影像紀錄在臨終心理諮商之運用

Applying Video and Documentary Film in End-of-Life Counseling

本文的目的在於展演如何將影像記錄，運用在臨終心理諮商的實務工作中。臨終心理諮商是一個新興領域，如何發展適合臨終病人的諮商方法，是臨床實務上的重要議題。影像具有超越語言，直指存在核心的能力，能成為末期病人產生體悟與促發療癒改變的重要媒介。將影像紀錄運用在臨終心理諮商工作，是伴隨本土化心理靈性陪伴模式（心蓮模式）的發展，而逐漸具體成形。此模式依循的理論概念包括：尊重生命的自然法則，將臨終病人的自我轉化視為一個回歸的旅程，以及將臨終歷程視為生命成長的最後階段。臨終心理諮商的目標，在於營造一個具有轉化能力的能量場，協助病人進入轉置狀態，使得病人能在朝死而生的生命時空中，繼續發展。影像記錄能夠運用在臨終的個人、家庭和團體心理諮商。影像運用的八個面向包括：具體化病人未來生活的可能性，調節病人與家人之間的關係，提升有限生命的意義，促發對生命難題的討論，提供家屬一個觀看的位置，深化陪伴，協助病人和家屬產生反身性的思考，見證病人的存有經驗，協助病人從看得見的影像，對生命困境產生超越性的理解。心理照顧者對影像的運用，以心蓮模式做為藍圖，著重從生活化的歷程中，促發病人的心靈轉化。心理照顧者對影像的整合和運用，能為臨終心理諮商開創更大的空間和效能，促使病人和家屬在行動中獲得療癒，在關係轉化與超越個人的締結中獲得療癒。心理照顧者扮演促發者、整合者和見證者的角色。本文最後指出，影像紀錄只是工具，重點在於照顧者對臨終心理轉化，諮商目標有清楚的概念，體認到臨終心理諮商，是在一個更大力量底下所進行的工作。透過生命交會和見證，照顧者有機會一窺生命的奧秘，並透過影像將臨終生命的力量延續下去。

The purpose of this article is to illustrate the rationale and clinical experiences of applying video and film (video/film) in end-of-life counseling. End-of-Life Counseling is an emerging area in advanced cancer care. Developing appropriate approaches and effective methods of providing psychological care to patients and their families has become a critical issue. Images in the forms of photography, video or documentary film serve as an important vehicle that supports patients in their search for meaning. Utilizing video/film to facilitate patients’ psycho-spiritual transformation was integrated in the psycho-spiritual care (Heart Lotus Model) at the Heart Lotus Palliative-Hospice Care Ward in Tzu-Chi Buddhist Hospital. Under this model, death and dying are regarded as a natural process, a journey of returning, and the last stage of growth. The goal of end-of-life counseling is to create a transformative energy field and space that facilitates the patient’s psycho-spiritual development at the end of life. Eight dimensions of applying video/film are summarized with examples, including 1) helping patients gain an understanding toward their future; 2) regulating family relationships; 3) extending the meanings of one’s life; 4) facilitating discussion between patients and caregivers; 5) providing family members with a “position” to see their loved ones; 6) deepening patients’ reflection on living and dying; 7) facilitating transcendental understanding from contemplating images; and 8) witnessing patients’ existential experience. Using video/ film reveals a way to work with patients through their daily life experiences, which demonstrates the frameworks of Healing in Actions, Healing in Transformed Relationships and Healing through Transpersonal Connection. The roles of the psychotherapist include a facilitator, an integrator and a witness. This article concludes that although video/film serve as a tool in end-of-life counseling, what is more important is that a psychotherapist clearly understands the process of psycho-spiritual transformation and recognizes that end-of-life counseling is conducted under the natural process of life, which is beyond the manipulation of human beings. Through encountering patients’ lives and witnessing their psycho-spiritual transformation, caregivers are provided with an opportunity to have a glimpse of mystery of life and pass on their love through images.