關係取向心理治療處理社交焦慮症患者之歷程研究

Process of Applying Relational Approach Psychotherapy on a Client with Social Anxiety Disorder

本研究目的為以關係取向心理治療之理論為基礎，闡述關係創傷對社交焦慮症患者的影響，以及其發展的人際關係困境。研究對象為一位長期有社交焦慮症的中年男性個案，經精神科醫師轉介進行每週一次、每次50分鐘，共44次的心理治療。研究資料為每次治療錄音檔的逐字稿、治療者的筆記與精神科醫師的評估。研究結果發現：（1）關係創傷：個案與母親的關係是個案關係創傷的主因，個案長期依賴母親形成內在的關係囚籠，進而導致其社交焦慮與人際疏離。（2）個案的人際關係模式與困境：在治療歷程中，個案與治療者重現舊有的關係模式，包含順服取悅他人與預期並誘發他人負面評價。（3）治療者覺察自己落入個案舊有人際模式：治療者重演個案的重要他人，感受到自身的糾結與無力。經由自我覺察與調整，治療者突破治療僵局，並協助個案創造新的關係經驗。（4）個案的重生：治療者發現個案已逐漸脫離關係囚籠，能開展行動、找回自己。最後，本研究認為關係取向心理治療有助於理解個案的關係模式，並協助個案發展出新的關係經驗，處理關係創傷所導致的關係困境。 The paper is based on Relational Approach Psychotherapy and apply its theory in order to examine the influences of relational trauma toward a client with Social Anxiety Disorder (SAD), and his development of interpersonal impasse. The participant was a middle aged male suffered from SAD, and referred by a/the/his psychiatrist. A total of 44 interviews were conducted weekly for 50 minutes per week. The research data included the psychotherapy records, the reflective manuscripts of the therapist, and the evaluation of the psychiatrist. The results are: (1) Relational trauma: the relationship between the client and his mother was the origin of the relational trauma. The client depended on his mother over a long period of time which caused the internal relational cage. Thus, the relational cage induced the client to the development of the social anxiety and interpersonal alienation. (2) Client's relational model and impasse: the client replayed the old relational model during the counseling process, including pleasing others and inducing the negative evaluations from the people. (3) Falling into client's old interpersonal model: the therapist (acted/re-acted) as the important other of the client, so the therapist felt (his/her) struggles and incapability. Through self- awareness and adjustment, the therapist overcame the impasse and helped the client to create the new relational experience. (4) Reborn: the therapist noticed the client gradually departed from the relational cage and was able to act on his own, and find his way. Finally, the researcheres believe that relational approach psychotherapy is helpful for understanding the relational model of the client, and facilitates the development of new relational experiences of the client. Therefore, the client will be able to deal with the relational impasse caused by relational trauma.

The paper is based on Relational Approach Psychotherapy and apply its theory in order to examine the influences of relational trauma toward a client with Social Anxiety Disorder (SAD), and his development of interpersonal impasse. The participant was a middle aged male suffered from SAD, and referred by a/the/his psychiatrist. A total of 44 interviews were conducted weekly for 50 minutes per week. The research data included the psychotherapy records, the reflective manuscripts of the therapist, and the evaluation of the psychiatrist. The results are: (1) Relational trauma: the relationship between the client and his mother was the origin of the relational trauma. The client depended on his mother over a long period of time which caused the internal relational cage. Thus, the relational cage induced the client to the development of the social anxiety and interpersonal alienation. (2) Client's relational model and impasse: the client replayed the old relational model during the counseling process, including pleasing others and inducing the negative evaluations from the people. (3) Falling into client's old interpersonal model: the therapist (acted/re-acted) as the important other of the client, so the therapist felt (his/her) struggles and incapability. Through self- awareness and adjustment, the therapist overcame the impasse and helped the client to create the new relational experience. (4) Reborn: the therapist noticed the client gradually departed from the relational cage and was able to act on his own, and find his way. Finally, the researcheres believe that relational approach psychotherapy is helpful for understanding the relational model of the client, and facilitates the development of new relational experiences of the client. Therefore, the client will be able to deal with the relational impasse caused by relational trauma.