揭露自殺裡的存在意義－意義中心團體心理治療前導研究

Search for Meaning in the Suicide Chaos: The Pilot Study of Applying Meaning-Centered Group Psychotherapy in Psychiatric Patients with Suicide Risk

莊淑婷(Shu-Ting Zhuang)；詹佳達(Chia-Ta Chan)

自殺 ； 絕望感 ； 意義治療 ； 存在心理治療 ； 意義中心團體心理治療 ； suicide ； hopelessness ； logo therapy ； existential psychotherapy ； meaning-centered group psychotherapy

中華團體心理治療

21卷3期（2015 / 09 / 30）

31 - 45

繁體中文

目的：探索以意義感作為精神科自殺風險族群之初始介入目標的可性。方法：從精神科門診招募有自殺風險或無望感之病人。採個案研究法，依據存在取向理論，探索運用意義中心團體心理治療模式所發生的象。結果：本研究5名成員普遍有想與人連結之需求。隨團體內人際越多互動，意義中心團體心理治療的「心理教育」形變為「人際互動」。運用該模式有助認識團體發生的死亡、自由、孤獨等議題辨識。結論：以意義感為初始目標有其可行之處。意義的發現和人際參與有關。將持續以意義中心團體心理治療模式為團體設計參考，探索以意義感為介入起點對自殺風險族群之助益。

Purpose: This pilot study tried to find out the possibility of increasing the sense of meaning as a primary intervention for psychiatric patients with suicide risk. Methods: It was a case study to explore the phenomenon of the therapeutic group which applied the meaning-centered group psychotherapy model (MCGP). The participators were referred from the psychiatric outpatient department. Results: All participants had a need of engagement. MCGP is an intervention based on psychoeducational counseling, and in this pilot study, it is added with the character of here-and-now because of the frequent interpersonal interaction. Meaning rose from in-and-out of group interpersonal interaction. Other ultimate concerns- Death, Freedom and Isolation, also evolved in the MCGP model. Conclusions: It works for psychiatric patients with suicide risks to increase the sense of meaning as a primary intervention. It is also worth to keep on research if it works or not to apply MCGP model for the general psychiatric patients with suicide risk.

1. Beck, A.T.,Beck, R.,Kovacs, M.(1975).Classification of suicidal behaviors: I. Quantifying intent and medical lethality.American Journal of Psychiatry,132,285-287.
2. Beck, A.T.,Brown, G.,Stewart, B.L.,Stewart, B.L.,Steer, R.A.(1990).Relationship between hopelessnessand ultimate suicide: a replicationwith psychiatric outpatients.American Journal of Psychiatry,147,190-195.
3. Beck, A.T.,Steer, R.A.,Kovacs, M.,Garrison, B.(1985).Hopelessness andeventual suicide: a 10-year prospective study of patients hospitalized withsuicidal ideation.American Journalof Psychiatry,142,559-563.
4. Breitbart, W.(2001).Spirituality and meaning in supportive care: spiritualityand meaning-centered group psychotherapy interventions in advanced cancer.Support Care Cancer,10(4),272-80.
5. Breitbart, W.,Barry, R.,Hayley, P.,Applebaum, A.,Kulikowski, J.,Lichten-thal, W.(2015).Meaning-centeredgroup psychotherapy: an effective intervention for improving psycholog-ical well-being in patients with advanced cancer.Journal of Clinical On-cology,33(7),749-754.
6. Breitbart, W.,Heller, Karen S.(Interview)(2003).Reframing hope:meaning-centered care for patientsnear the end of life.Interview by Karen S. Heller Journal of PalliativeMed,6(6),979-88.
7. Breitbart, W.,Poppito, S(2014).Meaning-Centered Group Psychotherapyfor Patients with Advanced Cancer- aTreatment Manual.New York:Oxforduniversity press.
8. Breitbart, W.,Poppito, S.,Rosenfeld, B.,Vickers, A.J.,Li, Y.,Abbey, J.,Olden,M.,Pessin, H.,Lichtenthal, W.,Sjoberg, D.,Cassileth, B.R.(2012).Pilot randomized controlled trial ofindividual meaning-centered psychotherapy for patients with advancedcancer.Journal of Clinical Oncology,30(12),1304-9.
9. Breitbart, W.,Rosenfeld, B.,Gibson, C.,Pessin, H.,Poppito, S.,Nelson, C.,Tomarken, A.,Timm, A.K.,Berg, A.,Jacobson, C.,Sorger, B.,Abbey, J.,Olden, M.(2010).Meaning-centered group psychotherapy for patientswith advanced cancer: a pilot randomized controlled trial.Psychooncology,19(1),21-8.
10. Frankl, V. E.(1992).Mans Searchfor Meaning.Boston:BeaconPress.
11. Frankl, V. E.(1988).The Will toMeaning: Foundations and Applications of Logotherapy.NY:Penguin Books.
12. Melges, F.T.,Bowlby, J.(1969).Typesof hopelessness in psychopathologicalprocess.Arch Gen Psychiatry,20,690-699.
13. Rudd, M.,Rajab, M.,Dahm, P.(1994).Problem-solving appraisal in suicideideators and attempters.AmericanJournal of Orthopsychiatry,64,136-149.
14. Watson, M.(Ed.),Kissane, D.W.(Ed.)(2011).Handbooks of Psy- chotherapy in Cancer Care.West Sussex, UK:Wiley Blackwell.
15. Yalom, I. D.(1980).Existential psychotherapy.NY:Basic Books.
16. Yin, R.K.(2009).Case study research: Design and methods.Thousand Oaks, CA:Sage.
17. Zhuang, S.T.,Chan, C.T.(2014).Thisis who wants to do - search for realneeds in a chaos.4th Meeting of Asia-Pacific Psycho-Oncology Network,Taipei, Taiwan:
18. Zhuang, S.T.,Chan, C.T.(2014).Keeping pace with an elder cancer patientwith suicide ideation to feel how lifeis- a 1-year follow-up case report.IPOS 16th World Congress of Psycho-Oncology,Lisbon, Portugal:

1. 劉達生、劉培林、黃馨葳(2018)。運用系統動態學探討國軍心理諮商與醫療人力供需之研究。危機管理學刊，15(2)，75-88。
2. 葉建宏,莊淑婷,邱浩彰(2019)。以全人照護角度探索結合各類團體方案之途徑－以治療年數兩年內的肌無力病人為對象。中華團體心理治療，25(3)，18-32。