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研究生:方俊凱
研究生(外文):Chun-Kai Fang
論文名稱:癌症末期併憂鬱症病患之心理治療:存在─認知模式初步建構
論文名稱(外文):Psychotherapy among Terminal Cancer Patients with Major Depressive Disorder: the Preliminary Construction of Existential-Cognitive Model
指導教授:李佩怡李佩怡引用關係
指導教授(外文):Pei-Yi Li
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:生死教育與輔導研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:177
中文關鍵詞:癌症末期憂鬱症安寧緩和照顧心理治療存在主義認知治療詮釋學
外文關鍵詞:terminal cancermajor depressive disorderhospice palliative carepsychotherapyexistentialismcognitive therapyhermeneutics
相關次數:
  • 被引用被引用:12
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  • 收藏至我的研究室書目清單書目收藏:11
背景:在安寧緩和照顧中,處理癌症末期併憂鬱症病患是困難的,有關這類病患的心理治療少有文獻。有研究建議,對癌症初期病患,存在主義心理治療與認知治療是有效應的。本研究的目的包括:從存在─認知的層面探討癌症末期併憂鬱症病患的議題,以心理治療來治療這類病患,以及嘗試建構存在─認知心理治療模式。
方法:四位癌症末期病患,經由精神科醫師診斷為憂鬱症,並在簽署知情同意書後,被轉介接受以存在─認知層面的心理治療。心理治療時全程數位錄音。文本為心理治療的逐字稿。透過海德格的此在詮釋學,研究者充分地瞭解在心理治療中發生的事。文本以Colaizzi的七個步驟分析。
結果:四位病患共有22個有效的文本。自殺是會診精神科的主要原因。癌症末期併憂鬱症病患主要的因素,包括:能力的喪失、無自尊、身體的疼痛、自動化負面思考、過去生命意義的瓦解、以及此在的無意義。心理治療的介入時所呈現的主題,包括:確定病患的意識狀態、促進病情的自我察覺、察覺自動化負面思考、挑戰自動化負面思考、促進病患存在於當下、與病患共在、討論病患過去的生命意義、以及促進病患建構當下的生命意義。心理治療後病患改變的因素,是治療者的同理心、尊嚴的對待、身體痛苦的改善、其他存在者的影響、病患當下的選擇、生命意義的整合、重新建構生命最後階段的存在意義,與愛的力量。癌症末期併憂鬱症病患的存在議題,為:死亡、自我覺察、尊嚴、意義與無意義、自主權與選擇、與關係。
結論:對於癌症末期併憂鬱症病患而言,合併存在主義與認知方式的心理治療,能夠影響病患生命最後階段的認知。存在─認知心理治療的模式可能發展成處理這類病患的新方法。
Background: It is difficult to manage terminal cancer patients with major deppressive disorder (MDD) in hospice palliative care. There were few literatures about psychotherapy among these patients. Some studies suggest that existential psychotherapy and cognitive therapy are effective for cancer patients of early stages. The purposes of the study include finding the main themes of terminal cancer patients with MDD in existential-cognitive viewpoints, treating these patients in psychotherapy, and trying to construct the model of existential-cognitive psychotherapy.
Methods: Four terminal cancer inpatients diagnosed as MDD by psychiatrists and transferred to receive psychotherapies in existential-cognitive aspects after signing letters of informed consent. The whole courses of psychotherapies were digital-recorded. Texts were the verbatim of psychotherapies. According to Heidegger’s dasien hermeneutics, the researcher gained full understandings of what happened during the psychotherapies. Texts were analyzed by the method of Colaizzi’s seven steps.
Results: There were twenty two valid texts of all four patients. Suicide is the main reason of psychiatric consultation. The main factors about terminal cancer patients with MDD include loss of ability, indignity, physical pain, automatic negative thought, disintegration of meaning of life, and meaninglessness of dasien. The themes during intervention of psychotherapies include ensuring the patient’s consciousness, facilitating self-awareness of illness, being aware of automatic negative thoughts, challenging to automatic negative thoughts, facilitating patients to be here and now, being with patients, discussing patients’ previous meanings of life, and facilitating patients to construct the present meanings of life. The factors of patients’ changes after psychotherapies are therapist’s empathy, empowerment of dignity, improvement of physical suffering, affect by other beings, patients’ choices at present, integration of the meaning of life, reconstructing the meaning of being in the final stage of life, and power of love. The existential issues terminal cancer patients with major depressive disorder are death, sellf-awareness, dignity, meaning and meaninglessness, autonomy and choice, and relations.
Conclusions: Psychotherapy that combined existential and cognitive approaches among the terminal cancer patients with major depressive disorder was able to affect the patients’ cognition of being in their final stage of life. The model of existential-cognitive psychotherapy might develop a new way to deal with these patients.
第一章 緒論
第一節 研究動機 頁1
第二節 研究目的與問題 頁2
第三節 名詞定義 頁2
第二章 文獻探討
第一節 癌症末期與安寧緩和醫療 頁5
第二節 癌症末期病患的心理治療 頁8
第三節 認知治療 頁10
第四節 存在主義與心理治療 頁12
第五節 認知─存在治療模式 頁16
第六節 詮釋學 頁17
第三章 研究方法
第一節 個我心理治療理論:存在─認知模式 頁21
第二節 心理治療的過程即蒐集資料的過程 頁27
第三節 以詮釋學為研究方法 頁30
第四節 研究倫理與研究嚴謹度 頁31
第五節 文本詮釋的過程 頁33
第六節 研究進度 頁36
第四章 結果與詮釋
第一節 病患被會診的因素與文本的基本資料 頁37
第二節 癌症末期病患併發憂鬱症因素的詮釋 頁47
第三節 心理治療的介入 頁64
第四節 病患改變的因素 頁93
第五章 綜合詮釋與討論
第一節 癌症末期併憂鬱症病患的自殺意圖 頁123
第二節 癌症末期併憂鬱症病患之心理治療的特殊性 頁128
第三節 癌症末期併憂鬱症病患的存在議題 頁131
第四節 建構最後的存在意義 頁137
第五節 治療者對治療歷程的反思 頁142
第六章 建構與結論
第一節 初步建構存在─認知心理治療的模式 頁148
第二節 結論 頁167
參考文獻 頁170
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