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研究生:洪梅禎
研究生(外文):Hung, Mei-Chen
論文名稱:臨床心理師遭遇倫理困境之心理現象
論文名稱(外文):Ethical dilemmas encountered by clinical psychologists.
指導教授:李錦虹李錦虹引用關係
指導教授(外文):Lee, Gin-Hong
學位類別:碩士
校院名稱:輔仁大學
系所名稱:臨床心理學系碩士班
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:2008
畢業學年度:96
語文別:中文
中文關鍵詞:倫理困境臨床心理師質性研究
外文關鍵詞:ethical dilemmaclinical psychologistqualitative research
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國外與心理師相關的倫理困境研究為數甚多,國內過去雖有相關研究,但多流於準則上的討論而未深入探討心理師於實務工作上所遭遇哪些問題、心理師面對這些困境時的主觀經驗,同時未對造成倫理信念與行為不一致之現象提出說明。為對此問題有一較為深入的了解,本研究選擇質性研究的深度訪談做為研究方法,以深度抽樣方法選取北部六位實務工作經驗七年以上臨床心理師為研究對象進行訪談。訪談重點置於(1)心理師遭遇何種類型的困境;(2)處於困境時的主觀經驗與感受;(3)如何處理所面對的問題。訪談內容以編輯式類型進行文本分析。

研究發現,臨床心理師將倫理困境定義為「一個模糊的情境、難以判斷,而此問題缺乏標準答案,但也因此而更有發揮的空間」。在實務工作上,心理師最常遭遇的困境主要有「心理師與專業合作的困境」,包括:精神醫療團隊、機構及社會政策;「心理師與個案間的困境」,包括:心理衡鑑與治療、雙重關係、隱私與保密、預警責任及通報等。在這些困境中,目前只有與個案病歷有關的保密問題,心理師在處理上有相似的方法。由於心理師希望能為個案做出更佳的選擇,但受限於資源、機構規定等因素,使得心理師無法選擇較佳的方案。當心理師面對這些困境時,會尋求諮詢的對象包括:同儕、督導、伴侶、長輩等。此外,受訪者一致指出國內臨床心理學界倫理準則制度不明,缺乏一可依循的標準,以及倫理委員會的運作機制不清。研究最後試圖發現影響心理師產生「信念與行為一致」及「信念與行為不一致」之因素,得到心理師在倫理困境中的信念、評估與決策之歷程,並對造成「信念與行為不一致」之現象提出解釋。

本研究對臨床心理師於實務工作上所遭遇之倫理困境與影響因素有初步的認識,綜合以上發現,不僅為反應現況,更指出制定倫理準為心理師於實務工作所必須,研究最後並對相關現象提出建議,部分問題仍有待後續研究深入探討。
目次
第一章 緒論 1

第二章 文獻探討
第一節 倫理理論與原則5
第二節 專業倫理 11
第三節 倫理困境的定義及相關研究 22
第四節 研究目的 34

第三章 研究方法
第一節 研究方法的選取 35
第二節 研究對象 36
第三節 資料蒐集與工具設計 39
第四節 研究步驟 41
第五節 資料處理與分析 43
第六節 資料分析的信度與效度 53
弟七節 研究倫理 54

第四章 研究結果 56
第一節 倫理困境的存在與定義 56
第二節 心理師與專業團隊 60
第三節 心理師與個案 76
第四節 身為一個臨床心理師 93
第五節 總結 105

第五章 討論 111
第一節 困境類型與相關研究 116
第二節 影響倫理決策的相關因素討論 126

第六章 建議
第一節 結論 131
第二節 建議 133
第三節 研究限制與未來研究方向 138
第四節 研究者反思 140

參考文獻 142

附錄
附錄一 參與研究同意書 153
附錄二 研究參與者資料表 154
附錄三 訪談大綱 156

表目次
表1 不同學者對倫理困境的定義 24
表2 受訪者基本資料表 38
表3 提取意義單元並給予編號 48
表4 個人主題列表 50
表5 團體主題總列表 51

圖目次
圖1 研究預備流程圖 42
圖2 編輯組織類型 45
圖3 研究架構流程圖 46
圖4 資料分析流程圖 52
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