遊戲治療中的主題、象徵與療癒：以一名身體受虐兒為例

Themes, Symbols and Healing of Play Therapy: The Clinical Case of a Physically Abused Child

10.3966/172851862019090056004

吳東彥(Dong-Yann Wu)；黃宗堅(Tsung-Chain Huang)

身體受虐兒 ； 象徵 ； 遊戲主題 ； 遊戲治療 ； Physically abused child ； play themes ； play therapy ； symbol

中華輔導與諮商學報

56期（2019 / 09 / 01）

97 - 130

繁體中文

本研究採取主題分析法，探究一名身體受虐兒在十五次的遊戲治療中，所呈現出的重複遊戲主題，分別為：（一）囚禁與脫逃、（二）界限的逾越與維持、（三）隱藏與現身、（四）死亡與重置、（五）兩極對立的辯證式消長。研究者除試圖從中萃取有意義的主題（what），同時也特別彰顯遊戲行為主題背後的啟動原因（why）及展現的方式（how）之外，亦關注遊戲主題與治療關係之間如何交織影響，最後則嘗試呼應遊戲主題可能具有的象徵意涵。隨著治療的進行，案主更能展現對內、外在經驗的涵容與自由流動，漸漸不再將生命能量全然置放於攻擊師長或反抗學校規範，而開始有能力遵守規則及要求，並且為自己的學業負起責任。案祖母亦表示案主已經不再刻意反對或是挑釁，兩個人有更多的時間可以和平共處，並且有較多正向的關係連結。研究亦發現，當治療者能夠協助案主矯正其投射性認同的機制後，案主的自我發展似乎從初期以全然「壞我」為主的狀態，轉變為開始能夠看見自己的正向力量或資源。在自我發展的內涵上，案主的有能感（competence）、整合感（integration）、人際互動關係（interpersonal relationship），以及欲力（libido）投注的方向也開始有所不同。文末也針對治療歷程及研究結果，提出具體建議與省思。

Recent studies have call for an increased attention to use play therapy as a crucial method for the treatment of physically abused children. While much work has been undertaken to examine the relationships between play therapy and treatment efficacy, few studies have addressed the symbolic and healing perspectives of children's play themes. In addition, the dynamic process of the therapeutic relationship has long been neglected. The researchers argued that not only the play behaviors between the sessions, but also the contextual and sequential meanings behind the play themes should be examined. Thus, the present study was aimed to synthesize the existing literature into a more process-oriented model that explains why and how play therapy works for the clients. Based on the approach of Thematic Analysis, the present study explored the repeated play themes from a physically abused child's 15 play sessions. Home-Room teacher, school counselor as well as the client's grandmother's reports were collected to increase data validation. Inter-Rater reliability between two researchers was carefully examined. Researchers read each play sessions' transcriptions and classified concepts based on conditions, contexts, action strategies and results. Researchers also conducted a re-inspection to verify the theoretical structure obtained in the above-mentioned analysis. Attention was placed on whether there was evidence pointing away from the theories obtained. Researchers also conducted continuous modifications and supplementary works based on discussions with scholars in related fields. Five major themes were identified from the data analysis: (1) captivity and escape; (2) go beyond or maintaining boundaries; (3) hide and seek; (4) death and replacement; (5) dialectical relationship between opposites. The researchers not only extracted meaningful themes of the child's play, but also draw attention to why the play behaviors were activated and presented. In addition, the interactions between play themes and the therapeutic relationship were investigated. The symbolic meaning of the play themes was also explored. As the therapeutic process continued, client was more able to contain his inner and outer experiences and allow them to flow. He was less against his teachers or school norms, in addition, he was more able to follow the rules and take responsibility for school assignments. Client's grandmother indicated that he was less provocative and had more positive interactions with her. The results also showed that, when the therapist can work on the client's projective identification, then the client was more likely to move his ＂bad me＂ identification to a more positive self image, that is, he became more realized that ＂bad＂ and ＂good＂ can both exist within himself. He was more able to set up a boundary and forgive the person who abused him. As to the content of his ego development, the client's abilities of competence, integration, interpersonal relationship and the devotion of libido were also improved. The present study adds to the existing literature on the etiology and underlying healing process of play therapy to a Taiwanese physically abused child. This has been done in an effort to increase understanding in Taiwanese families and to test previous conceptualizations and findings based on the available literature, which has typically observed or measured from White, middle-class families in America. This study highlights the importance of incorporating theoretical and methodological advances in the mainstream literature into research with culturally diverse population, while remaining sensitive to the culture-specific issues of Taiwanese - an obvious requirement that has not been met in much of the previous research. Influential reflections as well as practical applications were discussed.

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