲傷。據復原力的理論與研究發現，若個體的內外在系統有更多保護因子，則愈能從逆境復原，其中社會系統的效果量最大。此外，國內外學者認為體驗式生死教育能獲得較好的學習成效，且研究證實使用與逝者連結之策略有助於悲傷調適。因此，於終身學習機構規劃體驗式生死教育活動，可能有助於喪親者調適悲傷與增長復原力。
本研究以前導研究探討一位喪父9年的中年女性，發現體驗臨終關懷活動及體驗與逝者對話活動協助其獲得較好的悲傷調適。因此，本研究欲深入探討體驗式生死教育活動，對喪親者的悲傷調適與復原力之增長情形，規劃8週（每週3小時）體驗式生死教育活動（體驗臨終關懷活動、體驗向此生告別活動、體驗與逝者對話活動），於終身學習機構（社區大學）向喪親者介入本活動。本研究目的為：（一）欲瞭解喪親者參與本活動前的悲傷反應與悲傷調適之阻力；（二）喪親者參與本活動之體驗情形；（三）喪親者參與本活動後之悲傷調適與復原力增長之情形；（四）瞭解喪親者參與本活動之悲傷調適與復原力之關係。依據本研究目的，本研究對象以立意取樣選取參與本活動前有持續多年悲傷，且在參與本活動後有較好的悲傷調適與復原力增長之喪親者。選取8位（7女1男）喪親2至39年，年齡介於45至55歲為研究對象。以詮釋學精神進行本研究，以三次半結構式深度訪談蒐集主要研究資料，第一次於研究對象參與本活動前蒐集研究目的一之資料，第二次於參與本活動後一個月內蒐集研究目的二、三、四之資料，第三次於參與本活動半年後蒐集參與本活動之延宕效果與補充訪談。本研究資料主要包含研究對象深度訪談文本、研究對象學習心得、研究對象之檢證者之檢證資料。在資料編碼後，本研究以文字化、概念化、命題化、圖表化、理論化等五階段進行資料分析，在辯證詮釋的過程以互為主體進行詮釋。
本研究結果為：（一）喪親者參與本活動前，在感覺、身體、認知、行為與社會五方面有持續多年的悲傷反應，其內外在系統調適悲傷的阻力如下。與逝者偏負向關係：基於傳統孝道文化認為在逝者生前未能圓滿某事而引發的悲傷；簽署放棄急救而感到悲傷；逝者離世後靈魂未獲安頓而引發的悲傷；逝者已不存在、想到逝者感到悲傷；認為被逝者拋棄；切斷與逝者連結。個人系統：未覺察到喪親悲傷因而未求助；個人壓抑情感表達；不瞭解心理諮商專業；認為應獨自面對喪親悲傷；負向死亡觀的束縛；生活忙碌而無暇自我照顧。家庭系統：家庭忌諱死亡；家庭壓抑情感表達；家人各自忙碌未覺察我悲傷；逝者往生的代罪羔羊；喪母後父再娶的父權文化；爭產造成與原生家庭疏離。社會系統：離開職場與搬離熟悉環境；社會忌諱死亡；社會不知如何關懷喪親者而壓抑情感；不瞭解心理諮商專業；社會缺乏認識悲傷的生死教育。（二）喪親者參與本活動期間有了回憶逝者正向記憶、表達悲傷、創造與逝者正向記憶與經驗，以及反思一生之平台。參與體驗臨終關懷活動：有助其喚起逝者的正向記憶、表達悲傷、覺察悲傷原因、建立正向觀點、感受同儕和教師的支持；參與體驗向此生告別活動：有助其反思過去一生、活在當下、具未來導向；參與體驗與逝者對話活動：有助其喚起與逝者的正向記憶，表達悲傷與內心話，創造與增加和逝者的正向互動經驗，留下正向形象。（三）喪親者參與本活動後，使其有較好的悲傷調適：協助喪親者在悲傷任務論的進展，並在身體、心理、心靈與社會層面獲得較好的悲傷調適。（四）喪親者參與本活動後，使其增長內外在系統多項保護因子，內容如下。與逝者關係的改善：喚起對逝者的正向記憶；憶起逝者時會連結逝者的正向形象，並產生正向情緒；知覺到逝者的愛存續；相信逝者已往生到善處。個人系統：增長能力、特質、認知、行為等方面的保護因子。家庭系統：向家人表達悲傷或談論逝者；向家人分享參與本活動心得；向家人表達道謝、道歉、道愛；珍惜與家人相處且感情更好；家人一起參與學習；知道未來如何向家人表達臨終關懷；至醫院向親人探病關懷。社會系統：在同儕、教師與社會方面，增長多項保護因子。（五）發現本活動提供的教學策略與文化因素協助研究對象調適悲傷，包含：融入認識悲傷、正念、任務論與體驗式教學法之生死教育；與逝者主動連結、向逝者表達關懷、悲傷與內心話；公開談論逝者、允許悲傷的安全與支持的學習團體；以及參與學習而適應沒有逝者的新生活。
最後，依據本研究結論提出建議，包括對體驗式生死教育活動教案與師資之建議、對終身學習機構之建議、對諮商輔導相關工作者之建議、對有持續多年悲傷的喪親民眾之建議，以及對未來研究建議。

