促進乳癌夫妻親密關係之團體工作坊方案助益性研究

A Study on Benefits of Using a Two-Day Workshop to Facilitate Intimacy of Breast Cancer Couples

李佩怡(Pei-Yi Li)；林蔚芳(Wei-Fang Lin)；李玉嬋(Yu-Chan Li)；王雪蓮(Hsueh-Lien Wang)；梁惠君(Hui-Chun Liang)

方案助益性 ； 乳癌夫妻 ； 混合研究法 ； 團體工作坊 ； 親密關係 ； benefits of group program ； breast cancer couples ； follow-up explanations model ； intimacy ； two-day workshop

中華輔導與諮商學報

45期（2016 / 04 / 01）

33 - 66

繁體中文

本研究旨在檢視乳癌夫妻親密關係團體工作坊方案之助益性。團體方案參考2008 年Sharon Manne與Hoda Badr 的「夫妻調適癌症之親密關係模式」，2010 年五對乳癌夫妻同意參與研究以13 小時團體工作坊進行，結束後進行回饋評量，兩個月後訪談。採解釋式混合研究法，以量性和質性資料探討團體方案的助益性。研究結果說明，本團體工作坊方案對促進乳癌夫妻親密關係有一定的助益。結論為：（1）本方案能增進乳癌夫妻親密關係的品質，呈現在團體後夫妻溝通時表達方式與時機的拿捏、嘗試正向肯定與讚美對方、增進彼此了解和體諒、摩擦衝突減少、自省覺察互動的疏失；（2）本方案最受成員肯定的活動是以身體互動傳遞非語言親密，及夫妻共創作品催化罹癌照顧時情緒經驗表達；（3）有助促進乳癌夫妻親密關係的團體方案著重在鼓勵罹癌和照顧經驗敘說、學習正向溝通與肯定讚美，形塑安全輕鬆的團體氣氛；（4）本團體方案僅促使成員表淺地討論乳癌夫妻性親密議題，此議題須在足夠安全信任和相互支持的團體氛圍中進行；（5）乳癌夫妻團體招募方式與活動設計，應考量性別差異，以催化男性參與動機及提升團體動力。

The aim of this study was to examine benefits of the group program to facilitate intimate relationships of breast cancer couples through a two-day workshop. The framework of the group program was based on ＂The Relationship Intimacy Model of Couple Adaptation to Cancer＂ proposed by Sharon Manne and Hoda Badr in 2008. 5 breast cancer couples agreed to participate in the 13-hour workshop after having read and signed the informed consents in 2010. Participants wrote the group feedback forms immediately after the workshop and were interviewed by researchers two months later. The follow-up explanations model was used to analyze quantitative and qualitative data. The results showed this group program had brought some benefits to facilitating breast cancer couples’ intimacy. The conclusions are as follows: (1) The group program enhanced the quality of couples’ intimacy. After the group program, couples showed improvements on their communication. Namely, to express themselves appropriately, to appreciate partners positively, to increase mutual understanding, to decrease conflicts, and to learn self-awareness and reflection on interactions. (2) Couples considered that using body language to communicate intimacy and creating artwork corporately were the most effective group activities. (3) Group programs facilitating couples’ intimacy encouraged couples to narrate their cancer experiences, learning to appreciate partners positively and to form a safe and cozy atmosphere. (4) Group programs slightly facilitated couples to talk about sexual intimacy. This subject should be conducted in a safe, trustworthy, and mutually supportive group atmosphere. (5) Group programs should consider sexual differentiation regarding recruitment and activities in order to enhance participation of men and the dynamics of the group.

