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研究生:黎麗貞
論文名稱:遊戲治療未成熟結案之歷程研究---遊戲治療師觀點之探究
指導教授:高淑貞高淑貞引用關係
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:2009
畢業學年度:97
語文別:中文
論文頁數:202
中文關鍵詞:遊戲治療遊戲治療師遊戲治療結案歷程未成熟結案
外文關鍵詞:play therapyplay therapistimmature terminationtermination process of play therapy
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遊戲治療未成熟結案之歷程研究―遊戲治療師觀點之探究
摘要
本研究主要研究目的是瞭解「未成熟結案因素對遊戲治療的影響」、「遊戲治療未成熟結案最後單元之內涵」以及「治療師經歷未成熟結案之心理歷程」。
本研究使用質性研究法,訪談十二位經歷未成熟結案的遊戲治療師,蒐集資料之後進行分析獲得的結果如下:
一、形成未成熟結案的原因包括「治療師主動結案」以及「他者主動提出結
案」。治療師主動結案包括治療師離職、治療架構不穩定及違反治療師信
念而結案。他者主動結案包括機構限制次數、家長負擔家計無法配合治療
接送、家長對治療持負面觀點、個案轉換環境而結案。
二、未成熟結案歷程治療師的情緒經驗:治療師在結案初期會有虧欠感及失落
感;結案後,治療師出現四種情緒包括釋然、擔心、罪咎與懷疑的感受;
結案一段時間後,治療師回復到自在的狀態。
三、遊戲治療師轉換未成熟結案的模式:包含治療師的內外在需求,以及轉換
治療架構與個案治療空間之機轉。轉換治療架構包含以協商方式決定結
案、治療師維持對結案的一致性,轉換個案治療空間機轉則是讓個案擁有
好的歷程經驗、開啟個案內外在資源及個案獲得改變。
四、治療師與個案系統的互動經驗:治療師與個案的互動經驗包括結案前後個
案對結案的接受程度;與個案親子系統的互動分成介入親子系統的阻力以
及治療師對家長提出結案的態度。
五、遊戲治療師的蛻變分成治療師的治療效能、在治療處理上的新發現、與家
長互動的新模式,以及結案後治療師自我照顧的方式。

本研究依據研究結果提出建議,提供未來的研究者以及實務工作者作為參考。

關鍵字:遊戲治療;遊戲治療師;未成熟結案;遊戲治療結案歷程
The purpose of this study is to understand how play therapy was influenced by the immature termination factors, the contents of play therapy in the very last session of an immature termination, and the psychological process of a therapist who experienced immature termination. The qualitative research method was used in this study, and twelve play therapists who had experienced immature termination were interviewed. The findings suggested the followings:
1.Immature terminations might be proposed by therapists or by others. The reasons for a therapist to propose the termination included that the therapist was leaving the agency where he or she counseled the client; that the therapist considered that the therapeutic structure was unstable (e.g., parents were not supportive of treatment and threatened to end treatment); and that the therapeutic environment was not arranged in the way consistent with the therapist's theoretic orientation. The reasons for others to propose the termination were that the agency set a limitation on treatment sessions; parents could not coordinate the transportation to therapist's office; parents possessed a negative view of treatment, and the client was moved to another location.
2. Therapists' emotional experiences to the immature termination consist of three phases. In the initial stage of the termination, therapists would experience a sense of lose and indebtedness to their clients; after the termination, therapists felt worried, doubtful, guilty or relieved; and in a period of time after the termination, therapists would recover to a status of comfort.
3. Play therapists handled the immature termination through dealing with their own needs which were brought up by the termination, and through restructuring the last couple of sessions to better suit their clients' needs. To meet their own needs, for example, therapists sought consultation in order to regulate anxiety related to the immature termination. On the other hand, therapists discussed with parents of their early terminated clients about the possibility of taking the client to therapy for the last time, and they arranged the last session or the last couple sessions to enable the client to experience a positive therapeutic experience, reassure the client about his/her internal resources, discuss with the client about external resources available to him or her, and focus on an issue which could be solved in the remaining sessions.

4. Therapists' experiences with clients and their parents were also an important part in the immature termination, including therapists' awareness of clients' acceptance of termination, working on overcoming parents' resistance, and therapists' reactions to parents who asked for termination.
5.Therapists' reported improvements include the changes in their therapeutic efficacy, the understandings/realization of new treatment/intervention strategies, the development of new models of working with patients' parents, and their engagement of self-care activities after termination.
Finally, based on research findings, recommendations for conducting further research and practicing in the field of play therapy were discussed.

Keywords: play therapy, play therapist, immature termination, termination process of play therapy
目次
第一章 緒論 1
第一節 研究動機 1
第二節 研究背景 2
第三節 研究目的及問題 7
第四節 名詞釋義 8
第二章 文獻探討 11
第一節 遊戲治療的結案 11
第二節 兒童心理治療未成熟結案的影響因素 26
第三節 結案歷程與感受 39
第三章 研究方法 49
第一節 研究方法論 49
第二節 研究受訪者 51
第三節 研究者 54
第四節 資料蒐集方法 59
第五節 研究程序 61
第六節 資料整理與分析 62
第七節 研究的品質與倫理 67
第四章 研究結果 73
第一節 遊戲治療師未成熟結案認定之意涵 73
第二節 未成熟結案歷程治療師的情緒經驗 83
第三節 遊戲治療師轉化未成熟結案的模式 95
第四節 遊戲治療師與個案系統的互動經驗 114
第五節 遊戲治療師的蛻變 132
第六節 治療師經歷未成熟結案之模式 149
第五章 討論與反思 151
第一節 討論 151
第二節 反思 162
第六章 結論與建議 175
第一節 結論 175
第二節 建議 178
參考文獻 186
中文部分 186
英文部分 188
附錄 197
附錄一 結案研究之邀請函 197
附錄二 遊戲治療師參與研究同意書 199
附錄三 訪談日誌 200
附錄四 遊戲治療師結案歷程逐字稿檢核表 201
附錄五 遊戲治療師結案歷程描述文評定表 202

圖目錄
圖2-1螺旋式兒童治療改變歷程(Thompson & Rudolph, 2007,
p. 47) 15
圖2-2諮商階段轉介及結案架構(Leigh, 1998, p. 8) 22
圖2-3兒童症狀循環圖(Micucci, 1998, p.18) 34
圖3-1治療師F意義單元擷取及命名示範 64
圖3-2「不重蹈覆轍用不同的方式溝通」之意義單元叢聚 65
圖3-3「治療師對個案系統工作的覺察」主題的脈絡性 66
圖4-1治療師未成熟結案歷程情緒轉換圖 94
圖4-2治療師未成熟結案心理歷程模式圖 150


表目錄
表3-1遊戲治療師基本資料 54
表3-2訪談大綱 60
表4-1形成未成熟結案原因之分析摘要表 82
表4-2未成熟結案歷程治療師的情緒經驗之分析摘要表 93
表4-3遊戲治療師轉化未成熟結案的模式之分析摘要表 113
表4-4個案在未成熟結案的歷程經驗暨治療師再接個案之意願之分析摘要表 122
表4-5遊戲治療師與個案親子與學校系統互動經驗之分析摘要表 131
表4-6遊戲治療師治療效能之分析摘要表 135
表4-7遊戲治療師在治療處理上的新發現之分析摘要表 143
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