一位輕症自閉症女性成人的同理心經驗與觀點

The Experience and Perspective of Empathy: Study of a High-Functioning Female Adult with Autism Spectrum Disorder

研究目的：過去認為自閉症類群障礙症（簡稱ASD）患者欠缺同理心。近期學者及實務工作者則質疑此論點，認為患者是有困難同理他人，而非缺乏同理心。然而，少有研究對此進行探討，本研究目的為了解輕症自閉症（簡稱HFASD）女性成人的同理心經驗與觀點。研究方法：採質性研究法。於2013年4月至12月間，針對一位21歲的HFASD女性成人進行4次個別訪談與5次同理心焦點團體（含4位HFASD成人、研究者與一位心理師）。研究者與研究參與者在過程中不斷反思與回饋，以充分理解參與者的經驗與觀點，資料處理包括謄寫逐字稿、形成文本、分析與總結。研究結果：1.對同理心的理解：同理心是根據自身過去經驗與網路資訊建置邏輯資料庫，來理解他人面對事情的情緒反應，尋找雙方認同之解答的歷程。2.同理困境：缺乏意願、獨特思考方式、感覺遲鈍混沌、不知如何正確回應。3.影響同理因子，包括（1）有利因子：對方為熟人、對方情緒明顯、與對方有類似經驗、教導社會接受的同理方式。（2）不利因子：資料不足、對方情緒平淡或複雜、欠缺與對方類似的經驗、互動對象超過兩人。研究結論：對HFASD成人而言，1.對同理心的認定著重認知同理，而較少情緒同理；2.認知同理受患者獨特的思考方式影響；3.情緒同理受多重因素影響，如：知覺感受的缺損、同理意願、及類似經驗等；4.同理表現的關鍵在於意願；5.同理是一資料處理歷程；6.知覺同理或反應同理的機制不同於一般人。

Purpose: Individuals with autism spectrum disorder (ASD) are often perceived as lacking empathy. Recently some researchers and practitioners have questioned this stereotype and argued that despite their difficulty empathizing with others, individuals with ASD do not lack empathy. However, few studies have been conducted to address this issue. This study explores the empathy experiences and perspective of a high-functioning female adult with ASD (HFASD). Methods: From April to December 2013, using a qualitative approach we conducted 4 individual in-depth interviews and 5 focus group interviews to explore the empathy experiences of a 21 year-old female with HFASD. In the focus group there were 4 HFASD adults (1 female, 3 males), the researcher (as group facilitator), and a clinical psychologist (as co-facilitator). After each individual and group session, the researcher and the participant wrote down their reflections and feedback about the session until the HFASD female’s empathy experiences could be comprehensively understood. Data analysis included verbatim transcription, organizing text, text analysis, and visual presentation of integrated data. Results: The HFASD female’s experiences about and perspective of empathy were as follows: (1) Her understanding of empathy: Empathy is a process of understanding the rationale behind other people’s emotional reactions and finding the solutions that are mutually recognized. And this process is learned through cumulatively collecting data from past experience of interpersonal interactions and internet information to establish many logical databases for her own use. (2) Her difficulty empathizing with others: Included her lack of willingness, idiosyncratic thinking, delayed or confused perception of emotion, and not knowing how to respond appropriately. (3) Factors that influenced her empathetic performance included (a) facilitating factors: familiarity with the person with whom she needed to empathize, salience of the other’s emotions, similarity of past experience, receiving instructions about adequate empathic reactions; and (b) hindering factors: insufficient information, blunt affect, complicated emotions, lack of similar experience, interacting with more than 2 people at the same time. Conclusion: (1) The HFASD female adult depends more on cognitive empathy than emotional empathy. (2) Cognitive empathy is affected by the ASD person’s idiosyncratic way of thinking. (3) Emotional empathy may be affected by multiple factors, such as deficient emotional perception, willingness, similarity of experiences, etc. (4) Willingness plays an important role in the empathetic performance of ASD adults. (5) Empathy involves data-processing, which is different from processing emerging experiences. (6) There are differences in mechanism of perceiving empathy or reacting empathetically between HFASD adults and neurotypical adults.