病床陪伴的心理機制：一個二元複合模式的提出

Two Psycho-spiritual Patterns for Companionship Through Dying：A Dual Model

本研究是自我們在2002年發表的《臨終過程心理質變論述》一文所延伸出來的想法，透過我們對臨終過程既有的理解，進一步探討陪伴病人臨終的過程中，與病人有宿緣的照顧者（父母、夫妻、兒女、親人、朋友等）所面臨到的心理過程，並提出可能的陪病模式。同時，這研究也試圖將心理諮商的領域擴大到心靈諮商(psycho-spiritual counseling)的領域，從「改變對方」轉變為「陪伴對方」，以心靈相契、存有相隨為主軸的病床陪伴與諮商(bedside companionship and counseling)。本文即是根據病人臨終過程的兩斷階模式，探討陪伴者在病人心理質變的不同階段中，陪伴所經歷的心理歷程為何。在理論上我們提出陪伴的二元複合模式(Dual Model)，以深化照顧者對病人進到病程末期時，所顯現的照顧接應方式。本文假定，若陪伴者以「常人自我」的狀態陪伴，非常適於臨終第一階段的陪伴，但是，當病人逐漸進入「背立轉向」之後，常態陪伴即逐浙失去與臨終者接近資能，此時，存有相隨的陪伴模式即可取代常態陪伴，而以靈性相陪，但是從常態轉為存有受到陪病雙方宿緣結構所縛，並不容易。本文也從對病人臨終過程的現象和陪伴心理歷程的瞭解之中，進一步發展陪伴者所需之「陪病諮商」的相關知識。

This paper is an extension of a long-term research program in palliative care. Based upon our understanding about the dying process, we would like to further discuss the psychological processes that affiliated caregivers (including parents, husband/wife, children, relatives, or friends) will go through, then move on to propose a new approach of bedside companionship for the dying patients. At the same time, this research builds on psychological counseling and expands it to psycho-spiritual care, which emphasizes not on changing the patients but on bedside companionship . The research results shows that two patterns of care are emerged during the different stages of patients’ condition: while the patient still remained in the social consciousness, the most fitted care will be ‘ a better management of bedside-things’, bu5 as the inward-turning happened, the better care will be the psychological calmness, silence by bedside and do nothing. As the dying arrives at the active dying stage, his mode of being will be deprived of the ego mentality, which will then lead to a breach between the caregivers and the dying patients, and bar the former from accessing the latter. The operational procedures for the caregivers to get into the existential mode of “being-with-the-patient,” which allow both parties to share tenderness, mercy, compassion, and god-like love is examined and the possible mechanism of patient-caregiver coupling theory for bedside companionship is explored.