動力式心理治療對安置及教養機構智能障礙男少年性心理發展之歷程分析

Analyzation of the psychosexual development process of mentally retarded male youth of the settlement and education institute in psychodynamic therapy

范丹屏(Tan-Ping Fan)

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(2013年)

https://doi.org/10.6846/TKU.2013.00398

摘要

本研究以動力式心理治療去了解安置及教養機構內智能障礙男少年性心理發展之歷程。研究者選擇以質性研究作為資料蒐集與文本分析的方法。研究者擔任諮商師，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遊戲箱的概念，先準備繪畫工具、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、個人反思以及督導，並持續與個案的主要照顧者（安置及教養機構內的主要照顧者與社工、學校老師等人）進行討論與意見回饋。本研究分為兩個階段，總共進行了55的動力式心理治療和37次的個人督導。
從分析和編碼歷程記錄後發現，主要探討的議題集中在諮商師和個案之間的「兩人關係」。此為治療中的關鍵，可分為「推動、分裂、涵容、內化」四個時期，且因著事件和議題的影響，牽動著兩人關係的遠近，形成螺旋式的關係。治療核心集中在處理個案童年被母親遺棄的創傷，因此諮商師涵容個案的內在攻擊，促使個案在接受動力式心理治療後，增進溝通表達能力以及改變了固著的攻擊與防衛機制。
個案的性心理發展部分，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。個案並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，使智能障礙男少年能彈性的在「分裂－偏執心理位置」和「憂鬱心理位置」之間轉換。
根據本研究結果和動力式心理治療的特性，建議日後進行相關研究者需要和其他照顧者、相關專業人員之間建立起團隊一同相互合作，且需要個人持續被諮商和督導。考量智能障礙者的認知和表達溝通的需求，建議運用日曆穩固治療架構，並提供情緒詞彙圖片 、使用物件、繪畫工具等媒材協助智能障礙男少年表達內在感受，以及提供後續的支持性治療。

關鍵字

安置及教養機構 ； 智能障礙男少年 ； 性心理發展 ； 動力式心理治療

並列摘要

The research is an analysis of the psychosexual development process of a mentally retarded male youth, who lives in settlement and education institute. The research used psychodynamic therapy and qualitative research as research methods. The researcher her own was a Counseling Psychologist. Considering the client’s cognitive and communication skills, the research used Melanie Klein’s “play box” method, to communicate with the client through using tools like painting tools, small objects, colored paper, mood pad and more to help the client to express his inner feelings. The researcher reordered client’s behaviors, researcher’s personal reflection, and supervisor’s feedback after each session. The researcher also discussed with client’s primary caregivers and gave feedback to them. (The caregivers included the teachers in the settlement and education institute, social workers, and schoolteachers). The whole process included 55 psychodynamic therapies and the other includes 37 personal supervisions and can be divided into two stages.
According to the analysis and coding data, the main issues of the client focused on the relationship between the counseling psychologist and the client. This was the key for his treatment and could be divided into four periods: pushing, separatism, containing and internalization. Affected by the impacts of the events and issues, the relationship between the counseling psychologist and the client is like a spiral relationship. The treatment focused on handling the client’s childhood trauma of being abandoned by his mother. The counseling psychologist contained the client’s inner attacks, helping him to improve his communication skills and his fixation attack and defense behaviors in the psychodynamic therapy.
In the early stage of the psychosexual developing treatment of the client, his mind was as closed as a flawless egg. He excluded any messages and people, and had long history to rely on external objects to assist his communication to outside world. His concept of boundary was weak and he also had low self-esteem. When he faced difficulties, he would choose to sleep to escape of facing the problems. In the treatment, he often expressed the characters came from unsatisfied oral stage and the overly repressed anal stage.
After the counseling psychologist contained the client’s emotion and applied projective identification, the client had experienced even if he repeatedly attacked the counseling psychologist emotionally, the relationship was still able to repeatedly repaired. He had the real experience with the emotions of love and guilt. It would help the client to elasticity changed his position between "paranoid-schizoid position" and "depressive position".

According to the results of this study and the characteristics of psychodynamic therapy, it is recommended that future researchers, other caregivers and related professionals with established teams to cooperate with each other. Counseling psychologist especially should have personal counseling and supervision during the process and after if needed. The counseling psychologist should use calendar securely treatment to establish a stable framework. Considering the cognitive abilities and the needs of communication of a mental retardation client, it is recommended to provide emotional vocabulary pictures, objects, drawing tools, and other media to help the client to express his/her inner feelings, and provide follow-up support treatment.

並列關鍵字

The settlement and education institute ； Mentally retarded male youth ； Psychosexual development ； Psychodynamic therapy

參考文獻

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