1. Andersen, B. L.,Carpenter, K. M.,Yang, H. C.,Shapiro, C. L.(2007).Sexual well-being among partnered women with breast cancer recurrence.Journal of Clinical Oncology,25(21),3151-3157.
2. Andersen, B. L.,Yang, H. C.,Farrar, W. B.,Golden-Kreutz, D. M.,Emery, C. F.,Thornton, L. M.,Carson III, W. E.(2008).Psychological intervention improves survival for breast cancer patients: A randomized clinical trial.Cancer,113(12),3450-3458.
3. Anderson, W. F.,Jatoi, I.,Tse, J.,Rosenberg, P. S.(2010).Male breast cancer: A population-based comparison with female breast cancer.Journal of Clinical Oncology,28(2),232-239.
4. Andrykowski, M. A.(2012).Physical and mental health status and health behaviors in male breast cancer survivors: A national, population-based case-control study.Psycho-Oncology,21,927-934.
5. Anllo, L. M.(2000).Sexual life after breast cancer.Journal of Sex & Marital Therapy,26,241-248.
6. Beech, A. R.,Hamilton-Giachristsis, C. E.(2005).Relationship between therapeutic climate and treatment outcome in group-based sexual offender treatment programs.Sexual Abuse: A Journal of Research and Treatment,17(2),127-140.
7. Bogdan, R. C.,Biklen, S. K.(1999).Qualitative research for education: Anintroduction to theory and methods.Boston, MA:Allyn and Bacon.
8. Dorval, M.,Guay, S.,Mondor, M.,Mâsse, B.,Falardeau, M.,Robidoux, A.,Maunsell, E.(2005).Couples who get closer after breast cancer: Frequency and predictors in a prospective investigation.Journal of Clinical Oncology,23(15),3588-3596.
9. Duggleby, W.,Bally, J.,Cooper, D.,Doell, H.,Thomas, R.(2012).Engaging hope: The experiences of male spouses of women with breast cancer.Oncology Nursing Forum,39(4),400-406.
10. Farrell, E.,Borstelmann, N.,Meyer, F.,Partridge, A.,Winer, E.,Ruddy, K.(2014).Male breast cancer networking and telephone support group: A model for supporting a unique population.Psycho-Oncology,23,956-958.
11. Feldman, B. N.,Broussard, C. A.(2006).Men's adjustment to their partners' breast cancer: A dyadic coping perspective.Health & Social Work,31(2),117-127.
12. France, L.(2000).Male cancer: A qualitative study of male breast cancer.The Breast,9(6),343-348.
13. Hagedoorn, M.,Sanderman, R.,Coyne, J. C.,Bolks, H. N.,Tuinstra, J.(2008).Distress in couples coping with cancer: A meta-analysis and critical review of role and gender effects.Psychological Bulletin,134(1),1-30.
14. Hammond, L. C.(2000).West Virginia, USA,West Virginia University.
15. Henson, H. K.(2002).Breast cancer and sexuality.Sexuality and Disability,20(4),261-275.
16. Heppner, P. P.(1981).Counseling men in group.The Personnel and Guidance Journal,60(4),249-252.
17. Hodgson, J. H.,Shields, C. S.,Rousseau, S. L.(2003).Disengaging communication in later-life couples coping with breast cancer.Family, Systems and Health,21(2),145-163.
18. Hopwood, P.,Lee, A.,Shenton, A.,Baildam, A.,Brain, A.,Lalloo, F.,Howell, A.(2000).Clinical follow-up after bilateral risk reducing ( 'prophylactic' ) mastectomy-mental health and body image outcomes.Psycho-Oncology,9(6),462-472.
