關係取向心理治療處理社交焦慮症患者之歷程研究

Process of Applying Relational Approach Psychotherapy on a Client with Social Anxiety Disorder

10.6308/JCPRC.201711_(31).0003

高志薇(Chin-Wei Kao)；邱一航(Yi-Hang Chiu)；江守峻(Shou-Chun Chiang)；陳婉真(Wan-Chen Chen)

關係取向心理治療 ； 社交焦慮症 ； 關係創傷 ； relational approach psychotherapy ； social anxiety disorder ； relational trauma

諮商心理與復健諮商學報

31期（2017 / 11 / 01）

71 - 102

繁體中文

本研究目的為以關係取向心理治療之理論為基礎，闡述關係創傷對社交焦慮症患者的影響，以及其發展的人際關係困境。研究對象為一位長期有社交焦慮症的中年男性個案，經精神科醫師轉介進行每週一次、每次50分鐘，共44次的心理治療。研究資料為每次治療錄音檔的逐字稿、治療者的筆記與精神科醫師的評估。研究結果發現：(1)關係創傷：個案與母親的關係是個案關係創傷的主因，個案長期依賴母親形成內在的關係囚籠，進而導致其社交焦慮與人際疏離。(2)個案的人際關係模式與困境：在治療歷程中，個案與治療者重現舊有的關係模式，包含順服取悅他人與預期並誘發他人負面評價。(3)治療者覺察自己落入個案舊有人際模式：治療者重演個案的重要他人，感受到自身的糾結與無力。經由自我覺察與調整，治療者突破治療僵局，並協助個案創造新的關係經驗。(4)個案的重生：治療者發現個案已逐漸脫離關係囚籠，能開展行動、找回自己。最後，本研究認為關係取向心理治療有助於理解個案的關係模式，並協助個案發展出新的關係經驗，處理關係創傷所導致的關係困境。

The paper is based on Relational Approach Psychotherapy and apply its theory in order to examine the influences of relational trauma toward a client with Social Anxiety Disorder (SAD), and his development of interpersonal impasse. The participant was a middle aged male suffered from SAD, and referred by a/the/his psychiatrist. A total of 44 interviews were conducted weekly for 50 minutes per week. The research data included the psychotherapy records, the reflective manuscripts of the therapist, and the evaluation of the psychiatrist. The results are: (1) Relational trauma: the relationship between the client and his mother was the origin of the relational trauma. The client depended on his mother over a long period of time which caused the internal relational cage. Thus, the relational cage induced the client to the development of the social anxiety and interpersonal alienation. (2) Client's relational model and impasse: the client replayed the old relational model during the counseling process, including pleasing others and inducing the negative evaluations from the people. (3) Falling into client's old interpersonal model: the therapist (acted/re-acted) as the important other of the client, so the therapist felt (his/her) struggles and incapability. Through self- awareness and adjustment, the therapist overcame the impasse and helped the client to create the new relational experience. (4) Reborn: the therapist noticed the client gradually departed from the relational cage and was able to act on his own, and find his way. Finally, the researcheres believe that relational approach psychotherapy is helpful for understanding the relational model of the client, and facilitates the development of new relational experiences of the client. Therefore, the client will be able to deal with the relational impasse caused by relational trauma.

