短期社區諮商介入災難救援場域之初探性研究：以八八水災的心理復健工作為例

Preliminary Study of Brief Community Counseling Services at a Disaster Rescued Location: Mental Health Interventions for Typhoon Morakot

本研究旨在探討社區諮商介入災難救援時之服務內涵、策略、團隊合作之挑戰及面臨之文化議題，研究者採取Lofland、Snow、Anderson與Lofland（2006）所提出的社會情境分析之參與式觀察和質性分析法，於2009年8月11日至8月23日帶領7位受訓諮商師進入南部某災區救援醫療單位及收容中心提供心理復健工作，以參與式觀察、心理復健服務記錄、督導討論及焦點訪談等方式蒐集資料，並進行質性分析。研究結果顯示，在災難初期以社區諮商的介入方式提供心理復健服務時，其服務隨著災民族群文化、不同專業文化及場域的不同而變化，衍伸出不同服務內涵與策略。其中，災區之社區諮商策略與內涵共有六大主題：「外在事務與內在心理服務之銜接」、「由被動到主動服務之心理轉化」、「文化多元與策略多樣之映襯」、「專業態度依循文化脈絡之調整」、「災難經驗的共構與轉化」、「多變情境與制式專業之磨合」；團隊合作的挑戰與因應則展現五大主題：「醫療模式與整體服務模式之辯證」、「專業文化差異之消融」、「制式化與學習性服務之轉化」、「組織階層化與權力因應」與「以災民利益優先因應競合生態」。最後，研究者針對社區諮商因應災難救援場域的特殊性與複雜的文化因素，對其所使用之介入方法的變化調整、合作議題與專業方法等相關議題進行討論。

The study explored the community counseling services, strategies, collaborative challenges, and cultural concerns encountered by professional helpers in a disaster rescued location. Situational analysis and participant observation method proposed by Lofland, Snow, Anderson and Lofland (2006) was applied in this study. Seven community counselor trainees provided services in the Typhoon Morakot disaster field in South Taiwan with the principal researcher August 11 to August 23, 2009. Data were gathered through participant observation, process notes, supervision discussion and focus group. Qualitative analysis indicated that when providing community counseling at the early phase of disaster management, service types and strategies changed according to the ethnic culture of victims, professional culture, and locations. Six themes of service strategies and content emerged from the data: (a) combining external business management and mental health interventions, (b) transforming passive attitude into active services, (c) diversifying strategies to adapt to diverse cultures, (d) adjusting professional attitudes to match the local cultural network; (e) co-constructing and transforming the disaster experiences, and (f) "mediating standardized service protocol and changing circumstances. Five themes concern collaborative challenges and strategies encountered by the team emerged: (a) dialectic of medical and holistic service models, (b) resolving conflicts among different professional modalities, (c) transforming standardized learning into service learning, (d) coping with power struggle within organizational stratum, and (e) putting victims' needs above competitive service ecology. Finally, issues related to cultural complexity of counseling interventions, collaboration, and trainee competences in disaster rescued locations are discussed.