整合式遊戲治療訓練模式之發展與訓練成效之研究:以遊戲治療新手為例

The Development and the Therapeutic Effect of the Integrated Play Therapy Training course: A Case Study of the Play Therapy Trainees

林美珠

指導教授 ： 蔡順良博士

國立臺灣師範大學/教育學院/教育心理與輔導學系/博士(2010年)

摘要

本研究分為二個階段，階段一的研究主要是發展整合式遊戲治療訓練模式及訓練用的實務指南講義。階段二的研究目的則是運用整合式遊戲治療訓練模式及實務指南講義，實際進行遊戲治療新手的訓練，一方面藉此檢視本訓練模式的可行性和實用性，並驗證整合式遊戲治療模式對兒童的治療效果；另一方面綜合遊戲治療新手在訓練及被督導過程中的學習與運用心得、以及研究者的個人省思，對原先所提出的整合式遊戲治療觀點及訓練模式和實務指南講義內容進行全盤檢視與修訂，使此模式更臻完整、實用。
參與本研究的遊戲治療新手計四位，均未曾正式學習及操作整合式遊戲治療，其中三位曾選修遊戲治療課程或者有接觸及進行非整合式遊戲治療之經驗。這四位遊戲治療新手都是心理諮商研究所三年級以上之研究生。
本研究所提出的整合式遊戲治療訓練模式，包括六天的工作坊以及十六週的團體督導。每位參與本研究的遊戲治療新手在完成工作坊的訓練後，需要進行：(1)實際與一位兒童進行整合式遊戲治療觀點的遊戲單元，並在徵得家長及兒童的同意下錄影；(2)於遊戲單元結束後需撰寫遊戲單元記錄，並接受研究者之團體督導；(3)每個月訪談兒童的家長一次；(4) 在完成整個訓練方案前、工作坊後、訓練方案進行後，均需填寫整合式遊戲治療自我效能自評表。另外，研究者在訓練方案實施前、工作坊後、以及整個訓練方案完成後，分別對遊戲治療新手進行訪談。
本研究運用現象學取向質性研究方式，進行資料的分析與撰述，並分別請研究參與者對其個人描述文及脈胳圖的部分進行核對與校正，以確定符合其本意。這些資料再經由轉化程序形成整體的重要陳述、意義單元、概念類別、以及敘述經驗的本質等，最後加入研究者的個人觀點，以及與理論的映照之討論分析撰寫本研究報告。
本研究的主要發現如下：
一、整合式遊戲治療訓練模式能協助遊戲治療新手增進其兒童遊戲治療專業之自我效能；以及重塑治療者本身客體關係型態。但在限定的期限內，多未能完成整合式遊戲治療觀點所倡議的五階段歷程。
二、整合式遊戲治療訓練模式能協助兒童改善困擾行為，在遊戲單元中的心理成長能符應整合式遊戲治療觀點所主張的各治療階段之成長指標。
三、接受整合式遊戲治療的兒童，其重要他人有的因為遊戲治療新手的訪談而產生對兒童教養態度的改變；同時亦顯示，即使部分兒童的重要他人無法改變時，整合式遊戲治療對兒童仍具有療效。
四、整合式遊戲治療訓練模式下的團體督導者能成為遊戲治療新手們的自體客體，協助他們更能成為兒童的自體客體。
五、原先提出的整合式遊戲治療觀點中有關治療階段的內容需加以修正，修正後的治療五階段為，（1）建立關係階段；（2）瞹昩共生階段；（3）治療性共生階段；（4）分化階段；（5）個體化階段。
本研究也根據研究結果與文獻進行討論，針對整合式遊戲治療訓練模式往後的應用、發展、及研究提出建議。

