創傷兒童之主要照顧者替代性創傷初探

Preliminary Research on Vicarious Traumatization of Caregivers

10.3966/181815462021064302003

李慧芳(Huei-Fang Li)

主要照顧者 ； 兒童 ； 性侵害 ； 替代性創傷 ； 暴力 ； caregiver ； child ； sexual assault ； vicarious traumatization ； violence

輔導與諮商學報

43卷2期（2021 / 06 / 01）

59 - 87

繁體中文

主要照顧者的替代性創傷（vicarious traumatization），來自於因密集的與受照顧者的互動，目睹或感受到受照顧者痛苦、無助，長期身處受傷害的感受中，開始有了重複經歷或想像自己的小孩受創傷的畫面，造成過度同理，同時心理開始有耗竭感，這樣的替代性創傷經常發生在創傷救助工作者。本文整理替代性創傷相關文獻，並以質性研究探討兩位具創傷經驗的兒童之主要照顧者為例，了解其替代性創傷的各項情緒跟行為，以及親子互動關係。研究結果發現高度責任感、低自尊、想法遲疑、壓抑之主要照顧者，以及當主要照顧者感受兒童的消極、內向壓抑面，較容易誘發替代性創傷的可能，他們之間形成相互矛盾的互動方式，且又互相加深對方用矛盾的方式應對。研究最後提出主要照顧者因應的策略：增加對加害者感受的覺察、增進辨識替代性創傷並且接納自己的感覺、避免過度苛責孩子受創之細節、與孩子建立適度界線、提升對自我人格特質的了解、尋求社會支援等，能幫助預防替代性創傷之形成。

The vicarious traumatization of the caregiver comes from a long period of the intensive interaction with the victim during which the caregiver witnesses or feels the victim's pain and helplessness. The long-term feeling of being hurt causes the caregiver to start repeatedly experiencing or imagining their own children being traumatized on their mind, which further leads to the caregiver being overly empathetic and meanwhile with a growing sense of exhaustion. Such vicarious traumatization often occurs in trauma rescue workers. This article collated literature on vicarious traumatization, and adopted qualitative research to explore the two caregivers of children with traumatic experience as examples. The research results found that caregivers with high sense of responsibility, low self-esteem, negative thoughts, and depression, as well as dependence etc., are likely to induce vicarious traumatization, and there is a contradictory interaction between caregivers and tramatised children. Finally, the research also proposes strategies for the caregiver to increase the awareness of the feelings, enhance the identification of vicarious traumatization, accept their own self, avoid excessively criticizing traumatized children, establish boundaries with children, understand the personality traits of themselves, and seek social support to help prevent the caregiver from developing vicarious traumatization.

