臨床心理學於安寧緩和場域之反思踐行

Reflective Praxis of Clinical Psychology in Palliative and Hospice Care

患者進入疾病末期階段，經歷生理、心理、社會人際與靈性等層面的陌生斷裂，臨床心理學的知識與實踐，可以如何協助他們回到熟悉感，是探討焦點議題。本文認為安寧緩和照護中，於身體照顧、症狀控制外，亦需強調結合心理社會靈性之照護系統，以提供患者與家屬整體性照護。本文透過文獻回顧法，整合研究與臨床心理服務現況，進而透過「生物心理社會靈性」模式，理解此模式對「末期患者」與「家屬」的需求與處境，對應至可能的心理介入方向。之後，經由反思實踐，提出臨床心理學在緩和醫療或末期照護上的貢獻，在於知識與實踐的合一，協助患者與家屬從「有」到「是」的過程。知識作為「有」的相關物（如自然或人為知識），這是作為理解實踐活動（praxis）的擁有本質。緩和醫療臨床心理服務將知識轉化為「是」，以揭示人自身的本質時，就是一種從理論到實踐的轉換；Heidegger提到「朝死而生」的此在（Dasein）在此現場開展。本文指出臺灣在緩和醫療場域，無論是壓力模式或存有取向，各有特色，但都是奠基於現場實踐成果。如此呈現多元概念與方法特性，回到臨床變動的實踐性，提升安寧緩和醫療與照護品質。最後，進而提出未來可延伸思考的方向。

When patients' conditions become terminal, they often experience a sense of unfamiliarity and alienations at the physiological, psychological, interpersonal, and spiritual levels. Therefore, applying the knowledge and practice of clinical psychology to help them in returning to daily life as possible is a key issue. This article posits that in addition to physical treatment and symptoms control, there is a need for the palliative and hospice care system to emphasize the integration of the psychological, social, and spiritual aspects of the situation, thereby providing holistic care for patients and their family caregivers. A literature review was conducted to present the current status of research and clinical psychological services and to reflect the ''biopsychosocial-spiritual'' model. This model was then used to understand the needs and situations of ''terminal patients'' and their ''family caretakers,'' on which based-empirical studies of holistic clinical psychological interventions are proposed. Subsequently, a reflective critique was employed, proposing that the contributions of clinical psychology to palliative medicine or terminal care are based on the integration of knowledge and praxis through a process of assisting patients and their family members to transition from ''having'' to ''being.'' Knowledge as related objects (such as natural or artificial) is the essence of understanding practical activities (praxis). Hence, the process of converting ''knowledge'' to ''being'' is to disclose Dasein, the existence of human beings thrown into ''being toward death''. This article points out that palliative and hospice care in Taiwan, whether its focus on the stress model or existential approach, based on the outcomes of on-site clinical practice, showing the characteristics of multiple concepts and methods in order to enhance the quality of care. It is the subject act of knowledge as praxis, and theory and practice is not binary, clinical psychology knowledge is the embodiment praxis of palliative care, based on which future issues and suggestions are discussed.