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研究生: 謝珮玲
Pey-Ling Shieh
論文名稱: 心理治療師在心理治療歷程之反移情經驗研究
A Study on a Psychotherapist’s Countertransference during the Process of Psychotherapy
指導教授: 王麗斐
Wang, Li-Fei
學位類別: 博士
Doctor
系所名稱: 教育心理與輔導學系
Department of Educational Psychology and Counseling
論文出版年: 2003
畢業學年度: 91
語文別: 中文
論文頁數: 139
中文關鍵詞: 反移情心理治療歷程現象學
英文關鍵詞: countertransference, process of psychotherapy, phenomenology
論文種類: 學術論文
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  • 本研究跟隨一名心理治療師的治療歷程,以現象學取向藉由每次治療後30小時內的訪談,與結案後回顧療程的訪談,探索其在十次治療中的反移情經驗。研究焦點涵括反移情經驗的背景因素、內涵以及轉變,並以提取自訪談資料的架構進行分析。
    研究結果共整理出22個反移情經驗,與背景因素對照下,受訪者對特定案主之反移情經驗,比其對反移情之界定與既有經驗更多樣化且具有雙面的意涵。反移情經驗的相關因素同時包括治療師之固定背景與治療師--案主互動之獨特成份,可依經驗性質區分為「對個案的感受或觀點」、「治療師與治療的角色及地位」、「治療關係與治療維繫」、「分心與聯想」四個主軸。
    「對個案的感受或觀點」在療程中佔最多數,治療師對案主有多樣的感受,其中部分感受會進一步產生對案主的觀點。「治療師及治療的角色與地位」主軸的反移情出現情形居次,治療師在其中的經驗環繞著「治療師究竟是什麼角色」與「治療的地位是什麼」兩個問題,被利用、不被尊重的感受強度可能會影響治療的維繫。在「治療關係與治療維繫」主軸中,治療師對關係的評估直接關乎治療維繫。「分心與聯想」的反移情經驗在本研究出現最少,治療師在其中經歷到隨案主的描述,而有不同聯想內容與認同立場的經驗。
    在經驗轉變的整體趨勢方面,隨著治療的進展,受訪者對個案由不熟悉到熟悉,了解個案之依據由自己的刻板印象和經驗架構,轉變為依據個案故事的特異性。注意焦點由分心於自身議題而專注在「對個案的情緒」、「突兀的反應」和「故事」上。假設驗證的主題由「個案故事與治療師經驗是否一致」,轉為驗證「個案故事內的一致性」、「個案故事與假設的一致性」。在治療之間較細微的轉變上,反移情經驗的轉變是起起伏伏、來來回回的過程,四個反移情經驗主軸出現在療程初期,與其他經驗有著延續與互為因果的關係。
    依據反移情經驗在療程中展現多樣性質,以及由多重因素共同形成與影響其發展狀況的發現,本研究提出在實務訓練與未來研究上的的努力方向。
    關鍵詞:反移情、治療歷程、現象學

