情緒障礙病人門診支持團體歷程

目的：考量情緒障礙症病人的疾病特性與需要，運用團體型態介入，提供病人一個支持性空間，成為彼此的回饋學習者。此文即是在工作領域創新服務方案的紀實，希望作為一案例參考及奠基未來持續發展的可能。方法：由北部某醫院精神醫學部醫療團隊轉介，透過團體前個別會談篩選，進行八次的封閉性團體。帶領者依據團體帶領倫理程序，並由兩位社工師輪流擔任主帶領者與共同帶領者，並邀請一位資深社工師擔任團體督導與觀察員，團體結束三人會後討論。由當次主帶領者負責彙整錄音、完成當次團體報告，成為團體結束後研究的原始資料。本研究採質性分析，以此團體為研究對象，並用團體動力的視角來分析團體歷程。結果：從團體動力角度檢視團體歷程，可扼要地歸納出團體從彼此試水溫、拿捏溫度，到團體差異浮現、去留的分水嶺，進而團體「我們感」形成、停留與前進，到話題跳動、甜蜜卻沉重下的集體轉移，及最後想深入又準備結束畫下句號的過程。於團體整體回顧，則討論團體主題從有到無的進展、協助成員對自我狀態的覺知、從短期支持性團體到治療性團體的跨越。結論：從此團體發展歷程提出1.此類團體在自我覺察的條件性與介入策略、2.成員進出對團體發展的影響與運用、3.團體發展與成員個別需求的兼顧。

關鍵字

情緒障礙；病人團體；團體歷程

並列摘要

Objective: Considering the characteristics and special needs of mood disorder patients, it is important to develop a support group intervention. The purpose of this study is to describe the development and process of a support group for outpatients with mood disorder and to share the practice experience of group work. Methods: Patients were referred by a psychiatric team and then individual interviews were conducted to select group participants in a medical center in Northern Taiwan. The support group was led by two clinical social workers and that they took turns to be leader and co-leader in different group sessions. We also invited a senior clinical social worker to observe and supervise the group process. Observation of the group process was audio-taped and transcribed for later analysis. Qualitative data analysis was conducted through the lens of group dynamic perspectives. Results: Different stages of group process emerged from the data that are in keeping with the group dynamic perspective. First, the group members were trying to explore the ＂water temperature＂ of the group. Second, the diversity among group members was appeared. Third, the concept of ＂us＂ was formed gradually among group members. Forth, topics of group discussion changed rapidly and went deeper. Last, the group members wanted to go even deeper but they also needed to prepare for group closure. As a whole to review, we discuss some issue about group topic, help members' awareness of self-status, from short-term supportive group to therapeutic group. Conclusions: Our findings suggested the importance of self-awareness and intervention strategies in support group for mood disorder patients. Moreover, the effect of group members come and go during the process and how we can use this group phenomenon to explore more of group dynamic. Finally, it is essential to balance and give consideration to both group development and individual member's needs.