短期心理治療過程評估

Process Analysis of Brief Dynamic Psychotherpy

本研究以Hill等人（1981）所發展的「輔導員語言類別反應系統」及「個案語言類別反應系統」為研究工具，一共研究了四個個案，其中兩個個案（個案1與2）完成了全部12次之治療，另兩個個案（個案3與4）在治療3次後便中斷；其結果計有：(1)以治療持續完成及中斷的向度來看，個案3及個案4比個案1及個案2出現較多的「請求」及「治療關係探索」的語言反應，而治療者處理個案3及個案4比處理個案1及個案2時，顯著地出現較多的「鼓勵」、「讚許－保證」、「消息」及「解釋」的語言反應。(2)個案1與個案2隨著治療的進行，「簡單反應」均顯著地下降，而「體驗」反應顯著地增加。(3)治療者處理個案1及個案2時，在前四次階段以「封閉式問句」、「開放式問句」及「直接指導」的語言反應較多；在中四次階段則以「消息」、「開放式問句」、或「解釋」的語言反應較多；在後四次的階段，「消息」、「讚許－保證」、「鼓勵」及「情緒反應」的語言反應增加。(4)由次序性的分析結果可知，處理個案1與個案2時，治療者的「封閉式問句」反應與個案的「簡單反應」之聯結最多，引發個案的「描述」反應，以治療者的「開放式問句」、「封閉式問句」及「重述」反應居多，個案的「體驗」反應則與治療者的「開放式問句」、「重述」及「封閉式問句」的聯結居多。(5)經過十二次的晤談，個案1及2的病情均有顯著的改善。

Using the ''Counselor Verbal Response System'' and ''Client Verbal Response System'' developed by Hill, et al (1981), we studied four clients. Two clients completed the full 12 sessions while 2 dropped out after the third session. Several findings were: (1) The two dropped-out cases (case 3 and 4) showed significantly more ''request'' and ''discussion of client-counselor relationship'' responses while the counselor showed significantly more ''minimal encourage'', ''approval-reassurance'', ''information'' and ''interpretation'' responses than the 2 clients who completed treatment. (2) The two clients who completed treatment showed increased ''experiencing'' and decreased ''simple responses'' as treatment progressed. (3) In the first four sessions, the counselor used more ''closed questions'', ''open questions'' and ''direct guidance''. In the middle sessions, the counselor utilized more ''information'', ''open questions'' and ''interpretation'' responses. In the last four sessions, the counselor invoked more ''information'', ''minimal encourage'', ''approval-reassurance'' and ''reflection'' responses. (4) A sequential analysis of the completed cases reveals that most frequently the counselor's ''closed questions'' elicited a ''simple response'' from the clients. Whereas, counselor's ''open questions'', ''closed questions'' and ''restatement'' commonly elicited ''description'' or ''experiencing'' responses from the clients. (5) When therapy completed, clients improved their symptoms.