19. Jun, E. Y.,Kim, S.,Chang, S. B.,Oh, K.,Kang, H. S.,Kang, S. S.(2011).The effect of a sexual life reframing program on marital intimacy, body image, and sexual function among breast cancer survivors.Cancer Nursing,34(2),142-149.
20. Kalaitzi, C.,Papadopoulos, V. P.,Michas, K.,Vlasis, K.,Skandalakis, P.,Filippou, D(2007).Combined brief psychosexual intervention after mastectomy: Effects on sexuality, body image, and psychological well-being.Journal of Surgical Oncology,96(3),235-240.
21. Klaeson, K.,Sandell, K.,Berterö, C. M.(2011).To feel like an outsider: Focus group discussions regarding the influence on sexuality caused by breast cancer treatment.European Journal of Cancer Care,20,728-737.
22. L' Abate, L.(1977).Enrichment: Structural interventions with couples, families and groups.Washington, DC:University Press of America.
23. Luoma, M-L.,Hakamies-Blomqvist, L.,Blomqvist, C.,Nikander, R.,Gustavsson-Lilius, M.,Saarto, T.(2014).Experiences of breast cancer survivors participating in a tailored exercise intervention-A qualitative study.Anticancer Research,34,1193-1200.
24. Manne, S.,Badr, H.(2008).Intimacy and relationship processes in couples'psychosocial adaptation to cancer.Cancer,112(11),2541-55.
25. Manne, S.,Ostroff, J.,Rini, C.,Fox, K.,Goldstein, L.,Grana, G.(2004).The interpersonal process model of intimacy: The role of self-disclosure, partner disclosure, and partner responsiveness in interactions between breast cancer patients and their partners.Journal of Family Psychology,18(4),589-599.
26. Manne, S.,Ostroff, J.,Winkel, G.,Goldstein, L.,Fox, K.,Grana, G.(2004).Posttraumatic growth after breast cancer: Patient, partner, and couple perspectives.Psychosomatic Medicine,66(3),442-454.
27. Moreira, H.,Crespo, C.,Pereira, M.,Canavarro, M. C.(2010).Marital quality among women with breast cancer: The role of marital intimacy and quality of life.Psicooncología,7(1),61-80.
28. Naaman, S.,Radwan, K.,Johnson, S.(2009).Coping with early breast cancer: Couple adjustment processes and couple-based intervention.Psychiatry,72(4),321-345.
29. Porter, L. S.,Keefe, F. J.,Baucom, D. H.,Hurwitz, H.,Moser, B.,Patterson, E.(2009).Partnerassisted emotional disclosure for patients with gastrointestinal cancer: Results from a randomized controlled trial.Cancer,115(S18),4326-4338.
30. Schover, L. R.(1991).The impact of breast cancer on sexuality, body image, and intimate relationships.CA Cancer Journal Clinicians,41(2),112-120.
31. Sheppard, L. A.,Ely, S.(2008).Breast cancer and sexuality.The Breast Journal,14(2),176-181.
32. Shields, C. G.,Rousseau, S. J.(2004).A pilot study of an intervention for breast cancer survivors and their spouses.Family Process,43,95-107.
33. Skerrett, K.(2003).Couple dialogues with illness: Expanding the"we.".Families, Systems & Health,21(1),69-80.
