諮商師個案概念化之初探研究—以受性侵害男童、少年個案為例

The research of case conceptualization by counselor— sampling of male youth who have been sexually abused

郭玲君(Ling-Chun Kuo)

指導教授 ： 洪素珍

淡江大學/教育學院/教育心理與諮商研究所碩士班/碩士(2010年)

https://doi.org/10.6846/TKU.2010.00553

摘要

本研究旨在探索諮商師對於受性侵害的男童、少年的個案概念化歷程與概念化的主題內容。研究方法，採用「深度訪談法」進行資料蒐集，以半結構訪談大綱訪談四位相關實務的心理專業工作者，並以「紮根理論」進行資料分析。最後研究者透過紮根理論之「開放編碼」與「主軸編碼」的編碼步驟對四位研究參與者之個案概念化歷程與概念化的主題進行分析。經分析後，本研究結果在「整體發現」部分有三點，一為研究參與者的「個案概念化是歷程性也是階段性的工作」，歷程性從思考個案的背景脈絡開始，到處理個案的創傷與復原議題結束；而階段性指個案概念化分成四個階段，分別是諮商的開始階段、工作階段早期、工作階段中期與工作階段晚期，每階段中都有其思考的焦點主題。二為「關係與權力的議題在整個歷程都需要被不斷檢視」。三為「諮商師性/性別的覺察對概念化歷程是重要的」。在「諮商開始期的發現」有兩點，一為「理解個案的轉介因素是進入治療的重要步驟」，因為男童與少年會透過其他方式包裝創傷，使創傷被隱藏起來。二為「文化、性別議題是理解個案脈絡的重要基礎」，因為面子與男子氣概讓男孩沒有受害者的位置，同時文化結構對男孩身體界限的模糊，也讓男孩受害了不自知。在「工作階段早期的發現」有兩點，一為「男性個案建立關係的方式不同於女性個案」，男性需要以忠誠、義氣、博感情表現對關係的需求，同理男子氣概及肯定其正向經驗等是與其建立關係的方式。二是「對發展任務的理解是概念化焦點中重要的一個部分」，因為青少年的社會發展、性發展以及親密關係的發展都會與其創傷經驗形成交互作用而發生影響。在「工作階段晚期的發現」有兩點，一是「創傷的影響與處理」，包含理解創傷的情緒、行為及相關之心理動力，並提出處理策略。二是「復原歷程」，理解個案從〝一個促發的因素〞開始，到自我功能的恢復，最後是〝關係的復原〞，讓個案步上復原之路。最後根據研究結果提出討論，並對個案、學校教育工作；諮商師的專業發展與未來研究提出建議。

關鍵字

個案概念化 ； 性侵害 ； 男童與少年

並列摘要

The purpose of this study is to explore how counselors conceptualized sexual abuse cases of boys and male juveniles. Four counselors were interviewed in semi-structural in-depth interviews. The data of case conceptualization processes and contents were analyzed by grounded theory using open coding and axial coding processes.Researcher categorized the finding into three main points. First, the case conceptualization process was a continuous and also a staged one. This process started from gathering background information of client, managing clients’ traumas, and to the end of recovering clients’ concerning issues. The staged work of case conceptualization included four stages, beginning stage, early working stage, middle working stage, and final working stage. Each stage focused on different subjects. Second, the relationship and power struggle between client and related people should be examined during entire process of counseling. Third, counselors’ sex and gender awareness was important for the case conceptualization process.There were two findings at the beginning stage. First, understanding reasons of referral was an important step of starting counseling, since boys and male juveniles would use different means to cover or hide traumas. Second, culture and gender issues were the foundations to understand cases, because males tends to deny their being the victims in order to avoid conflict with masculinity. In addition, the body boundary between males was vague in their culture, therefore, boys and male juveniles might not aware being abused. There were two findings in the early working stage. First, counselors used different ways to develop relationship with male clients than with female clients. Loyalty, brotherhood, masculinity and positive experiences were the ways for developing relationship between counselors and male clients. Second, familiarity and understanding of the developmental tasks was an important part of conceptualization. Social, sex, and intimacy developments would interact and then impact on clients’ traumas. In the final working stage, there were two important issues, which should be focused on. First, the management of traumas included understanding clients’ feelings and behaviors and psychodynamic, and then developing coping strategies. Second, the recovering process started from “a trigger recovering factor” to self-function recovering, and then to relationship recovering.Finally, the study discussed the research findings and proposed several recommendations for clients, counselors, and educators.

並列關鍵字

case conceptualization ； sexual abused ； boys and male juveniles

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