住院藥癮患者團體心理治療之互動現象

Interactions among Drug-addicted Inpatients during Group Psychotherapy

目的：基於反毒運動及戒毒工作近年在國內如火如荼地進行，本研究乃進行為期兩年、之住院藥癮患者團體心理治療，以瞭解其團體互動現象中，是否具有某種特定之社會文化特徵。方法：自民國79年3月起至81年3月兩年間分別在高雄市立凱旋醫院藥癮戒治病房內就戒斷症狀緩解後之患者依診斷不同，分為含海洛因、安非他命、速賜康及強力膠成癮之144名異質性及僅安非他命成癮之117名同質性兩團體進行每週兩次，每次90分鐘，開放自由參加之半結構式，強調此時此地議題討論，任務導向及現實為基礎之治療團體。結果：分析歸納其社會文化特徵如下：(1)異質性團體中主動成員傾向接近治療者，同質性成員則較認同及接近協同治療。(2)兩個團體討論時所呈現的主題多與成員實際之生活經驗相關。(3)異質性團體成員因較多具有司法問題，在團體中傾向直接向治療者互動，較防衛有敵意；而同質性團體較多透過治療者與其他成員互動、分享，希望博取治療者之支持及肯定。(4)出席率方面，因受症狀影響使同質組有較低之出席率。結論：除罪化，嚴格篩選個案，防止治療者與協同治療者間之競爭，應可改善治療之過程及結果。建議在病房中嘗試進行自治團體的演練，以做為日後患者回歸社區後成立自助團體之雛型。而在更嚴謹之研究設計下，同質性團體分治療及對照組比較分析，且採多家機構之聯合研究計劃，可再次驗證此社會文化特徵之穩定與否。

Objective: This study investigated the sociocultural implications of group interactions of drug-addicted inpatients during two-year group psychotherapy. Methods: In a psychiatric ward especially designed to promote abstinence, all drug addicts were encouraged to participate in semi-structured, here-and-now focusing, task-oriented and reality-based group psychotherapy sessions. A heterogeneous group of 144 opiate, pentazocine, amphetamine and glue addicts received group psychotherapy from May 1990 to May 1991. and another homogeneous group composed of 117 amphetamine addicts received group psychotherapy from June 1991 to May 1992. Each treatment was conducted in an inpatient setting arid consisted of 72 twice weekly 90-minute open sessions. Results: Analysis of group interactions among inpatients revealed that active members sat closer to the therapist in the heterogeneous group; on the contrary, active members sat closer to the cotherapist in the homogeneous group. Because of more forensic issues in the heterogeneous group, members tended to show more hostile interactions toward the therapist and defensive relationship with others; whereas in the homogeneous group, members tended to show the interaction pattern of need for more support and approval through the therapist and experience sharing relationship with others. The main topics presented by the members were compatible with the actual life experiences in both groups. Attendance rates were lower in the homogeneous group due to the disturbing effects of psychotic symptoms. Conclusion: The findings of this study suggest that it would be possible to improve the effectiveness and outcomes of group psychotherapy for drug addicts through decriminalization of drug use, and careful screening of patients and by taking measures to prevent competition between the therapist and cotherapist during psychotherapy. We also suggest that implementation of a ward recovery group model followed by community self help after discharge may be the most effective management for drug addicted inpatients. (Full Text in Chinese)