婚姻治療改變歷程之研究：以情感性疾患夫妻為例

A Qualitative Investigation of the Change Process in Couple Therapy: The Case Analysis of an Affective Disorder Couple

10.7082/CARGC.200503.0069

梁淑娟(Shu-Chuan Liang)；趙淑珠(Shu-Chu Chao)

改變機制 ； 婚姻治療 ； 歷程研究 ； mechanism of change ； couple therapy ； process of change

中華輔導學報

17期（2005 / 03 / 01）

69 - 103

繁體中文

本研究係以一個歷經十九次婚姻治療之情感性疾患夫妻為研究參與者，於婚姻治療結束後採質性深度訪談，進行婚姻治療改變歷程之研究。旨在瞭解案家夫妻於婚姻治療中的知覺經驗、改變的療效因子與反療效因子，以及改變的機制與歷程。研究發現來自案家夫妻對治療的動機與承諾，以及治療的同盟關係等前置條件因素是改變的首要條件。治療室內的系統性療效因子則包括雙人組的家庭作業、反映關係位置、反映行爲互動模式、理解與認可雙方的感受、劃清次系統間的界限等。同時，研究並發現治療室外也有重要的影響因子存在；再者，研究也展現了系統改變的循環機制。本研究最後根據研究結果提出婚姻治療實務工作上與未來相關研究在方法論與議題上的建議，同時也以身兼治療師之角色提出對治療過程的反思。

Using a qualitative approach, the purpose of his study was to explore the process of couple therapy. The participants in this study were an affective disorder couple accepting couple therapy for 19 sessions. After the therapy, the couple were interviewed to understand their perceptions of the therapy, the therapeutic and the nontherapeutic elements, and the mechanism of change. The results were as follows: (1) the couple's motivation and commitment to therapy and the therapeutic alliance were the important therapeutic preconditions; (2) the systematiclly therapeutic elements of change included prescribing a dyadic homework, reflecting the relational position, reflecting the interaction pattern, understanding and validating the couple's feelings, and marking the subsystem boundaries. There were between-sessions factors. Basing on the findings, implications for couple therapy, and discussions and suggests for future studies were made.

