Study of Childhood Depression: Exploration of Features Revealed in the Psychodynamic Psychotherapy Process

學齡期兒童憂鬱症研究：症狀探討

林玉華(Yu-Hua Clare Lin)

《輔仁醫學期刊》 8卷2期 (2010/06) Pp. 77-84

摘要

背景與目的：兒童憂鬱是一個不可被忽略的問題，國內針對兒童憂鬱症的研究不多，雖然許多研究已經對於兒童憂鬱的症狀做了明確的定義，然而兒童憂鬱常與其他症狀共病，又因兒童憂鬱症的內在症狀不易被發現，因此較不易被下診斷，因此有必要藉由其他管道了解兒童的憂鬱現象。方法：四名由醫院轉介而來且符合兒童憂鬱量表中文版(CDI)篩選標準之兒童接受為期十次之「動力導向兒童心理治療」。所有兒童遊戲內容皆謄成逐字稿。本研究員和另一位接受過動力導向兒童心理治療訓練六年以上的專家針對「動力導向兒童心理治療」逐字稿，以質性研究模板分析方式進行內容分析，並由下往上進行歸類，直到達成共識。最後再請兩位專家進行最後確認。結果：研究結果發現三大類和十四小項的特質，包括嚴厲的超我、過度罪疚感與抑制、內在貧乏、無力和無助感、理想化與自卑、攻擊與焦慮、混淆的內在、負向客體關係以及伊底帕斯問題。結論：本研究發現憂鬱兒童所呈現的特質可能與伊底帕斯衝突／焦慮有關。

關鍵字

兒童憂鬱症 ； 動力導向心理治療 ； 歷程研究

並列摘要

Background and purpose: The epidemiology of childhood depression shows that it is a serious problem for children, their caretakers, and society. Because of its high rate of comorbidity, it is often difficult to reliably diagnose depression. It is necessary to further explore the clinical features of childhood depression. The clinical features revealed in the process of psychodynamic psychotherapy have rarely been studied. Hence this research intended to explore themes and features of childhood depression revealed during the treatment process. Methods: Four children (aged 9~11 years) diagnosed as having depression were referred from psychiatric hospitals. The Chinese version of the CDI-Parent Rating and Depression Rating Scale for Children was used to ensure that the subjects matched the criteria. Each child received 10 sessions of psychodynamic psychotherapy. All 40 therapy sessions were recorded, transcribed, and coded. Based on a modified Template Analysis Method, the researcher and another clinician utilized the quantitative data analysis software, Atlas. ti 5.0, to code and analyze the psychotherapy session notes. They then conducted a bottom-up content analysis, first independently and then in mutual consultation, until a consensus was reached. Expert reliability was obtained with the contributions of 2 other senior child psychotherapists. Results: The analysis of the child's psychotherapy revealed the following themes and issues: a severe and punitive superego, excessive guilt and inhibitions, inner deprivation, feelings of helplessness and hopelessness, the need to control, idealization and inferiority, internal aggression and anxiety, confused internal states, negative object-relation representation, and oedipal problems. Conclusions: This paper found that childhood depression might be related to unresolved oedipal conflicts and anxieties. It is hoped that this study will add to the knowledge of childhood depression and provide child clinicians with a useful reference for further research and implementation of treatment plans.

並列關鍵字

childhood depression ； psychodynamic psychotherapy ； process study