儘管已有充分的本地研究指出各種精神/心理問題與病人/案主之家庭系統密切關聯,並不斷呼籲系統取向介入處遇的重要性,目前台灣婚姻、家族治療實務工作發展仍極度不足。為具體瞭解本地實務界的現況,本研究回顧自1992至2004年在台灣發表之相關文獻72篇,並深入分析其中11篇實務案例研究,以探討台灣婚姻/家族治療現有的發展與遭遇的困境。 依「理論取向」、「問題分析」、「治療過程」、「治療成果」四個層面對十一篇案例研究進行內容比較分析後發現:(1)實務研究數量有限,但治療人員、治療場景與涵蓋問題堪稱多元;(2)在理論取向上偏重「結構取向」與「蕯提爾模式」兩種,多元性有限;(3)「頭重腳輕」的發展傾向-在文獻發表數量及內容上皆傾向依賴理論及介入技巧;(4)治療歷程傾向專注於治療師介入,有遠離家庭本身經驗之虞;(5)文化因素可對治療產生關鍵性影響,然尚未受到普遍重視。 根據分析結果,本文建議:(1)積極推展本地婚姻、家族治療實務工作,及跨領域專業間之聯繫合作;(2)在實務工作上豐富理論取向的多元性;(3)培育實務督導師資、開設實務取向訓練課程,以轉化既有理論認識為實踐能力,增進治療效能;(4)重視並進一步研究文化因素對本地家族治療過程的影響。
Numerous studies in Taiwan have indicated a connection between mental illness and patients' family systems and called for systemic intervention. However, to date, couple and family therapy is little practiced in Taiwan. This study entails a review of 72 relevant studies from 1992-2004 and a qualitative comparative analysis of 11 clinical case studies in terms of theoretical approach, problem assessment, therapeutic process, and treatment outcome. Results indicated: (1) a variety of therapeutic disciplines, settings, and presenting problems; (2) little theoretical diversity, with the structural approach and the Satir model prevailing; (3) publications of theoretical discussion outnumber those of clinical practice, and the therapy process has tended to rely on theoretical frameworks and correspondent techniques; (4) descriptions of the therapy process have tended to focus more on therapist intervention and less on the family's experience; and (5) there has been little emphasis on Taiwanese culture, which sometimes can play a critical role in therapy. Implications of this study include the need to (1) promote the practice of couple/family therapy in Taiwan and enhance collaboration across disciplines; (2) enrich the diversity of theoretical approaches in clinical practice; (3) establish practice-oriented raining programs, and cultivate experienced clinical supervisors to help local therapists transform their theoretical knowledge into clinical practice; and (4) pay more attention to and conduct more research on the role of culture in family therapy.