一個結構－－策略家族治療改變歴程與文化意涵

The Change Process and the Embedded Cultural Meanings of a Structural-Strategic Approach Family Therapy

本研究經由觀察一個結構－策略家族治療的二十次家庭治療，探究家族治療介入的內涵及發展歷程，研究的家庭成員包括睡眠障礙、酗酒的大學生及其父親、母親及妹妹。研究者以俗民誌的微觀分析法進行分析，由此探討台灣家族治療反映的社會文化意義及文化脈絡下的家族治療介入。研究結果發現治療者運用的治療介入主要包括「融入家庭結構」、「挑戰家庭結構」、「挑戰問題的建構」、「治療關係的介入」、「策略性介入」、治療介入包括（1）協助家庭參與治療；（2）建立對治療者的信任與合作；（3）順應癥狀挑戰關係；（4）關係介入的挑戰；（5）對夫妻結構挑戰；（6）探索改變與結束等六個歷程。每個歷程包含癥狀、家庭結構與治療介入三個面向同時循環進行。本研究也發現癥狀的意義與所在的醫療文化相互建構，在醫療情境中治療者以「專家」姿態和家庭互動，同時，因著家庭對癥狀重視，治療介入也是「癥狀」與「系統」並行。在家族治療歷程中治療介入面對文化議題的衝突包括「家人一體」與劃清代間界限；對子女「關心過頭」與鼓勵自主；父母以子女問題取代「家庭」問題。因此，在文化脈絡下的家庭治療介入也特別注重：邀請父親「參與」家族治療；順應父權與尊長而挑戰家庭結構；順應親職的壓力與維持「好父母」形象。研究者由此指出家族治療應用於本土社會中的文化覺察與反省。

The purpose of this study was to discover a family therapy change process based on the structural-strategic approach. The parents with their adolescent daughter who suffered from sleeping problem and alcoholism came to a local mental hospital in Taipei for help. A family therapist provided twenty family therapy sessions to the family. Each session was one hour long and it lasted for 9 months. The entire family therapy process was video-taped, transcribed and analyzed by a research team including the researcher, the therapist and an observer, A qualitative interpretive microanalysis method was employed in data analysis procedures. The major findings were organized into three parts: the therapist's interventions, the movement of the therapy process, and the social and cultural meanings embedded in the therapy process. Categories of intervention skills were discovered including joining, challenging the family structure and the perception of family problem, developing therapeutic alliance, and employing strategic intervention skills. The movement of the therapy process was followed by helping family members join into the family, developing trusting and collaborative working relationship, accommodating the symptom and challenging the family relationship, changing the couple relationship, facilitating the change and closing the therapy. Symptom, family structure, and intervention, were interwoven in the therapy process. The social-cultural meanings embedded in the process including togetherness of the family, independence and concerning too much for each other, hierarchical family structure, preserving face, and gender issue in the family. The family therapist performed behaviors accommodated the cultural norms. These behaviors included honoring and inviting father's participation, respecting the patriarchy family system and elders in the family, and face saving. It was also found that the therapist's interventions not only aimed for changing the family system but also the adolescent patient's symptom because the family paid great attention to symptoms. The findings were discussed and the implications of the study were addressed at the end.