關鍵字

整合式遊戲治療 ； 遊戲治療新手 ； 遊戲治療自我效能 ； 整合式遊戲治療訓練模式

並列摘要

Two stages had been taken in the execution of this research.
Stage 1: The purpose of the research was to develop the integrated play therapy training course and the handouts for the practical guide in the therapeutic training.
Stage 2: The purpose of the research was to apply in practice the integrated play therapy training course, as well as the handouts, in carrying out the session of the integrated play therapy trainees. On the one hand, it was to examine, by means of the session, the feasibility and practicality of the integrated play therapy and thus certify the treatment effects of the integrated play therapy for children. On the other hand, it was to review the findings of both the integrated play therapy trainees and the individual researcher in the process of the supervision group and their application of the play therapy. Therefore an overall review and modification can be made in respect of the original view of the integrated play therapy and the practical guide/handouts, so as to make them more practical and acceptable.
Four integrated play therapy trainees were involved in this research. None of them had any previous experience in the learning and operating of the integrated play therapy. However, three of them had had courses in play therapy and might have acquired some experience in non-integrated play therapy. All of them were graduate school students for more than three years in psychiatric counseling.
The integrated play therapy training course as presented in this research includes a six-day workshop with sixteen-weeks of group supervision. After completing the workshop, all four of the integrated play therapy trainees had to carry out the following items:
1. To go through integrated play sessions with a child and, with the permission of the parent and the child, to video tape them and document their permission;
2. To keep a written record after completion of a play session, and to accept the group supervision of the researcher;
3. To have monthly interviews with the parents;
4. To complete a self-efficacy checklist of the effects of the integrated play therapy before, during, and after the training course, especially at the end of the six-day workshop.
In addition, the researcher individually arranged interviews with each of the play therapy trainees before, during, and after the training course, especially at the end of the six-day workshop.
The research adopted the format of the aptitude research phenomenology, analysis, and composition of the information data. To make sure that it wss in accordance with their own intentions, each participant in the research was requested to collate and revise in terms of their own personal descriptions and genealogy diagrams. All of the data were then brought through the process of transformation forming an integrated meaningful play session of statements, concept category, and present narration of the essence of the experiences. At the end the personal views of the researcher were added, and thus a discussion and an analysis in comparison with the theories were incorporated in the writing of the research report.
The essential findings of the research are as follows;
1. The integrated play therapy training course was capable of assisting play therapy trainees to improve their efficiency in the play therapy profession for children; it also reconstructs the object relations pattern of the therapy trainees themselves. However, when the trainees finished the training course, most therapy trainees fail to complete all five stages as suggested in the integrated play therapy.
2. The play sessions of integrated play therapy were capable of assisting children to improve their disturbing behavior and were capable of making their psychological growth in the play session in correspondence with all the suggested growth targets.
3. The children accepted the integrated play therapy and the trainees interviewed the children’s significant others. As a result these significant others changed their own attitudes and their ways of parenting; at the same time, the research indicated that even when no changes happen with regard to the significant others, the benefits of the integrated play therapy for the children were still valid.
4. Those in charge of the group supervision under the integrated play therapy training course were capable of becoming both the selfobject for the play therapy trainees, and assist them to become better selfobject for the children.
5. The contents of the therapeutic stages as originally presented in relation to the integrated play therapy had to be revised, and the five revised stages were:
(1) the stage of building up relationships
(2) the stage of ambivalent symbiosis
(3) the stage of therapeutic symbiosis
(4) the stage of differentiation
(5) the stage of individuation
The conclusion and the written documentation of this research had also been discussed in view of the application, development and research recommendations of the integrated play therapy training course.

並列關鍵字

integrated play therapy ； play therapy trainee ； play therapy self-efficacy ； the integrated play therapy training course

參考文獻

蔡毅樺（2007）：目睹婚姻暴力兒童手足遊戲治療主題及互動行為之探究。暨南國際大學諮商與輔導研究所碩士論文。

教育部第二次全國特殊兒童普查執行小組（1991）：性格與行為量表。台北市，國立台灣師範大學特殊教育學系。

梁培勇（2006）：遊戲治療理論與實務第二版。台北市，心理出版社。

林美珠(2002)：兒童中心遊戲治療助人歷程初探(下)。諮商與輔導，194，27--31。

林美珠(2002)：兒童中心遊戲治療助人歷程初探(上)。諮商與輔導，193，2--5。