哀悼與重生：地震後失去手足兒童的遊戲治療

九二一集集大地震導致一些災區居民呈現出不同程度的創傷後壓力反應，此反應包括創傷事件的再度體驗，持續逃避與創傷事件有關的刺激，以及持續警覺度增加的反應。本文報告一例因地震失去手足的七歲四個月兒童，產生中等程度的創傷後壓力反應，治療師以案主中心治療取向，對該兒童進行遊戲治療。遊戲治療為期十二個月，共19次。治療過程依改變方向分為三個階段：釋放壓抑情緒，對案姊的懷念與祝福，及積極自我的成長。文中將三階段的主題，代表性對話，及治療師所扮演的角色與使用技巧加以說明。並從不同的理論觀點，探討案主改變的機制及處理此類個案之建議。

Posttraumatic stress reaction (PTSR) is characterized by reexperiencing, avoidance and hyperarousal when people confront with huge disaster, like 921 Chi-Chi earthquake. Children are found to be affected in attention, emotion, social interest and other development. This report presents a child who lose his elder sister after the big earthquake and revealed some symptoms of PTSR. The author used a client-centered oriented play therapy for this 7-year-4-month boy in 12 months period total of 19 sessions. Based on the major changes across the 19 sessions, the process can be divided into 3 phases, namely uncovering avoidant emotion, expressing repressed remembering and praying, and active self growth. The formulation of this case and management were discussed. The author also provided some suggestions for dealing such case in the future.