- 學位論文
親子互動治療運用於台灣父親─以兩個案為例
Application of Parent-Child Interaction Therapy in Taiwanese Fathers: Two Case Reports
摘要
目的：親子互動治療(parent-child interaction therapy)為國外針對2-7歲具有決裂性行為問題孩童及其父母，所設計的一套具實驗證實具療效的行為取向父母訓練方案。然而，過去研究大多以母親及其子女接受親子互動治療之療效進行探討。本研究目的在初步探討兩位台灣父親與其子女接受親子互動治療之療效。方法：本研究藉由網路與心理衛生專業人士轉介招募個案，在療前評估時若子女在父親填寫之評估決裂性行為問題量表得分達臨床顯著程度，且該父親願意參與療程，則納入本研究。本研究共招募到甲、乙兩組家庭之父親(分別為37與38歲)及其子女(6歲男童與5歲女童)參與親子互動治療，其中乙組之母親(38歲)，亦與其配偶同時參與療程。本研究分別在治療前、治療後，與治療結束後三個月追蹤等三個時間點，評估(a)子女行為問題與子女對父親命令順從度、(b)親職壓力，以及(c)父親在親子互動治療技巧上的改變，來檢驗治療療效。其中子女行為問題和親職壓力，是以父親填寫之量表來評估。而子女對父親命令順從度，和父親學習到親子互動治療技巧，則是使用親子二人互動紀錄系統三個五分鐘的標準化親子互動情境[兒童主導遊戲(Child Led Play; CLP)，父母主導遊戲(Parent Led Play; PLP)，和「收拾玩具情境(Clean-Up; CU) ]，來進行為觀察與紀錄。而有關父親學習到親子互動治療技巧部分，則主要包含與子女進行正向互動行為技巧，避免使用負向互動行為技巧，和能正確地下達有效命令，及當小孩出現順從及不順從的行為時，能貫徹、一致地執行行為後果。結果：本研究發現，相較於治療前評估，甲組父子與乙組父女在接受治療後和在三個月追蹤，在(a)子女行為問題與子女對父親命令順從度、(b)親職壓力，以及(c)父親在親子互動治療技巧上皆獲得改善。討論：本研究證實親子互動治療應用於本研究中的兩組台灣父親與其子女上，具有療效。此外，本研究發現本研究之兩位父親及其子女，需要較多療程數來完成親子互動治療(在治療中的以兒童為主導的階段多出1到2次療程，在以父母為主導的階段，則多出4次療程)，才能達到及維持上述的療效。而本研究的父親皆全程參與療程，除了在療程時間上配合父親的時間外，在療前評估時強調父親參與治療的重要性，依據父親所重視的子女問題，進行介入，以及每週療程在上週狀況回顧時，針對父親當時之生活壓力和兒童行為的困擾，給予立即回饋與建議，皆可能是本研究中的父親同意參與及持續參與療程的原因。上述發現皆可做為臨床工作者或研究者，日後在邀請台灣父親參與親子互動治療及在進行療程時的參考。
並列摘要
Purpose: Parent-child interaction therapy (PCIT) is an evidence-based, behavioral parent training intervention for 2 to 7-year-old children with disruptive behavior problems and their families. However, most of previous PCIT studies have focused on its therapeutic effect as applying it with mother-child dyads. The purpose of this study was to investigate the therapeutic effect of PCIT on two Taiwanese father-child dyads. Methods: Participants were recruited through Internet or were referred by mental health professionals. Prior to the intervention, children, who have a clinically elevated level of disruptive behavior problems based on father ratings, and their fathers, who were willing to receive PCIT, were enrolled in this study. Two fathers (i.e., father A aged 37 and father B aged 38) and their children (i.e., a 6-year-old boy A and a 5-year-old girl B) participated in the PCIT. For father B, his spouse (aged 38) also participated in the treatment. To examine the therapeutic effect of PCIT on the two Taiwanese father-child dyads, children's levels of behavioral problems and children’s compliance to fathers’ commands, paternal stress, and fathers’ mastery of skills taught during PCIT were assessed at pre-treatment, post-treatment, and a three-month follow-up. The children’s levels of behavioral problems and paternal stress were assessed based on fathers’ ratings. The Dyadic Parent-Child Interaction Coding System was conducted in three 5-minute standard parent-child interaction situations [child-led play (CLP), parent-led play (PLP), clean-up play (CU)] to observe and code the children’s compliance to fathers’ commands and fathers’ mastery of skills taught during PCIT. Regarding fathers’ mastery of skills taught during PCIT, these skills included engaging in positive interaction skills, avoiding the use of negative interaction skills, giving effective commands and being able to consistently follow through the consequences depending on children's compliance or noncompliance behaviors. Results: The results of this study showed that the father-child dyads of families A and B displayed significant improvements at post-treatment and the three-month follow-up, comparing to pre-treatment, in (a) children's levels of behavioral problems and children’s compliance to fathers’ commands, (b) paternal stress, and (c) fathers’ mastery of skills taught during PCIT. Discussions: This study showed the therapeutic effect of PCIT on the father-child dyads. This study also found the two fathers and their children needed more treatment sessions to complete PCIT (1 to 2 additional sessions in the child directed interaction phase, and 4 additional sessions in the parent directed interaction phase) to achieve and to maintain the therapeutic effect mentioned above. Both fathers who participated in this study completed PCIT. There were four possible reasons for their agreement and continuation of the treatment. First, the treatment time was scheduled based on the families' convenience. Second, the importance of fathers’ involvement was emphasized at pre-treatment assessment. Third, intervention was centered on the fathers' concerns about their children’s problems. Finally, during weekly check-in, immediate feedback and suggestions were provided to address fathers’ concerns about their children’s problem behaviors and their stress in daily life. The above findings can be used as references by clinicians and researchers when they attempt to invite Taiwanese fathers to participate in PCIT and to implement the treatment with them in the future.