一位選擇性緘默症兒童在沙遊治療之歷程研究

The Case Study over the Behavior Changes and the Sandplay Therapy Process for a Child with Selective Mutism

周惠君(Hui-Chun Chou) ； 王萬清(Wan-Ching Wang)

《輔導與諮商學報》 29卷2期 (2007/11) Pp. 15-40

https://doi.org/10.7040/JGC.200711.0015

摘要

本研究之目的在探討接受沙遊治療的選擇性緘默症兒童，在沙遊歷程中使用沙、水、物件或其他藝術媒材表達內在經驗的情形，以及從開始治療後，在實際生活中人際溝通行為的改變。本研究採用個案研究法，以成功大學附設教學醫院兒童發展中心醫師轉介的一位國小二年級選擇性緘默症兒童為研究對象。進行治療前，研究者與個案、家長進行晤談，再進行二十次沙遊治療，每次四十分鐘，在治療期間，持續與個案的家長和老師進行訪談。結果發現如下：
一、個案在沙遊治療中，呈現的發展階段，由探索、表達、自我滋養、而達到意識和潛意識的流通，並經由宣洩內在衝突，個案得以有力量去面對並解決問題。
二、個案在沙遊治療中，使用物件數量、種類少，顯示他有適應上的困難；未取用人偶，顯示他有人際相處上的問題。取用又放回的物件，呈現個案負面的情緒或內在問題。
三、個案在沙遊治療中，在母子互動關係、同儕關係發展以及對外在世界的知覺，都有正向轉變的跡象。
四、個案經過沙遊治療，在實際生活與人相處時，較能勇敢於面對他人，言語表達的行為也增加了。
本研究依上述結果，提出對選擇性緘默症兒童的治療及未來研究的建議，以供實務工作者及研究者參考。

關鍵字

選擇性緘默症 ； 個案研究 ； 沙遊治療

並列摘要

The main purpose of this research was to explore how a child with selective mutism used sand, water, miniatures and other media to express his internal experiences and how his communicative behavior changed in his daily life. Case study was adopted as the methodology for this research. The object studied was an elementary school third grader who had selective mutism. He was a referral by a doctor in a child development center. Before giving the sandplay therapy, the object and his mother were consulted. Then, a twenty-session therapy was followed. Each session lasted for 40 minutes. During the research period, interviews with the parents and his teacher were often conducted. The conclusions of this study are as the following:
1. During the therapy process, development stages of behavior were observed in his sand-play, which include the exploration over the sand-tray, the self-expression, self-nutrition, and the psyche situation that moved from consciousness to sub-consciousness. After working off his internal conflicts, the case gained the confidence to face his problem and think about the resolutions.
2. The case takes a few miniatures signaled the problem of adaptation. Another sign that he never chose human miniatures signaled the mutism had generated problems in his interaction with others. The case takes miniatures and puts back are usually of particular meanings as they imply the case's negative emotion or internal conflicts.
3. During the therapy, positive changes from the case's behavior were noticed in mother-son relationship, the peer relationship and the conceptions toward the outer world.
4. After the sandplay therapy, the case gained noticeable improvement in communicating with others.
Accordingly, recommendations and suggestions were made for the future therapies' and researchers' reference.

並列關鍵字

a child with selective mutism ； case study ； sandplay

參考文獻

特殊教育電子報

Allan, J.,Berry, P.(1987).Sandplay.Elementary School Guidance & Counselling.21,300-306.

American Psychiatric Association(1994).Diagnostic and statistical manual of mental disorders.Washington, DC:American Psychiatric Association.

Aoki, S.(1981).The retest reliability of the sand play technique-2nd report.British Journal Projective Psychology.26(2),25-33.

Bradway, K.,McCoard, B.(1997).Sandplay-Silent workshop of the psyche.New York:Routledge.