智能障礙男少年之心智世界的一角

本研究以動力式心理治療去瞭解安置機構內智能障礙男少年心理發展之歷程。以質性研究作為資料蒐集與文本分析的方法。研究者之一擔任諮商師，考量智能障礙男少年（簡稱個案）的認知和溝通表達能力的需求，依據Klein（1931）遊戲箱的概念，準備繪畫工具、小物件、色紙、情緒墊板等媒材輔助個案表達內在感受。研究者在治療結束後撰寫歷程記錄、與研究小組討論以及督導，並持續與個案的主要照顧者（安置及教養機構內的家老師與社工、學校老師等人）進行討論。本研究分為兩個階段，總共進行了55 次的動力式心理治療和37 次的個人督導及研究小組的討論。從分析和編碼歷程記錄後發現，治療初期個案像是封閉的蛋，把訊息和人物排除於外，並長期依賴外在客體協助表達，對於界線的概念薄弱且較自卑，面對困難會以睡覺來逃避思考。個案經常在治療時表現出口慾期未獲滿足、肛門期過度壓抑的性格。經過諮商師涵容與投射性認同，個案經驗到雖然他一再攻擊諮商師，但是關係卻仍能一再修復。在真實的體會愛和罪疚的情感後，使個案內在心智狀態較有彈性。經過資料分析發現個案的內在狀態心智狀態可分成「分裂對立狀態」、「自閉的狀態」、「壞自我與好自我的幻想」和「又愛又恨的矛盾情感」四個階段。

關鍵字

安置機構；智能障礙男少年；動力式心理治療；心智發展

並列摘要

The purpose of this study is to explore the mental development of the mental retarded male youth, who lives in the institute. The research method included psychodynamic therapy and qualitative research. One of the researchers was the counsellor. The therapy used Melanie Klein's ＂play box＂ method to communicate with the client by using tools in order to help the client to express his inner feelings according to the developmental situation of the youth. The researcher reordered the process of the therapy, researcher's personal reflection, supervisor's feedback after each session and the research team discussion. The youth's mind was closed as a flawless egg in the early stage of the treatment. He excluded any messages and people, and had long history to rely on external objects to assist his communication with outside world. His concept of boundary was weak and he also had low self-esteem. He would choose to sleep to escape the difficulties. He also often expressed the characters came from unsatisfied oral stage and overly repressed anal stage. The youth had experienced the relationship between the counsellor and himself was able to recover through the process of containing and projective identification. The youth was less fearful of his attacking drive. He was able to experience his real emotions of love and guilt. It would help him to elasticity changed his position between ＂paranoid-schizoid position＂ and ＂depressive position＂.