心理治療者面對自殺個案的反應：以一位新手的經驗為例

Abstract

本研究旨在呈現新手心理治療者第一次治療自殺個案之經驗及分析其內涵。本研究以深度訪談，搜集乙位新手心理治療者治療自殺個案九個月期間之經驗（個案有自殺史，在治療前期有「自殺企圖」，而後持續至少數個月有「自殺意念」），再以敘事研究法的「整體—內容」及「類別—內容」兩種模式分析之。主要研究結果如下：\n\n一、個案在治療前期之自殺企圖，引發新手心理治療者的驚慌失措。其核心內涵為「死亡」與「責任」。\n二、個案之慢性自殺意念，引發新手心理治療者的「反移情恨意」。\n三、治療前期因為對個案不了解，新手心理治療者易以自己的價值觀來負面評價個案的自殺決定，且想阻止個案自殺。\n四、治療後期隨著對個案的了解及對角色之釐清，新手心理治療者較能看到個案的痛苦，開始心理治療工作。\n五、時間影響新手心理治療者面對自殺個案之經驗歷程。\n\n 末對研究結果提出討論，並對心理治療者建議如下：\n一、思考自己的死亡觀與自殺觀，有助減緩治療前期面對自殺個案之驚慌，遵守「價值中立」之倫理原則。\n二、思考自己對於自殺個案的治療觀，有助減緩治療前期面對自殺個案之失措，遵守以「當事人福祉」為首要之倫理原則。\n三、了解心理治療者面對個案慢性自殺意念可能萌生之「反移情恨意」，有助覺察與處理，避免行動化。

This research aims to present and analyze a junior psychotherapist’s nine (9) –month experience in treating a suicidal patient (who has attempted to suicide before the treatment, attempted to suicide in the initial stage of the treatment, and having long term suicidal ideation thereafter). This research is conducted by narrative analysis method, and the main findings of which are as follows:\n\n1.The junior psychotherapist experienced panic in emotion, and uncertainty in response, when facing the patient’s suicide attempt in the initial stage of the treatment. The core triggers of such experience are “death” and “responsibility.”\n2.The junior psychotherapist experienced “countertransference hate” when facing the patient’s long term suicidal ideation.\n3.In the initial stage of the treatment when the junior psychotherapist knew little about the patient, the psychotherapist may view the patient’s decision to suicide from his own values, as opposed to the patient’s, and may readily take it negatively.\n4.When the junior psychotherapist got time to know the patient, and got time to clarify his role responsibilities as a psychotherapist, he got to see the patient’s suffering behind the suicidal ideation, and then psychotherapy began.\n5.Time is of essence in transforming the junior psychotherapist’s experience.\n\n At the end, the researcher suggests psychotherapists to think through how they value suicide and death, and to think through how they treat suicidal patients, so as not to take unethical actions upon suicidal patients especially during the initial stage of the treatment. The researcher also suggests psychotherapists understand the countertransference hate which may easily be aroused by the patient’s long term suicidal ideation, so as to help awareness and avoid acting out.