囿而不限──遊戲治療的規則與結構化

Limitting but not Inhibiting–Rules and Structuring in Play Therapy

本文目的在於統整近年來梁培勇督導經驗中常見的設限提問，蒐羅遊療師在遊戲治療過程中所面臨的規則設置疑惑與操作困難，試圖歸納、整理並合併進「衡鑑－猜測（假設）－介入」臨床工作架構模式之中，重新檢視遊療師在操作介入之前的思考歷程。 全文以梁培勇的督導經驗為主要參考文本，統整歷來各助人工作界的遊療師針對治療歷程中的規則所提出的困難，同時挑戰遊療師對治療學派的內化程度與治療歷程的細膩理解。本文提出以下三點進行探討：一、綜觀台灣遊戲治療發展之歷史脈絡，分析台灣遊療師以個人中心學派為主之成因，並點出多數遊療師在遵守個人中心學派之三大原則之外，鮮少仔細思考執行治療之現實層面與理論概念之間應如何實踐與遵循。二、羅列台灣遊療師在設限上常見的困難與阻礙，特別是個人中心學派遊療師心中緊繫的三大原則與現實條件的衝突與矛盾，導致「知其然而不知其所以然」；因此，藉由重新反思遊療師介入之前的「衡鑑－猜測（假設）－介入」臨床工作架構模式，以微觀的視角檢視其介入之依據與考量，並強調此乃不斷持續循環的動態歷程。三、強調遊戲治療之結構化與投契關係之維繫並非如待辦清單在起始期時交代完畢即可，而是在整個治療脈絡中不斷調整維護、隨著治療狀態流動的架構，呼應前述「衡鑑－猜測（假設）－介入」臨床工作架構模式。 文末，再以Paul於1967年所提出的疑問，重新提出遵循「衡鑑－猜測（假設）－介入」臨床工作架構模式之再問，提醒遊療師在治療上對自身立場或觀點的視角需有一定的敏感度；同時，也提出除了在治療室內的施作探討之外，規則或結構化在現實場域中的個人隱私之維護與多重關係之堅持，對遊療師在治療的承諾與投入程度上是否有所改變。

The purpose of this article was to integrate and systematize questions regarding boundary setting frequently emerging in Dr. Liang Pei-Yung's supervisions by collecting the challenges and difficulties that play therapy clinicians encounter in rule-setting during the therapy process. By incorporating the organized results into the existing 'assessment-guessing(hypothesis)-intervention’ clinical working model, this article aimed to help play therapy clinicians examine their thinking process prior to intervention delivery. Data were mainly obtained from the texts of Dr. Liang's supervision sessions in which various questions regarding rule setting and rule implementation were raised by the supervisees in response to the therapeutic processes. Meanwhile, these texts revealed how Dr. Liang examined his supervisees' level of competency in relevant theories through posing challenges and the way he guided his supervisees to expand knowledge and deepen understanding of the nuanced therapeutic processes in play therapy. Findings were illustrated as follows: 1) the historical/ contextual background in which the Person-Centered Therapy became the leading theoretical orientation among play therapy clinicians in Taiwan was presented; difficulties in carrying out and following through the three PCT principles, unconditional positive regards, accurate empathetic understanding, and therapists' congruence and genuineness, were indicated and discussed; 2) a list of challenges that play therapists encountered in boundary-setting was proposed, with a focus on the inevitable conflicts and incongruence between Taiwan's social/educational/ cultural realities and the three fundamental principles underpinning PCT that the clinician held on to, which led to the 'know-how without know-why’ phenomenon among clinicians. As a result, a microscopic lens was taken to investigate clinicians' underlying considerations underneath the interventions by continually reflecting on their practices based on the ‘assessment-guessing (hypothesis)intervention’ clinical working model and regarding this 'action-reflection’ cycle as a repeated, dynamic, circular process. 3) Structuring and rapport-building need to be constantly regulated and maintained throughout the therapeutic process rather than being viewed as a one-time task on the top of the to-do-list that is supposed to be completed at the beginning of the first session. This finding resonates the abovementioned 'assessment-guessing (hypothesis)-intervention’ clinical working model. At the end of the article, the author(s) placed the therapeutic inquiries proposed by Cordon (1967) within the ‘assessment-guessing (hypothesis)-intervention’ clinical working model and provided tentative responses. Also, this current article stressed the importance that as a clinician, one needed to be aware of his/her positionality and situated perspective. Meanwhile, one's choices on personal privacy and dual/multiple relationships outside therapy sessions are reflections of their perceptions on structures and rules within therapy, which might have significant implications on his/her commitment and engagement in therapy.