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研究生: 許維耘
Wei-Yun Hsu
論文名稱: 實習諮商心理師面對案主自殺經驗之敘說研究
Narrative analysis on counseling psychology interns dealing with the experiences of clients suicide
指導教授: 李佩怡
Li, Pei-Yi
學位類別: 碩士
Master
系所名稱: 教育心理與輔導學系
Department of Educational Psychology and Counseling
論文出版年: 2013
畢業學年度: 101
語文別: 中文
論文頁數: 248
中文關鍵詞: 實習諮商心理師案主自殺
英文關鍵詞: counseling psychology interns, clients committed suicide
論文種類: 學術論文
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  • 本研究旨在透過實習諮商心理師之生命敘說,探討其在面對案主自殺過程中之經驗內涵、主觀需求與調適型態,並瞭解此事件對其個人生命及專業發展的影響。本研究以三位曾遭遇案主自殺經驗的實習諮商心理師為研究參與者,採用敘說研究方法,藉由故事的呈現讓研究參與者的經驗現身,並以「整體─內容」及「類別-內容」兩種方式進行資料分析,研究結果與發現如下:

    一、在與自殺案主晤談的過程中,實習諮商心理師付出了關懷的代價,經歷獨特的角色身份而來的剝奪經驗,以及自殺情境引發的死亡焦慮;當遭遇案主自殺時,實習諮商心理師呈現出兼具遺族與專家角色的悲傷內涵,並透過心理交易(bargain)來回應自殺事件的衝擊。最後,案主自殺後的生死狀態,也可能是無從得知的,使得實習諮商心理師陷入曖昧不明的失落與懸而未決的悲傷之中。

    二、隨著案主自殺經驗中各個階段的脈絡發展,實習諮商心理師也衍生出不同的主觀需求與調適型態。剛開始接觸到自殺危機時,他們需要危機處理的專業知能,並在助人關懷與自我照顧之間取得平衡。當展開晤談歷程後,實習諮商心理師則需要持續敏覺自己的情緒狀態、安全接納的支持環境和實習系統的整體資源,以協助他們因應沈重的危機壓力與自我照顧。當經歷自殺事件後,實習諮商心理師在創傷初期需要有人陪伴,知道自己並非獨自一人面對,接著需要釐清對自殺事件的困惑、從混亂中重拾秩序感,以及內外在資源的積極介入;藉由反覆書寫和敘說、完成心中的未竟事務、將關係轉化為內在連結、重建個人的生活步調與模式四種型態,則反映出實習諮商心理師因應自殺衝擊的調適歷程。

    三、經歷案主自殺事件後,實習諮商心理師原有的信念也隨之解構與重新建構了。他們看見諮商並非全能的拯救而是有限度的助人,開始發展出對自殺危機的積極處遇與專業認同,並重新整合對自殺案主的助人信念。同時,他們重新省視個人對於死亡的態度與生命的價值觀,從對生命的覺察和體認中轉化為實際的行動,看見活著與死亡是一體的兩面,而逐漸學習與死亡共處。

    最後,根據本研究結果與發現,針對實習諮商心理師、學校教育訓練系統、實習機構及未來研究方向提出相關的建議。

    The purpose of this study was to explore the counseling psychology interns’ experiences, subjective demands and adjustment process when they dealt with clients’ suicide and to understand the impact of those cases on their personal lives and professional development.
    In this study, participants was three counseling psychology interns who have experienced clients’ suicide. The narrative analysis method is used and through the presentation of the story made that the experiences of the study participants appeared. The methods “ holism-content” and “category – content” are both used to analyze the data, the results and findings are as follows:

    1.In the process of suicide cases interview, counseling psychology interns paid the cost of caring, who had disenfranchised grief experiences through the unique role and also experienced the death anxiety caused by the suicide situation. When the clients suicided, the counseling psychology interns showed grief of the bereaved families and specialist, and also responded to the impact of suicide through bargain. At the end, the counseling psychology interns probably cannot know whether their clients were dead or alive after suicide, it made them drop into the ambiguous loss and unresolved grief.