1. Banyard, V. L.,Englund, D. W.(2001).Parenting the traumatized child: Attending to the needs of nonoffending caregivers of traumatized children.Psychotherapy: Theory, Research, Practice, Training,38(1),74-87.
2. Brown, L. S.(2011).Review of the book Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors, by L. A. Pearlman & K. W. Saakvitne.American Journal of Clinical Hypnosis,38(4),298-299.
3. Byrne, M. K.,Lerias, D.,Sullivan, N. L.(2006).Predicting vicarious traumatization in those indirectly exposed to bushfires.Stress & Health: Journal of the International Society for the Investigation of Stress,22(3),167-177.
4. Carter, B. J.(1993).Child sexual abuse: Impact on mothers.Affilia,8(1),72-90.
5. Carter, B. J.(1999).Who's to blame? Child sexual abuse and non-offending mothers.University of Toronto Press.
6. Devilly, G. J.,Wright, R.,Varker, T.(2009).Vicarious trauma, secondary traumatic stress or simply burnout? Effect of trauma therapy on mental health professionals.Australian & New Zealand Journal of Psychiatry,43(4),373-385.
7. Dunkley, J.,Whelan, T. A.(2006).Vicarious traumatisation: Current status and future directions.British Journal of Guidance & Counselling,34(1),107-116.
8. Figley, C. R.(1995).Compassion fatigue: Coping with secondary traumatic stress in those who treat the traumatized.Routledge.
9. Flick, U.,李政賢（譯）,廖志恒（譯）,林靜如（譯）(2007).質性研究導論.五南.
10. Forgatch, M. S.,DeGarmo, D. S.(1999).Parenting through change: An effective prevention program for single mothers.Journal of Consulting and Clinical Psychology,67(5),711-724.
11. Green, A. H.,Coupe, P.,Fernandez, R.,Stevens, B.(1995).Commentary on "incest revisited: Delayed post-traumatic stress disorder in mothers following the sexual abuse of their children".Child Abuse and Neglect,19(10),1275-1282.
12. Hiebert-Murphy, D.(1998).Emotional distress among mothers whose children have been sexually abused: The role of a history of child sexual abuse, social support, and coping.Child Abuse and Neglect,22(5),423-435.
13. Holden, R. R.,Fekken G. C.(2017).Basic personality inventory.Encyclopedia of Personality and Individual Differences
14. Holden, R. R.,Fekken, G. C.,Cotton, D. H.(1990).Clinical reliabilities and validities of the microcomputerized basic personality inventory.Journal of Clinical Psychology,46(6),845-849.
15. Jackson, D. N.,Hoffmann, H.(1987).Common dimensions of psychopa-thology from the MMPI and the basic personality inventory.Journal of Clinical Psychology,43(6),661-669.
16. Manion, I. G.,McIntyre, J.,Firestone, P.,Ligezinska, M.,Ensom, R.,Wells, G.(1996).Secondary traumatization in parents following the disclosure of extrafamilial child sexual abuse: Initial effects.Child Abuse and Neglect,20(11),1095-1109.
17. Masten, A. S.,Hubbard, J. J.,Gest, S. D.,Tellegen, A.,Garmezy, N.,Ramirez, M.(1999).Competence in the context of adversity: Pathways to resilience and maladaptation from childhood to late adolescence.Development and Psychopathology,11(1),143-169.
18. McCann, I.,Pearlman, L.(1990).Vicarious traumatization: A framework for understanding the psychological effects of working with victims.Journal of Traumatic Stress,3(1),131-149.
19. McCleary, L.,Ridley, T.(1999).Parenting adolescents with ADHD: Evaluation of a psychoeducation group.Patient Education and Counseling,38(1),3-10.
20. Pearlman, L. A.,Saakvitne, K. W.,洪素珍（譯）,楊大和（譯）,黃燕珠（譯）(2002).創傷與治療師－亂倫生存者心理治療中的反移情與替代性創傷.五南.
21. Perry, B. D. (2014).The cost of caring: Secondary traumatic stress and the impact of working with high-risk children and families. Children Trauma Academy. https://ovc.ojp.gov/sites/g/files/xyckuh226/files/media/document/sts_impact_on_child_advocates-508.pdf
22. Pisterman, S.,Firestone, P.,McGrath, P.,Goodman, J. T.,Webster, I.,Mallory, R.,Coffin, B.(1992).The effects of parent training on parenting stress and sense of competence.Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement,24(1),41-58.
23. Plummer, C.,Eastin, J.(2000).The mothers of sexually abused children.Victimization of Children and Youth: An International Research Conference,New Hampshire, U.S.:
24. Pynoos, R. S.(Ed.)(1994).Posttraumatic stress disorders: A clinical review.The Sidran Press.
25. Reddon, J. R.,Jackson, D. N.(1989).Readability of three adult personality tests: Basic personality inventory, Jackson personality inventory, and personality research form-E.Journal of Personality Assessment,53(1),180-183.
26. Regehr, C.(1990).Parental responses to extrafamilial child sexual assault.Child Abuse and Neglect,14(1),113-120.
27. Sabin-Farrell, R.,Turpin, G.(2003).Vicarious traumatization: Implications for the mental health of health workers?.Clinical Psychology Review,23(3),449-480.
28. Salston, M.,Figley, C. R.(2003).Secondary traumatic stress effects of working with survivors of criminal victimization.Journal of Traumatic Stress,16(2),167-174.
29. Shakespeare-Finch, J. E.,Smith, S. G.,Gow, K. M.,Embelton, G.,Baird, L.(2003).The prevalence of post-traumatic growth in emergency ambulance personnel.Journal of Traumatology,9(1),58-71.
30. Tucker, S.,Gross, D.,Fogg, L.,Delaney, K.,Lapporte, R.(1998).The long-term efficacy of a behavioral parent training intervention for families with 2-year-olds.Research in Nursing and Health,21(3),199-210.
31. Walker, J.(2007).Unresolved loss and trauma in parents and the implications in terms of child protection.Journal of Social Work Practice,21(1),77-87.
32. Witzel, A.(1982).Verfahren der qualitativen Sozialforschung. Überblick und Alternativen.Campus Verlag.
33. Wyman, P. A.,Cowen, E. L.,Work, W. C.,Hoyt-Meyers, L.,Magnus, K. B.,Fagen, D. B.(1999).Caregiving and developmental factors differentiating young at-risk urban children showing resilient versus stress-affected outcomes: A replication and extension.Child Development,70(3),645-659.
34. 王玥好（2006.05.07）：做倖存者的好父母。信望愛全球資訊網。2020 年03 月 01 日，取自 https://www.fhl.net/main/goh/goh5.html
35. 王昭蕙(2010)。國立陽明交通大學。
36. 汪淑媛(2014)。替代性創傷是助人工作者不可避免之風險？。社區發展季刊，147，136-154。
37. 邱琇琳(2005)。國立台灣大學。
38. 麥麗蓉(2009)。助人工作者於危機處理過程中的壓力因應與自我照顧。台灣心理諮商季刊，3(1)，11-21。
39. 黃雅筠(2018)。國立台灣師範大學。
40. 蔡依玲(2013)。國立政治大學。

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2. (2023)。看見災難中的創傷──談兒盟失依家庭服務模式與悲傷復原力推廣。社區發展季刊，181，245-266。