癥狀與家庭互動的轉變歷程：結構策略家族治療的觀點

The Change Process of Symptoms and Family Interaction Based on the Structural-Strategic Family Therapy Approach

賈紅鶯(Hong-Ying Chia) ； 陳秉華(Ping-Hwa Chen)

《本土心理學研究》 15期 (2001/06) Pp. 163-220

摘要

本研究以結構策略家族治療學派的觀點，觀察並探討一個出現睡眠障礙、酗酒癥狀的大學生及其家人（包括父親、母親及妹妹），在二十次家庭治療中被認定為病人(IP)的癥狀與家庭互動的轉變歷程。研究者與治療者、評判員形成研究小組並以俗民誌的微觀分析法對治療全程的錄影帶進行分析，得到以下主要發現：
(1)IP的癥狀與家庭互動歷經六個階段的轉變歷程：
階段一(A)：家庭為IP癥狀求助；
階段二(B)：IP癥狀改善而親子衝突浮現；
階段三(A')：IP癥狀發作與父母家事分工衝突出現；
階段四(B')：IP癥狀改善與家庭結構維持穩定；
階段五(A'')：IP癥狀再復發與父母家事分工面臨挑戰；
階段六(B”)：IP癥狀消失、親子結構改變，父母家事分工結構未變。
(2)IP的癥狀與其父母之間關係呈動態的互動，癥狀對家庭結構的改變具有功能性意義，癥狀隨著家庭互動的變化，在「復發」與「改善」之間循環進展。
(3)夫妻的家事分工結構改變仍有困難，此困難與所在的文化脈絡密切相關。
研究者進一步就家庭結構的動態性，以及社會文化對家庭及家庭治療的影響提出討論。

關鍵字

改變歷程 ； 家庭互動 ； 結構策略家族治療 ； 癥狀

並列摘要

The purpose of this study is to explore the change process of a 23 year-old university student, suffering from a sleeping disorder and alcoholism, in twenty sessions of structural-strategic family therapy. The process was videotaped and analyzed through ethnographic microanalysis by a research team including the authors, a family therapist, and a judge. Results revealed six stages of dynamic interaction in the change process: 1) The parents sought help for the patient because of her symptoms; 2) symptoms improved, but conflicts occurred between the patient and her parents; 3) symptoms recurred and conflict over division of labor occurred between the patient's parents; 4) symptoms improved and family interaction stabilized; 5) symptoms recurred and the therapists challenged the parents to change their conflict over division of labor; 6) symptoms improved, and the alliance between the patient and her parents changed, but the basic interactive pattern between the parents remained the same. Two additional key observations were made. First, the functional significance of the symptoms to family structure and the recur/improve change cycle of symptoms with respect to the family were identified. Second, the difficulty in changing the structure of the division of labor between the couple could not be eliminated. The difficulty in resolving that structure may be closely related to existing culture, and may be a result of socio-cultural influences on family interactions. Further research is recommended to determine implications for family therapy.

並列關鍵字

change process ； family interaction ； structural-strategic family therapy ； symptoms

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