慢性精神分裂病患生涯故事與生涯復健之探究

A Study of Career Narratives and Career Rehabilitation for Patients with Chronic Schizophrenia

溫錦真(Chin-Chen Wen) ； 溫嬛椿(Shuan-Chun Wen) ； 林美珠(Meei-Ju Lin) ； 王迺燕(Nai-Yen Wang) ； 洪曜(Yao Hung)

《中華輔導與諮商學報》 24期 (2008/09) Pp. 147-179

https://doi.org/10.7082/CJGC.200809.0147

摘要

本研究關心社區復健中心慢性精神分裂病患的生涯復健議題，藉「敘說」展開一個從「認識」到「行動」的探究過程。研究一的目的是為認識病患的生涯故事及其遭遇那些生涯困境。方法是訪談十位年齡介於29至49歲病友的生涯故事，並以「敘說形式」進行分析。結果發現，病患的帶病生涯走向一個背離常人應有的正軌發展，即使暫時安頓在社區復健中心，心理上則是陷入患病帶來的失落與傷痛、對未來的不確定及漂浮感而無法安身立命。研究二的目的是設計與實施「敘說取向」的生涯復健團體，期待病患透過團體找回安身立命之道。行動結果是十二位年齡介於25至48歲病友因受限於疾病症狀而使團體缺乏活力與互動，但病友仍可以透過團體的帶領重新敘說有方向的生涯故事，再度肯定工作的價值、體認生病不是生命的全部並可以規劃未來。行動結果初步支持生涯復健團體的可行性。最後，本研究進一步提出研究者的省思以及未來對慢性精神分裂病患生涯復健實務工作的具體建議。

關鍵字

生涯復健 ； 敘說 ； 慢性精神分裂病

並列摘要

The purpose of this study was to understand the career stories of patients and predicaments they have undergone. The study adopted a narrative method to reveal the process, from ”understanding” to ”acting”, of the career rehabilitation of patients with chronic schizophrenia in a community rehabilitation center. In the first part of this study, ten patients (aged from 29 to 49) were interviewed and their career stories were analyzed with the method of narrative form. The results showed that patients' concept of career development had gradually deviated from a normal path since they suffered from psychotic diseases. Even when temporarily settled in community rehabilitation center, they still sustained loss and pain induced by psychotic disorders. They also felt uncertainty for the future and a sense of fluidity that, as a result, stops them from settling down in a place and establishing a career. the second part of this study, it was designed in terms of ”acting”-to develop a narrative approach based career rehabilitation group in order to assist patients with chronic schizophrenia to resettle in their lives and careers. The result showed that twelve patients, aged 25 to 48, could re-narrate new and constructive career stories through group interventions, despite the fact that the group dynamic was limited by the patients' psychotic symptoms. They reaffirmed the value of work, realized that the illness was only a part of their lives, and thus, accepted the possibility of a personal career plan for the future. These results supported the feasibility of the narrative approach based career rehabilitation group. Finally, the study presents a number of reflections from the researchers and suggestions for refining career rehabilitation strategies for patients with chronic schizophrenia in the future.

並列關鍵字

career rehabilitation ； chronic schizophrenia ； narrative

參考文獻

Brott, P. E.(2001).The storied approach: A postmodern perspective for career counseling.The Career Development Quarterly.49,304-313.

Bruner, J.(1986).Actual mind, possible worlds.Cambridge, Mass:Harvard University Press.

Davidson, G. C.,Neal, J. M.,Kring, A. M.(2004).Abnormal psychology.NJ:John Wiley & Sons.

Gergen, K. J.,Gergen, M. M.,L. Berkowitz (Ed.)(1988).Advances in experimental social psychology.New York:Academic Press.

Gergen, K. J.,Gergen, M. M.,R. Abeles (Ed.)(1987).Life-span perspectives and social psychology.Hillsdale, NJ:Erlbaum.