34. Taylor, S.,Harley, C.,Ziegler, L.,Brown, J.,Velikova, G.(2011).Interventions for sexual problems following treatment for breast cancer: A systematic review.Breast Cancer Research Treatment,130,711-724.
35. Wai-Ming, V. M.(2002).Psychological predictors of marital adjustment in breast cancer patients.Psychology, Health & Medicine,7(1),37-51.
36. 王環莉譯、張碧琴譯、張廣運譯、陳雅英譯、鄧光雯譯、謝曜任譯、龔寧馨譯、Wheeler, G.ed.、Backman, S.ed.(2009)。親密花園：完形取向伴侶治療理論與實務。臺北:心理。
37. 朱仲謀譯、Johnson, A. P.(2006)。行動研究導論。臺北:五南。
38. 行政院衛生福利部國民健康署(2014)。民國100 年癌症登記報告。
39. 何長珠(2003)。團體諮商－心理團體的理論與實務。臺北=Taipei, Taiwan:五南=Wunan Publishing。
40. 吳明富、黃傳永(2013)。藝術園丁：失落與悲傷藝術治療。臺北=Taipei, Taiwan:張老師=Living Psychology Publishing。
41. 吳武典、洪有義、張德聰(2010)。團體輔導。臺北=Taipei, Taiwan:心理=Psychological Publishing。
42. 吳樹平(1986)。臺北=Taipei, Taiwan，東吳大學社會學研究所=Department of Sociology, Soochow University。
43. 李麗燕(2002)。臺北=Taipei, Taiwan，臺北醫學院護理學研究所=School of Nursing, Taipei Medical University。
44. 沈致吟(2008)。桃園=Taoyuan, Taiwan，長庚大學護理學研究所=School of Nursing, Chang Gung University。
45. 林婉華譯、Buckman, R.、Whittaker, T.(1999)。乳癌。臺北:智庫。
46. 林莉慧(2009)。新竹=Hsinchu, Taiwan，玄奘大學應用心理學系碩士班=Department of Applied Psychology, Hsuan Chuang University。
47. 胡至家(2005)。高雄=Kaohsiung, Taiwan，高雄醫學大學行為科學研究所=Kaohsiung Medical University。
48. 孫鳳岑(2006)。高雄=Kaohsiung, Taiwan，樹德科技大學人類性學研究所=Graduate School of Human Sexuality, Shu-Te University of Sciences & Technology。
49. 徐西森(2011)。團體動力與團體輔導。臺北=Taipei, Taiwan:心理=Psychological Publishing。
50. 連廷嘉譯、徐西森譯、McLeod, J.(2000)。諮商與心理治療質性研究。臺北:心理。
51. 陳信昭譯、陳碧玲譯、Weeks, G. R.、Treat, S.(2004)。婚姻治療：有效的技術與取向。臺北:五南。
52. 陳美端(2008)。南投=Nantou, Taiwan，暨南國際大學輔導與諮商研究所=Department of Counseling and Guidance, National Chi Nan University。
53. 陳海焦(1996)。臺北=Taipei, Taiwan，國防醫學院護理學研究所=School of Nursing, National Defense Medical Center。
54. 陳婉瑜(2005)。桃園=Taoyuan, Taiwan，長庚大學護理學研究所=School of Nursing, Chang Gung University。
55. 陳鳳鈴(2011)。臺南=Tainan, Taiwan，長榮大學護理學系碩士班=Department of Nursing, Chang Jung Christian University。
56. 曾志偉譯、王慧玉譯、Creswell, J. W.、Plano Clark, V. L.(2008)。混合方法研究導論。臺北:心理。
57. 鈕文英(2008)。教育研究方法與論文寫作。臺北=Taipei, Taiwan:雙葉書廊=Yeh Yeh Book Gallery。
58. 黃素菲譯、許伶佩譯、Ellis, A.、Crawford, T.(2004)。夫妻溝通成功七律。臺北:張老師。
59. 黃浿綺(2009)。高雄=Kaohsiung, Taiwan，樹德科技大學人類性學研究所=Graduate School of Human Sexuality, Shu-Te University of Sciences & Technology。
60. 楊惠卿譯、張琦敏譯、Burton, M.、Watson, M.(1988)。癌症患者諮商手冊。臺北:心理。
61. 溫淑真 譯、Dychtwald, K.(1987)。身心合一。臺北:牛頓。
62. 廖韋傑(2013)。桃園=Taoyuan, Taiwan，中原大學心理學研究所=Department of Psychology, Chung Yuan Christian University。
63. 鄭淑華(2006)。臺北=Taipei, Taiwan，臺灣大學護理學研究所=Department of Nursing, National Taiwan University。
64. 鄧旗明(2003)。嘉義=Chiyi, Taiwan，南華大學生死學研究所=Department Life and Death, Nanhua University。
65. 鍾美玲(1999)。臺北=Taipei, Taiwan，國防醫學院護理研究所=School of Nursing, National Defense Medical Center。
66. 羅家玲(2008)。彰化=Changhua, Taiwan，國立彰化師範大學輔導與諮商學系所=Department of Guidance & Counseling, National Changhua University of Education。

1. 李亭萱(2021)。以結構家族治療探討成人伴侶性探索與性溝通團體方案設計。輔導季刊，57(4)，45-60。