    2.With the context developments of various stages of clients' suicide experiences, the counseling psychology interns also had different subjective demands and adaptation states. At the start of contacting suicide crises, they need professional knowledge to deal with crisis intervention and keep the balance between helping others and self-care. Once the counseling began, the counseling psychology interns have to keep sensitive their own emotional states, it is necessary to have an overall safety and supportable environment and also an internship system resource to assist them in response to the heavy pressure from the crisis and self-care. After experienced these suicide cases, the counseling psychology interns need companions in the early trauma and bear in mind that they are not alone to face the situation. After that they need to clarify the confusion of the suicide cases, in order to regain the order from chaos and positive intervention from intrinsic and extrinsic resources. There are four steps that reflect the counseling psychology interns' adaptation processes in response to the suicide impact:(1)repeatedly writing and narrative;(2)Accomplishment of unfinished business;(3)Transfer from the relationship to inner link,(4)Rebuilding the personal pace of life.

    3.After experienced the suicide cases, the original faith of the counseling psychology interns will be deconstructed and reconstructed. They saw that the help that they could provide is not almighty but limited, then they started to develop professional identify and positively dealing with the suicide crises, they also re-integrated their belief of helping suicide clients. At the same time, they re-inspected their own attitude toward death and life's value, transformed their awareness of life into a real action, and they gradually managed to coexist with death seeing that the death or being alive are two sides of the same coin.

    Finally, according to the finding and results of this research, researchers will have some advices to the counseling psychology interns, school training systems, internship organization and other future researches.

    謝辭………………………………………………………………………………… 1 中文摘要…………………………………………………………………………… 3 英文摘要…………………………………………………………………………… 5 目錄………………………………………………………………………………… 7 表次………………………………………………………………………………… 9 圖次…………………………………………………………………………………10 第一章 緒論 第一節 研究動機…………………………………………………………11 第二節 研究目的與問題…………………………………………………19 第三節 名詞釋義…………………………………………………………20 第二章 文獻探討 第一節 助人者在治療關係歷程中付出的關懷代價……………………21 第二節 助人者遭遇個案自殺的處境……………………………………38 第三節 實習諮商師的主觀經驗與心理需求……………………………50 第三章 研究方法 第一節 採用質性研究方法的理由………………………………………61 第二節 敘說研究…………………………………………………………62 第三節 研究參與者………………………………………………………69 第四節 研究者……………………………………………………………71 第五節 研究歷程…………………………………………………………74 第六節 資料分析…………………………………………………………78 第七節 研究判準…………………………………………………………84 第八節 研究倫理…………………………………………………………86 第四章 研究結果 第一節 實習諮商師與案主從相遇到分離的故事………………………88 第二節 實習諮商師經歷案主自殺之經驗內涵…………………………127 第三節 實習諮商師面對案主自殺經驗之主觀需求與調適型態………144 第四節 案主自殺事件對於實習諮商師個人與專業上的意義…………167 第五節 研究發現與綜合討論……………………………………………180 第五章 結論、反思與建議 第一節 結論………………………………………………………………215 第二節 研究者的覺察與反思……………………………………………218 第三節 研究限制與建議…………………………………………………223 參考文獻 中文部分………………………………………………………………………231 英文部分………………………………………………………………………237 附錄 附錄一 研究邀請函………………………………………………………246 附錄二 訪談同意書………………………………………………………247 附錄三 訪談大綱…………………………………………………………248 表次 表3-3-1 研究參與者基本資料…………………………………………………70 表3-5-1 研究參與者訪談時程…………………………………………………77 表3-6-1 資料分析編碼表………………………………………………………80 表4-5-1 實習諮商師經歷案主自殺的經驗內涵之主題整理………………...192 表4-5-2 實習諮商師經歷案主自殺的主觀需求與調適型態之主題整理…...207 表4-5-3 案主自殺的經驗對實習諮商師個人與專業影響之主題整理……...214 圖次 圖2-1-1 關懷循環圈……………………………………………………………22 圖2-1-2 慈悲壓力與慈悲疲倦模式……………………………………………27 圖2-1-3 同理投入的風險………………………………………………………37 圖4-1-1 旭平面對案主自殺經驗之心理轉折歷程…………………………...101 圖4-1-2 樊玲面對案主自殺經驗之心理轉折歷程…………………………...114 圖4-1-3 展青面對案主自殺經驗之心理轉折歷程…………………………...126 圖4-5-1 實習諮商師遭遇案主自殺之經驗內涵主題脈絡…………………...193 圖4-5-2 實習諮商師經歷案主自殺的主觀需求與調適型態之主題脈絡…...208

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