運用治療性遊戲協助肌肉萎縮症兒童處理情緒

Application of Therapeutic Plays to the Emotion Handling of Children with Spinal Muscular Atrophy

本文係以理性情緒行為治療理論之內涵於治療性遊戲，以協助學齡期肌肉萎縮症兒童能正向思考，以處理自我情緒。筆者與個案長期接觸，了解病童因身體障礙致使學校活動參與受限，進而產生如生氣、哭泣等負向情緒，因此筆者配合學齡期兒童之認知發展，以理性情緒行為治療理論之內涵為架構設計遊戲：以把情緒畫出來、畫手掌表自我掌控情緒並學習自我決策及照片治療，導引個案正向思考。於活動過程中，發現個案雖然拒絕畫出腳不能走，引發負面情緒感覺，但意外發現她對自己未來的期待；且在畫手掌之決策遊戲中，雖負向想法居多，但也導引其產生「休息一下喝水」的正向想法；在尋找意義照片遊戲中，讓個案描述照片內容，除使個案抽離負向情境外，使其再次肯定自我。經由此個案護理報告，建議護理人員在照護肌肉萎縮症兒童過程中，應可運用理性情緒行為治療理論之治療性遊戲處理情緒問題，以增進社會化發展。

This case study provided the ways of using the therapeutic plays developed from the meaning of rational emotive behavior therapy (REBT) to help school-age children suffering from spinal muscular atrophy deal with their emotions and think positively. Having been in long-term contact with the study subject suffering from spinal muscular atrophy, the author has observed how the patient often develops negative emotions such as anger and frustration due to her inability to participate in school activities. The author took the cognitive development of school-age children into account and devised the therapeutic plays based on the REBT framework. It is hoped that these therapeutic plays may help them to control their emotions, learn how to make decisions, and build the self-esteem through expression of emotion by drawing, palm drawing, and photographic therapy, thereby allowing the study subject to think positively. In this case study, the author has observed that although the study subject refused to show in her drawing her inability to walk, which induced negative emotions, she has discovered through the process her own expectations for the future. In the game of drawing a palm to help make decisions, the study subject again showed some negative emotions, but was led to agree to the positive view of “taking a break to drink water”. In the photographic therapy session, the study subject was asked to describe the content of the photo as a way to draw her away from negative associations but more importantly, for her to feel confident about herself and build self-esteem. This case study suggests that the nursing staff make use of the REBT-based therapeutic plays to handle the emotional problems of the children with spinal muscular atrophy, and thus enhance the development of socialization.