運用敍事治療於一位憂鬱症患者之護理經驗

本文以一位女性憂鬱症（Major Depression）住院病患為個案，護理期間為89年11月21日至90年2月11日，以敍事治療之外化、解構和重寫故事的觀點，來處理其未獲解決的哀傷所導致的自傷及無望感。在治療過程中，利用外化的會談，讓個案看見離婚是「事件」，與人的能力無關，學習自我接納後，而減少對離婚的自責與失落；藉著解構式的問句，引導其找出故事中的例外，經由正向經驗的敍說，體驗到自己能掌握及有能力的部分。最後，個案找到的希望是決定與女病友同住，積極和清潔工作的老闆聯繫，為出院作準，重新撰寫生命的故事。筆者運用敍事治療來協助個案療傷，讓個案從自我傷害和無望，進步到建設性地安排將來的生活，此護理過程著實帶給個案與筆者豐富的成長。

The purpose of this case study was to make use of narrative therapy, consisting of externalization, deconstruction and re-authoring the story, to nurse a female major depression patient to deal with self-harm and hopelessness caused by unsolved grieve. The period of nursing care was from November 21st, 2000 to February 11, 2001. Conversation externalization helped this client understand that divorce was an event unrelated to personal competence and then encouraged her to learn to accept herself in order to reduce her self-blame stemming from the divorce. Using deconstruction questions guided this client to find more positive life experiences and to get more confidence in regaining control of things. In the end, this client could make discharge plans to live with another female client and to contact her former employer to find a job. The author used narrative therapy to assist this client in dealing with her losses and arranging her future life constructively without self-harm and hopelessness. This also helped the author to obtain valuable experiences.