如何運用「治療同盟破裂化解模式」：個案報告

How to Apply “Rupture-Resolution-Model”: A Case Report

背景：在本個案報告中，一位26歲的未婚男性於四年前出現了社交畏懼症症狀，其症狀始於和他交往中的女性突然變心後。在長期治療的過程中，案主逐漸向該女性治療師敞開其內心，而克服了無法與任何人接觸的恐懼。治療同盟固然穩固，但治療師卻日益意識到治療關係中存在著問題。隨著時間的推移，治療師身為自案主受到打擊後第一位接受他的女性，愈發感覺到案主的過度依賴。介入：在治療師和案主明確談論界線議題後，案主主觀上經歷了治療師的「拒絕」，並以逃避的方式回應。本文以Safran & Muran（2000）提出的五階段「治療同盟破裂化解模式」闡明如何有效運用「後設溝通」。結果：治療師有效地將治療同盟中的危機轉化為新的契機。結論：「治療同盟破裂化解模式」提供一個有用的視角，可應用於任何治療同盟出現危機的時刻。期待本個案報告對於在治療關係中面臨瓶頸的治療師有所助益。

Background: This case study presents a 26-year-old single male who began experiencing symptoms of social phobia 4 years ago, following a sudden“change-of-heart” by a female with whom a brief romantic relationship took place. Over the course of the long-term therapy, the client gradually overcame his fears of associating with anyone by slowly allowing himself to process about his inner thoughts and feelings with the female therapist. While the therapeutic alliance may be characterized as well-established, the therapist became increasingly aware of the problematic nature of the alliance. Over time, the client appeared to be progressively more dependent on the therapist-- the first female who seemed to accept him since his heart was broken. Intervention: The therapeutic task of discussing the boundary issues led to a rupture in therapeutic alliance: The client subjectively experienced rejection by the therapist and responded with withdrawal. The case study illustrates the resolution of the alliance rupture via metacommunication, based on the 5-stage Rupture-Resolution-Model proposed by Safran and Muran (2000). Outcome: The rupture in therapeutic alliance was successfully resolved. Conclusion: The clinical utility of the resolution model requires further examination, however, the present case report offers preliminary support for its use in the resolution of therapeutic alliance ruptures. Treatment recommendations are provided.