關鍵字

客體關係理論 ； 持續連結 ； 復原力 ； 悲傷任務 ； 悲傷調適 ； 體驗式生死教育

並列摘要

This study looks into the effects of experiential death activities on grief adjustment and resilience of mourning adults through an eight-week program. Activities included dying care, bidding farewell to life, and conversation with the deceased at an establishment promoting lifelong learning, such as a community college, for three hours a week. The purpose of this study includes:1. Bereaved adults' pre-activity response to grief and difficulty in recovering from grief; 2. Observations of bereaved adults' response during program activities; 3. Bereaved adults' post-activity grief adjustments and resilience; 4. Effects of program activities on bereaved adults' grief adjustment and resilience.

For the purposes of this study, the group of adults sampled was that of those who have been in mourning for many years pre-activity and exhibited positive results post-activity. Sampling included seven female and one male adults ranging from 45 to 55 years of age who lost a family member two to thirty-nine years ago. A hermeneutic approach was taken where three semi-structured in-depth interviews were conducted to obtain pre- and post-activity data, with the third taking place six months after completion of the program to look into delayed effects. Collected data was transcribed, conceptualized, propositionalized, graphed, and then theorized for further analysis and interpretation.

Results showed that:
1. Before the activities, bereaved adults experienced long-term grief reactions in the perceptual, physical, cognitive, behavioral, and social areas of their lives. Cultural barriers for both internal and external systems that obstructed grief adjustment are as follows: The interviewees had negative relationship with the deceased, reasons for their pessimistic outlook included traditional filial perception that the deceased had unfinished business, had signed a Do Not Resuscitate, had thought the deceased spirit had not been laid to rest, had realized that the deceased was no longer with them, had felt abandoned by the deceased, and had disconnected from the deceased. Individual factors include the not seeking assistance due to the inability to recognize grief, emotional suppression, being uninformed of professional psychologists' expertise, believing grief must be dealt with alone, having a pessimistic view on death, and not allowing time in the daily schedule for self-care. Family factors include the taboo approach to death, emotional suppression of family members, hectic lives of individuals that keep them from noticing one another's sorrow, scapegoating, father remarrying after the death of the mother in a patriarchal society, and dispute over inheritance. Social factors include leaving the workplace or familiar surroundings, the taboo approach to death in society, emotional suppression as a result of the lack of knowledge on how to care for grieving individuals, being uninformed of professional psychologists' expertise, and being ill-prepared for life-death situations.

2. During the activities, participation in program activities allowed grieving adults to recall positive memories of the deceased, express sadness, remember the deceased in a positive light, and reflect on life. Taking part in dying care activity allowed participants to recall positive memories of the deceased, express sadness, become aware of the source of sadness, build a positive approach, and experience support from fellow participants and the program facilitator. Participating in farewell activity helped participants to reflect on life, live in the moment, and be future-oriented. Taking part in conversations with the deceased activity allowed participants to recall positive memories of the deceased, express sadness during inner dialogues, create positive interactions with the deceased, and leave a positive impression.

3. After participation in program activities, participants adjusted better from grief in terms of progression through the Four Tasks of Mourning and were better adjusted physically, emotionally, spiritually, and socially.

4. Participation in program activities allowed participants to increase multiple protective factors in both internal and external systems such as the following:
Improved relations with the deceased by way of recalling positive memories, pleasant impressions, positive emotions, feeling loved by the deceased, and believing that the deceased has moved on to a better place. Individual factors include ability, characteristics, perception, and behavior. Family factors include expressing grief or talking about the deceased, sharing thoughts from program participation, communicating gratitude, apologies, or love to family members, cherishing family members, improvement of relationships with family members, family's willingness to participate in some programs together, learning how to provide dying care in the future, and visiting relatives in hospitals. Social factors include increased support from fellow participants, the program facilitator, and society.

5. Activities that allowed participants to face traditional cultural barriers that inhibited grief adjustment were those that included these factors: grief recognition, mindfulness, task theory, experiential approach to life-death education, proactive approach to connecting with the deceased, expressions of care for the deceased, inner dialogues on sadness, public discussions about the deceased, being accepting towards the sense of security and comfort provided by grief support groups, and participating in learning to adapt to a new life without the deceased.

Findings from this research lend towards recommendations for theory on response to and adjustment for grief, activity plans for experiential approach to life-death education, facilitators for experiential activities, establishments promoting lifelong learning, professions in the counseling field, adults coping with grief, and future research.

並列關鍵字

continuing bonds ； experiential life-death education ； grief adjustment ； object relations theory ； resilience ； tasks of grief

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