    A Study on a Psychotherapist’s Countertransference during the Process of Psychotherapy
    Pey-Ling Shieh
    Abstract
    The purpose of this study is to explore the countertransference during an ongoing process of psychotherapy. The study is conducted by the phenomenology approach. As a ten-session psychotherapy progressed, the psychotherapist was interviewed within 30 hours after each session. The data were analyzed by a framework retrieved from the data itself. The contextual factors, natures and transformation of the countertransference were all described.
    The result yielded 22 units of countertransference experience. When compared with contextual factors, the psychotherapist’s countertransference to the specific client was found to have dual implications and to be more various than her original definition of and previous experiences of countertransference. The related factors of countertransference consisted of the fixed background of the therapist as well as the unique portion of the therapist-client interaction. The four domains of countertransference were classified as ‘feelings or cognitions toward the client’, ‘the role and position of the therapist and psychotherapy’, ’relationship and therapy maintenance’ and ‘distraction with associations’.
    Most units of countertransference fall into the category of ‘Feelings or cognitions toward the client’. The therapist had various feelings toward the client and some of those feeling led to cognitions about the client. ‘Role and position of the therapist and psychotherapy’ is the second most frequent category of the countertransference, which happened when the therapist wondered about ‘what is the role of a therapist’ and ’what is the position of psychotherapy’. The feeling of being used and of not being respected would contribute to the discontinuity of therapy. As for the countertransference of ’relationship and therapy maintenance’, therapist’s assessment of the relationship was directly related to the maintenance of therapy. On ‘distraction with associations’, the therapist experienced various association and identification.
    During the process of the psychotherapy, the familiarity of the therapist with the client increased. The global trend of understanding moved from stereotype-based and experience-based toward specific issues of the client. The focus of hypotheses-testing moved from ‘content consistency between client’s story and therapist’s experience’ toward ’internal consistency within client’s aspects of story’ or ’consistency between client’s story and hypotheses’. The transformation between sessions fluctuated and was recurrent. All four domains occurred at the initial stage and were intertwined with each other throughout the psychotherapy. process.
    Given the findings that the countertransference displayed various natures and was formed by multiple factors, the author suggests some directions about future training and research.
    Keywords: countertransference, process of psychotherapy, phenomenology

    目 錄 致謝 中文摘要 英文摘要 目錄 表次 圖次 附錄次 第一章 緒論…………………………………….………………. 1 第一節 研究動機…………………………………………. 1 第二節 研究目的與研究問題……………………………. 4 第三節 名詞界定………………………………………….. 5 第二章 文獻探討……………………………………………….. 7 第一節 反移情的理論觀點……………………………….. 7 第二節 研究中的反移情………………………………….. 16 第三節 反移情經驗的歷程……………………………….. 26 第四節 現象學研究法…………………………………….. 32 第三章 研究方法……………………………………………….. 46 第一節 研究取向與基本精神…………………………….. 46 第二節 研究參與者……………………………………….. 48 第三節 研究工具………………………………………….. 52 第四節 研究程序………………………………………… 55 第五節 資料整理與分析…………………………………. 57 第六節 信度與效度的檢核………………………………. 63 第七節 結果撰寫…………………………………………. 65 第四章 結果……………………………………………………. 66 第一節 反移情經驗的背景因素…………………………. 66 第二節 各次治療中的反移情經驗……………………….. 76 第三節 反移情經驗的轉變……………………………….. 101 第五章 討論與建議…………………………………………….. 122 第一節 討論……………………………………………….. 122 第二節 建議………………………………………………. 128 參考文獻 ………………………………………………………….. 132 附錄 ………………………………………………………….. 138 表 次 表2-1 反移情的操作性定義整理表…………………………………. 20 表2-2 反移情研究的主題、素材與方式整理表……………………. 23 表4-1 反移情經驗的主軸與主題……………………………………. 78 表4-2 主軸一的反移情經驗:對個案的感受與觀點………………. 79 表4-3 主軸二的反移情經驗:治療師及治療的角色與地位……….. 81 表4-4 主軸三的反移情經驗:治療關係與治療維繫………………. 82 表4-5 主軸四的反移情經驗:分心與聯想…………………………. 83 表4-6 反移情經驗主軸內涵摘要……………………………………. 84 表4-7 反移情經驗相關因素類別與次數分析表……………………. 85 表4-8 反移情經驗主軸的相關因素…………………………………. 87 表4-9 反移情經驗影響類別與次數分析表…………………………. 94 表4-10 反移情經驗主軸的影響分析…………………………………. 95 表4-11 各次治療中的反移情經驗主軸………………………………. 114 表4-12 反移情經驗相關因素與背景因素之關聯表…………………. 117 圖 次 圖3-1 資料收集流程與治療歷程的關聯……………………………. 56 圗3-2 資料整理與分析步驟流程圖…………………………………. 59 圖4-1 反移情經驗的背景因素………………………………………. 75 圖4-2 反移情經驗的整體轉變趨勢…………………………………. 101 目錄次 附錄 研究說明書……………………………………………………. 138

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