1. 黃囇莉(2001)。身心違常:女性自我在父權結構網中的 「迷途」。本土心理學研究，15，3-26。
   連結：
2. 董秀珠、林萬億(2003)。「夫妻對偶互動關係研究」學術研討會。台北:中央研究院中山人文社會科學研究所。
   連結：
3. Alexander, J. F.,Holtzworth-Munroe A.,James, P.(1993).Handbook of psychotherapy and behavior change.New York:Wiley.
4. Baucom, D. H.,Shoham, V.,Mueser, K. T,Daiuto, A. D.,Stickle, T. R.(1998).Empirically supported couple and family interventions for marital distress and adult mental health problems.Journal of Consulting and Clinical of Psychology,66,53-88.
5. Bischoff, R. J.,Mcbride, A.(1996).Client perceptions of couples and family therapy.American Journal of Family Therapy,24,117-128.
6. Christensen, L. L.,Russell, C. S.,Miller, R. B.,Peterson, C. M.(1998).The process of change in couples therapy : A qualitative investigation.Journal of Marital and Family Therapy,24,177-188.
7. Gaul, R.,Smith, I.,Friedlander, M. I.,Heatherington, L.,Cutler, C.(1991).Correspondence of family therapists perceptions with the FRCCCS for triadic interactions.Journal of Marital and Family Therapy,17,374-379.
8. Greenberg, L. S.,Ford C. L.Alden, L. S.,Johnson, S. M.(1993).In-session change in emotionally focused therapy.Journal of Consulting and Clinical of Psychology,61,79-84.
9. Greenberg, L. S.,James, P. S.,Cory, R.(1988).Perceived change process in emotionally focused couple therapy.Journal of Family Psychology,2(1),5-23.
10. Greenberg, L.,Pinsof, W.(1986).The psychotherapeutic process : a research handbook.New York:Guilford.
11. Gurman, A. S.,Kniskem D. P.,Pinsof, W. M.(1986).Handbook of psychotherapy and behavior change.New York:Wiley.
12. Heatherington, L.,Friedlander, M. L.(1990).Couple and family alliance scales:Empirical considerations.Journal of Marital and Family Therapy,16,299-306.
13. Heiman, J.,Epps, P. H.,Ellis, B.(1995).Clinical handbook of couple therapy.New York:Guilford.
14. Helmeke, K. B.,Sprenkle, D. H.(2000).Clients' perceptions of pivotal moments in a qualitative study of change in therapy.Journal of Marital and Family Therapy,4,469-483.
15. Hill,C. E.,Thompson, B. J.,Cogar, M. C.,Denman, D. W.(1993).Beneath the surface of long term therapy : Therapist and client reports of their own and each other's covert process.Journal of Counselling Psychology,40,278-287.
16. Holtzworth-Munroe, A. Jacobson, N. S.,DeKlyen, M.,Whishman, M. A.(1989).Journal of Consulting and Clinical Psychology.
17. Huber, C. H.,Milstein, B.(1985).Cognitive restructuring and a collaborative set in couples'work.American Journal of Family Therapy,13,17-27.
18. Johnson S. M.,William-Keeler, L.(1998).Creating healing relationships for couples dealing with trauma : the use of emotionally focused couple therapy.Journal of Marital and Family Therapy,24,25-40.
19. Johnson,S. M.,Greenberg, L.S.(1988).Relating process to outcome in marital therapy.Journal of Marital and Family Therapy,14,175-183.
20. Johnson.S. M.,Hunsley, J.,Greenberg, L.,Schindler, D.(1999).Emotionally focused couples therapy: status and challenges.Clinical Psychology : Science and Practice,6,67-79.
21. Kuehl, B. P.,Newfield, N. A.,Joanning, H.(1990).A client-based description of family therapy.Journal of Family Therapy,3,310-321.
22. Lebow, J. L.,Gunman, A. S.(1995).Research assessing couple and family therapy.Annual Review of Psychology,46,27.
23. Lee, B.,Marshell, F.(2000).Client perceptions of couples therapy: helpful and unhelpful aspects.American Journal of Family Therapy,28,295-311.
24. Moon, S. M.,Dillon, D. R.,Sprenkle, D. H.(1990).Family therapy and qualitative research.Journal of Marital and Family Therapy,16,357-373.
25. Olson, M.M.(2001)..
26. Pinsof, W. M.(1988).The state of the art in the family therapy research: Controversies and recommendation.New York:Family Process Press.
27. Pinsof, W. M.(1981).Handbook of family therapy.New York:Brunner/Mazel.
28. Pinsof, W. M.(1989).A conceptual framework and methodological criteria for family therapy process research.Journal of Consulting and Clinical of Psychology,57,53-59.
29. Pinsof, W. M.,Wynne, L. C.(1995).The efficacy o f marital and family therapy:An empirical overview, conclusions, and recommendations.Journal of Marital and Family Therapy,21,585.
30. Prince, S. E.,Jacobson, N. S.(1995).A review and evaluation of marital and family therapies for affective disorders.Journal of Marital and Family Therapy,21,377-401.
31. Schutz, A.(1962).Collected paper (1-3): The problem of reality.The Hague:Martinus Nijhoff.
32. Sells S. P.,Smith, T. E.,Coe, M. J.,Yoshioka, ,M.,Robbins, J.(1994).An ethnography of couple and therapist experiences in reflecting team practice.Journal of Marital and Family Therapy,20,247.
33. Sells S.P.,Smith, T. E.,Moon, S.(1996).An ethnography study of client and therapist perception of therapy effectiveness in an university-based training clinic.Journal of Marital and Family Therapy,22,321.
34. Smith, J. C.,Brown, R. A.(1994).Ingredients of successful marital therapy. A survey of therapists' views.Family Journal,2(4),317-330.
35. Smith, T. E.,Sells, S. P.,Clevenger, T.(1994).Ethnographic content analysis of couple and therapist perceptions in a reflecting team setting.Journal of Marital and Family Therapy,20,267-286.
36. Walker, L. G,Patten, M. I.(1990).Marriage Guidance Counseling: II .What counselor want to give?.British Journal of Guidance and Counseling,18(3),294-307.
37. Wark, L.(1994).Therapeutic change in couples' therapy: Critical change incidents perceived by therapist and client.Contemporary Family Therapy,16,39-52.
38. 王慧玲、連雅慧譯(2002)。家族治療的理論與方法。台北:洪葉文化事業有限公司。
39. 高淑芬、陳珠璋、張達(1990)。結構式家族治療個案報告。中華精神醫學，1(4)，63-72。
40. 張秀桃(1992)。一個出現解離症狀婦女的婚姻治療。杜區發展季刊，60，75-78。
41. 楊連謙(2003)。「夫妻對偶互動關係研究」學術研討會。台北:中央研究院中山人文社會科學研究所。
42. 楊連謙(2000)。婚姻治療中賦權使能的歷程:病態嫉妒個案的經驗。應用心理研究，5，213-250。
43. 賈紅鶯(2000)。。
44. 熊秉荃、李朝雄、蕭淑貞(1993)。躁鬱病患者的家族治療:個案報告。中華精神醫學，3(7)，184-190。