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研究生:管貴貞
研究生(外文):Kuei-Chen Kuan
論文名稱:諮商人員處理自我傷害個案經驗之分析研究
論文名稱(外文):Experiences of Counselors Working with Self-Mutilating Clients
指導教授:蕭文蕭文引用關係
指導教授(外文):Wen Hsiao
學位類別:博士
校院名稱:國立彰化師範大學
系所名稱:輔導與諮商學系所
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:2007
畢業學年度:95
語文別:中文
論文頁數:246
中文關鍵詞:諮商人員的反應諮商人員的因應自我傷害
外文關鍵詞:counselor 's responsescounselor 's copingself-mutilation
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本研究主要目的在了解諮商人員處理自我傷害個案的經驗,包括在處理中諮商人員的反應、諮商人員如何因應這些反應,及對諮商人員在專業和個人層面的影響。
本研究訪問九位處理過三次以上自我傷害個案的諮商人員,每位受訪者進行二到三次的深度訪問,以回顧敘述的方式來描述個人的經驗,將收集的資料轉謄成為逐字稿,作為資料分析的文本,再以質性研究方法中的現象學進行資料分析,相關研究結果如下:
一、每位受訪者都處理過二種以上類型的自我傷害個案,以割腕最常見,其次
是割身體其他部位。大部分受訪者接受結束生命是解決問題的方式之一,
但是不得已的選擇。在處理這類個案的關鍵是「個案的自我接納」、「諮
商關係的建立」、「善用就醫時間」、「建立輔導網路」和「留電話的掙
扎」五方面。
二、受訪者在處理自我傷害的過程中出現的反應包括「情緒的負擔」、「沉重
的壓力」、「反移情的行為」、「替代性創傷的情緒」和「倦怠」五種反
應,害怕和焦慮是最常見的情緒負擔,沉重的壓力和反移情的行為是受訪
者共同的反應,超過半數有倦怠的狀況。
三、諮商人員面對處理自我傷害個案反應時,他們會以「尋求專業的解惑」、
「社會網絡的情緒支持」、「閱讀文獻」、「整合資源」、「自我反
思」、「堅持信念」和「滋養生活」方式來因應,尋求專業解惑是受訪者
最常採用的方式。
四、處理自我傷害個案對諮商人員的影響,包括「調整諮商方式與心態」、
「對諮商專業的肯定」、「關照與肯定自我」、「生活的變動」、「生命
的回觀」和「離職」六方面,幾乎所有受訪者都調整諮商方式與心態,有
人更加肯定諮商的幫助,也有人離開原來的職場。
依據本研究結果提出具體建議,以提供諮商教育、實務工作者和研究者作為參考。
The purpose of the study was to gain a deeper understanding of counseling with self-mutilating individuals. The study examined counselors’ reactions to the process of counseling, their coping styles, and the impact of counseling on their individual and professional lives. This study adopted a phenomenological research approach. Nine counselors who had worked with at least three self-mutilating individuals were recruited by purposive sampling. In depth-interviews lasting 2-3 sessions were conducted to collect data. Data were transcribed and analyzed for themes and patterns.
All participants reported working with at least two kinds of self-mutilation. Wrist- cutting was the most common pattern of self-mutilation, followed by body-cutting. The majority of the participants expressed acceptance that the decision to end one’s life is a choice that can be used to resolve problems but felt that this is not the only choice. Five components that contributed to the process of effective counseling were identified: fostering clients’ self-acceptance, establishing rapport with clients, helping clients to see a psychiatrist, establishing a counseling service network for clients, and struggling to leave a personal cellular phone number of the counselor to the client.
Responses reported by counselors in dealing with self-mutilating cases included emotional burdens, feeling stressed out, countertransference, affection resulting from vicarious traumatization, and burnout. The coping patterns reported by counselors included seeking professional help for problem solving, gaining emotional support from social networks, reviewing professional literature, integrating resources for clients, self-introspecting, keeping professional beliefs, and nourishing life.
The impact on counselors of working with self-mutilating cases is reflected by six themes: adjusting personal counseling styles and attitudes, valuing the counseling profession, validating self and self-care, changing life styles, re-thinking the meaning of life, and quitting one’s job. A discussion of the findings suggests a need for counselor education and future research focused on issues related to working with self-mutilating cases.
目 錄
第一章 緒論………………………………………………… 1
第一節 研究動機與目的………………………………… 1
第二節 研究問題………………………………………… 9
第三節 名詞解釋………………………………………… 9

第二章 文獻探討…………………………………………… 11
第一節 自我傷害的個案………………………………… 11
第二節 諮商人員處理自我傷害個案的反應…………… 20
第三節 諮商人員因應處理自我傷害個案的反應……… 33

第三章 研究方法…………………………………………… 41
第一節 研究取向………………………………………… 41
第二節 訪談對象………………………………………… 43
第三節 研究工具………………………………………… 45
第四節 研究過程………………………………………… 49
第五節 資料分析………………………………………… 53

第四章 研究結果…………………………………………… 60
第一節 與自我傷害個案相遇…………………………… 60
第二節 諮商人員在處理自我傷害個案的反應………… 85
第三節 諮商人員處理自我傷害個案的因應…………… 122
第四節 處理自我傷害個案對諮商人員的影響………… 156
第五節 綜合討論………………………………………… 186

第五章 結論與建議………………………………………… 206
第一節 研究結論………………………………………… 206
第二節 建議……………………………………………… 212

參考書目……………………………………………………… 224
壹、中文部分……………………………………………… 224
貳、西文部分……………………………………………… 229

附錄
附錄一:研究邀請函……………………………………… 237
附錄二:研究說明與研究同意書………………………… 238
附錄三:訪談大綱(前導性研究)………………………… 239
附錄四:訪談大綱(正式)………………………………… 240
附錄五:謄寫訪談逐字稿須知…………………………… 245
附錄六:訪談日誌紀錄表………………………………… 246
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