「和而不同」的生病事件建構：以對偶關係探究腸造口癌症患者及其照顧者的心理生活經驗

In Harmonious Yet Different Worlds:Exploring Psychological Experiences and Co-constructive Illness Events from the Dyadic Relationship between Stoma Patients and their Primary Care-giver

本研究以「腸造口患者及其主要照顧者」為配對樣本，探討「病患」與「照顧者」雙方的共構心理生活經驗。研究場域是南部某醫學單位癌症中心，同時訪談患者及其主要照顧者。共蒐集五組對偶資料。五位受訪患者中，有四名男性與一名女性，診斷皆為直腸癌第二至三期，並於最後一次訪談時，接受憂鬱狀態評量。五位照顧者中，有一名男性與四名女性。每對平均受訪次數為2.4次，患者的罹病時間平均為16.2 個月，照顧者照顧經驗平均為14.6個月。資料經詮釋分析後，結果顯示病患與照顧者雙方的偏航模式是「不對稱狀態」。透過牽引線歷程，使雙方在多元脈絡下存活，建構「和而不同」的事件意義，並進一步形成「對稱和諧」對偶關係，且患者情緒狀態較佳。本文探討病後新生命曲線所指向的「和而不同」歷程之臨床意涵；並反思「我們感」的對偶關係衍生之意義。最後，筆者提出本研究結果於臨床心理學上的應用與限制。

This paper explores the psychosocial reactive experiences and lifestyles of cancer survivors, and the caring experiences and coping strategies of their primary caregivers using participant observation, interviews, and interpretive phenomenology. Five patient-caregiver dyads (4 male and 1 female patients; 4 female and 1 male care-givers) were interviewed an average of 2.4 times each at a hospital in southern Taiwan over a 2-year period. The average duration of illness was 16.2 months. The average duration of care was 14.6 months. In the last interview, the depression scale was administered to the cancer patients as an adaptation index after a chronic illness. Results showed cancer patients and their caregivers shared a similar psychosocial process. After the cancer event, they both felt their biographies could be narrated metaphorically. They felt ‘The life trajectory is out of the daily rotines'. Through the narrative line, the life trajectory could be drawn to the routined order as before. However, the cancer assaulted their lived world; their life story changed ontologically. The patients and their caregivers constructed different lifestyles from each other, which not only presented limitations, but also revealed their adaptations for the patients. But from the caregivers' view, the illness caring experiences might be the burden processes for the maladaptive dyad. The analysis showed that a sense of we-ness can enhance mutual intimacy and empower a relationship. By enacting the we-ness care pattern, the clinical psychologist and related mental health workers could offer healing by taking care of their biological, social, and psychological needs and ensure positive new trajectories.