1. 周育滕(2015)。關係取向心理諮商之歷程分析─以一位國小中年危機教師為例。中華輔導與諮商學報，42，125-156。
   連結：
2. 施宇峰、譚子文(2011)。依附關係和自我概念之關聯性研究。台中教育大學學報，25(1)，1-27。
   連結：
3. 陳婉真、蔡依玲、黃惠惠、吳國慶(2014)。關係理論取向諮商中個案因應內在依賴衝突之分析。教育與心理學報，46(1)，141-163。
   連結：
4. 陳婉真、吳國慶（2016，審稿中）。心理師在社區開業：談關係取向深度心理諮商。
5. American Psychiatric Association(2013).Diagnostic and statistical manual of mental disorders.Washington, DC:Author.
6. Aron, L.(1996).A meeting of minds: Mutuality in psychoanalysis.Hillsdale, NJ:The Analytic Press.
7. Blatt S. D.,Homann, E.(1992).Parent-child interaction in the etiology of depen- dence and self-critical depression.Clinical Psychology Review,12,14-91.
8. Bowlby, J.(1980).Attachment and loss: Vol. 3. Loss: Sadness and depression.New York, NY:Basic Books.
9. Bowlby, J.(1982).Attachment and loss: Retrospect and prospect.American Journal of Orthopsychiatry,52(4),664-678.
10. Buss, A. H.(1980).Self-consciousness and social anxiety.San Francisco, CA:Freeman.
11. Cameron, S.,Turtle-Song, I.(2002).Learning to write case notes using the SOAP format.Journal of Counseling and Development,80(3),286-292.
12. Cassidy, J.,Shaver, P. R.(2008).Handbook of attachment: Theory, research, and clinical applications.New York, NY:Guilford Press.
13. Collins, M.,Read, S. J.(1994).Attachment style, working model, and relationship quality in dating couple.Journal of Personality and Social Psychology,58,644-663.
14. Eisner, E. W.(Ed.),Peshkin, A.(Ed.)(1990).Qualitative inquiry in education: The continuing debate.New York:Teachers College Press.
15. Finnegan, R. A.,Hodges, E. V.,Perry, D. G.(1998).Victimization by peers: Associations with children's reports of mother-child interaction.Journal of Personality and Social Psychology,75(4),1076-1086.
16. Fonagy, P.,Gergely, G.,Jurist, E.,Target, M.(2002).Affect regulation, mentalization and the development of the self.New York, NY:Other Press.
17. Greenberg, L. S.(Ed.),Waston, J. C.(Ed.),Lietaer, G.(Ed.)(1998).Handbook of experiential psychotherapy.New York, NY:Guilford Press.
18. Horney, K.(1970).Neurosis and human growth.New York, NY:Norton.
19. LaGreca, A. M.,Stone, W. L.(1993).Social anxiety scale for children-revised: Factor structure and concurrent validity.Journal of Clinical Child Psychology,22(1),17-27.
20. Leary, M. R.(1983).Understanding social anxiety: Social personality and clinical perspectives.Beverly Hills, CA:Sage.
21. Leiberman, A.,Van Horn, P.(2008).Psychotherapy with infants and young children.New York, NY:Guilford Press.
22. Levenson, H.(1995).Time-limited dynamic psychotherapy: A guide to clinical practice.New York, NY:Basic Books.
23. Mitchell, S. A.(1997).Influence and autonomy in psychoanalysis.Hillsdale, NJ:The Analytic Press.
24. Mitchell, S. A.(1988).Relational concepts in psychoanalysis: An integration.Cambridge, MA:Harvard University Press.
25. Morrow, L. S.(2005).Quality and trustworthiness in qualitative research in counseling psychology.Journal of Counseling Psychology,52(2),250-260.
26. Parade, H. S.,Leerkes, M. E.,Blankson, N. A.(2010).Attachment to parents, social anxiety, and college relationships of female students over the transition to college.Journal of Youth and Adolescent,39,127-137.
27. Prieto, L. R.,Scheel, K. R.(2002).Using case documentation to strengthen counselor trainees' case conceptualization skills.Journal of Counseling and Development,80(1),11-21.
28. Richo, D.(2012).Coming home to who you are: Discovering your natural capacity for love, integrity, and compassion.Boston, MA:Shambhala Publications.
29. Safran, J. D.,Muran, J. C.(2000).Negotiating the therapeutic alliance: A relational treatment guide.New York, NY:Guilford Press.
30. Stolorow, R.(1994).More integrative than thou: Commentary on Steven Stern's "Needed relationships".Psychoanalytic Dialogues,4,353-355.
31. Teyber, E.(2000).Interpersonal process in psychotherapy: A relational approach.Pacific Grove, CA:Brooks/Cole.
32. Teyber, E.(2006).Interpersonal process in therapy: An integrative model (5th ed.)..Belmont, CA:Thomson Brooks/Cole.
33. Teyber, E.,McClure, F. H.(2011).Interpersonal process in psychotherapy: An integrative model.Belmont, CA:Brooks/Cole.
34. Wachtel, P. L.(2008).Relational theory and the practice of psychotherapy.New York, NY:Guilford Press.
35. 吳麗娟(1987)。理情教育團體對大學生理性思考、社會焦慮與自我接納效果之研究。教育心理學報，30，183-204。
36. 陳婉真(2013)。關係取向心理諮商之歷程分析。教育與心理研究，36(3)，29-55。
37. 陳婉真(2015)。關係取向心理諮商的架構：理論與實務。台北市:張老師。
38. 歐陽儀、吳麗娟(1998)。教養方式與依附關係代間傳遞模式之研究。教育心理學報，30(2)，33-58。

1. 戴恩信(2021)。從人際歷程治療取向觀點談邊緣型人格障礙個案之應用。輔導季刊，57(1)，39-46。
2. 黎欣怡,田秀蘭(2019)。同行與轉化：心理治療歷程中雙方參與者的轉化。生命敘說與心理傳記學，7，263-292。
3. 周穎琦(2020)。失控中的控制－從關係取向心理諮商談依賴關係的內在衝突與控制。輔導季刊，56(4)，31-40。