自殺關懷訪視員服務重複自殺企圖者首期服務歷程所遇抗拒與介入初探

A Preliminary Study of the Resistance Encountering and Intervening between Suicide Prevention Case Managers and Re-suicide Attempter during the First Period Outreaching Service

本研究主要是了解自殺關懷訪視員服務重複自殺企圖者於首次三個月服務期間，經驗之抗拒行為及關懷員所採介入，訪談六位關懷員，研究發現如下：個案抗拒原因有不信任、需求不適配兩大類。個案抗拒行為之類別有婉拒、直接拒絕、避離和怒拒四大類。面對個案之抗拒行為，自殺關懷訪視員之介入包含認知、情緒、行動三大類，認知部分，有理解抗拒行為表徵意義一大類，行動部分有建立關係和評估高危險並進、積極－不放棄建立連結、維持自主三大類。其中，個案之抗拒原因與行為具文化色彩，自殺關懷訪視員之行動介入積極－不放棄建立連結之行動積極且多元，共十一次類，亦多具本土色彩。惟同理支持的介入囿限於個案的自我揭露而有其困難，抗拒經久仍不易鬆動，自殺關懷訪視員雖以維持自主為基本介入，但常經歷負向情緒。根據以上發現對自殺關懷訪視員之教育訓練、督導實務、自殺防治研究提出建議。

The purpose of this study is to understand the resistance and intervention between suicide prevention case managers and re-suicide attempt clients during the first period lasting three months. This research uses qualitative research methodology which uses in depth interviews, which involves 6 suicide prevention case managers to share their practical working experience. The findings are as follows, there are two types of resistance reasons: distrust and unsatisfied need; four types of resistance behaviors: Euphemistic rejection, straightforward rejection, escape from meeting, and rejection angrily. The intervention includes three categories: cognitive, emotional and behavioral classification. For cognitive category, it includes understanding the meaning of resistance behavior. For behavioral category, it contains 3 subcategories: establishing relationship while assessing the risk of suicide, being active building related relationship with client, and keeping client being independent. It presents locally cultural characteristics in the resistance reasons, behaviors of clients. There are 11 subcategories of being active actions in the intervention, and it also presents locally cultural characteristics. Case managers have difficult to keep empathy with clients because of being limited by the quantities of content of client's self-disclosure. All case managers keep clients being independent on their own while client's resistances are hard to break and lasting, case managers experience negative emotions. According to the findings, suggestions are made to serve as future researches, regarding the training of case managers, and the practical supervision in suicide prevention.