憂鬱症動力取向人際團體心理治療成員流失的原因質性分析

目的：透過質性研究發現憂鬱症患者在接受動力取向人際團體心理治療時，可能的流失原因。方法：收集參加憂鬱症動力取向人際團體心理治療資深治療者之深入訪談資料，並以質性研究方式，歸納出本土團體心理治療成員流失可能的原因。結果：本研究發現引發成員流失的主因，來自：“怕”及“另請高明”。在“怕”的流失因子之下又可分為兩大類，包括：（1）臨陣畏縮、（2）「好」轉反應。臨陣畏縮包括有兩成份為「切開創傷，太痛了！」及「個案當時還太脆弱」；「好」轉反應包括有四成份為「心隨外境轉」、「藥物改善了個案的情緒狀態」、「從他人的話題中有一些觀察學習」及「只是初步的改善」。“另請高明”的流失因子之下又可分為兩大類，包括：（1）所託非人、（2）道不同不相為謀。所託非人包括兩成份為「團體不夠溫暖」及「專業的心理醫生在哪裡！」；道不同不相為謀包括有三成份為「這不是我要的」、「我們是不一樣世界的人」及「團體前評估沒有過濾掉不適合的個案」。結論：依據本研究的分析，團體帶領者應考慮在團體早期以較積極的態度，重視給予成員適當的支持及充分的安全感，協助成員在共同話題下與治療者及其他成員互動。在團體中期，要思考如何幫助團體形成凝聚力，讓成員在面對彼此的差異時，仍然願意在團體持續參與，在歷經彼此差異的當下，透過人際回饋與自我覺察，獲得成長。此外，團體前的個案篩選也相當重要。

關鍵字

動力性人際團體；憂鬱症；成員流失；質性研究

並列摘要

Objectives: The purpose of the study is to find the possible causes of dropout in dynamic-interpersonal group psychotherapy for the depressed by qualitative research. Methods: We use qualitative method to analyze the transcript collected by interviewing senior therapists for summarizing the possible causes of dropout. Result: There were 2 major causes for dropout, including "Fear" and "Expecting on other therapists". Fear was divided into two subcategories: withdrawing on site and good changing. Withdrawing on site came from the painful sensation on exposure of traumatic experience and the venerability of the patient. Good changing came from the mind changed with the environment, the effect of medication, the learning from observation and the initial improvement in the group. Expecting on other therapists for others were divided into two subcategories: not the right man and not the right way. Not the right man came from the group is not warm enough and the questioning on the therapist. Not the right way came from this is not what I want, we live in different world and inappropriate cases were not excluded before the group. Conclusions: According to our study, leaders need to be more active and provide optimal support and adequate safety in early stage of group for preventing dropout. Besides, facilitating interactions between members and leaders under common topics was important. In the middle stage of group, leaders help the formation of group cohesiveness, which would enable the members to face the difference among one and another and promote personal growth by interpersonal feedback and self-awareness. On the other hand, appropriate screening before the group is also important.