叙事治疗在儿童情绪障碍中的应用研究
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摘要
当前,儿童情绪障碍对青少年身心健康成长的负面影响已日益受到教师和心理治疗师的重视。本研究将叙事疗法作为干预手段,以儿童情绪障碍患者及其父母为研究对象,探索叙事治疗对儿童情绪障碍家庭的影响及其疗效,并为儿童情绪障碍的综合干预以及叙事治疗的本土化提供理论和实验的参考。
作为家庭治疗的后现代流派,叙事治疗从社会文化的广阔视角,关注主流文化价值观如何影响家庭成员的互动,从而导致心理问题的产生。叙事治疗帮助个体解构问题故事和价值观,发展偏好故事和价值观,探索解决问题的知识和技能,并建构积极的身份认同。
本研究以有效样本30例儿童情绪障碍患者及其父母为研究对象,采用系统家庭动力学量表(SSFD)、父母养育方式量表(EMBU)和家庭环境量表(FES-CV)比较治疗前后家庭动力学、父母养育方式和家庭环境的变化。采用访谈法对4例儿童情绪障碍患者进行访谈,了解他们对叙事治疗的体验、治疗的获益和治疗不足之处,以促进治疗方法的改进。采用个案研究探索具体个案的转变过程和疗效。研究结论如下：
1.治疗后儿童情绪障碍患者家庭动力学的家庭气氛和个性化维度有显著改善,治疗后儿童情绪障碍患者的母亲家庭动力学的家庭气氛、个性化和系统逻辑等维度有显著改善,治疗后儿童情绪障碍患者的父亲家庭动力学各维度无显著变化。
2.治疗后儿童情绪障碍患者的家庭环境在亲密度、矛盾性、知识性、娱乐性和组织性等因子上有显著改善。
3.治疗后儿童情绪障碍患者的父母养育方式中的父亲情感温暖理解、母亲情感温暖理解、惩罚严厉、拒绝否认等因子有显著改善。
4.儿童情绪障碍患者的父母养育方式治疗转变同家庭动力学的治疗转变具有相关性。父亲情感温暖理解、母亲情感温暖理解差值同家庭气氛差值呈负相关,父亲惩罚严厉、父亲拒绝否认、母亲惩罚严厉、母亲拒绝否认同家庭气氛差值呈正相关。母亲情感温暖理解差值同个性化差值呈负相关,母亲惩罚严厉差值同个性化差值呈正相关。
5.儿童情绪障碍患者的父母养育方式治疗前后变化同家庭环境治疗前后变化具有相关性。父亲情感温暖理解、母亲情感温暖理解差值同亲密度、知识性、娱乐性差值呈正相关；父亲情感温暖理解、母亲情感温暖理解差值同矛盾性差值呈负相关；母亲拒绝否认、母亲惩罚严厉差值同矛盾性差值呈正相关；父亲拒绝否认、母亲拒绝否认差值同娱乐性差值呈负相关；母亲惩罚严厉差值同组织性差值呈负相关。
6.儿童情绪障碍患者不同年龄、治疗次数、性别在疗效上没有显著差异。
7.儿童情绪障碍患者及其父母的问题价值观在治疗前后有显著转变。
8.质的研究表明叙事治疗对儿童情绪障碍患者的情绪改善,家庭及人际关系改善、偏好价值观、个人主权、闪光事件或替代故事等方面有较好疗效,治疗存在提问不够清晰、治疗时间不够长、部分个案起效慢等不足。
9.叙事治疗在本土化过程中,需要考虑本土隐喻和传统文化,治疗实践应做出相应的调整。
Currently, the negative influence of emotional disorder on children has already been a great concern among teachers and therapists. This study attempts to explore the effect of narrative therapy on family dynamic, parental rearing pattern and family environment in adolescents with emotional disorder and provide psychological theory and experimental proof for the localization of narrative therapy and the new comprehensive intervention for adolescents with emotional disorder.
As the post-modern branch of family therapy, narrative therapy focus on how dominant culture influence the interaction of familiy member and creat psychological problems from a social-culture perspective. Narrative therapy assists people to deconstruct problematic stories and values, develop preferred stories and values, explore knowledge and skills that could solve problems and construct positive indentity.
The subjects for the study are30adolescents with emotional disorder and their parents. Family dynamics, parental rearing pattern and family environment were assessed using Self rating scale of systemic family dynamics (SSFD), Egma Minnen av Bardndosnauppforstran (EMBU) and Family Environment Scale-Chinese Version (FES-CV) and were compared between pre-and Post-therapy. Four adolescents with emotional disorder were interviewed in order to explore their experience of narrative therapy, the benefit and shortcoming of narrative therapy and promote the improvement of narrative therapy. The case study was used to explore the process of change and effect on specific cases.The following conclusions are reached.
1. Family atmosphere and individuation of adolescents'SSFD have positive change at post-therapy. Family atmosphere, individuation and systemic logic of mothers'SSFD have positive change at post-therapy. The fathers'SSFD has no significant change between pre-and post-therapy.
2. The cohesion, contradict, intellectual orientation, active-recreation orientation and organization in FES-CV have positive change at post-therapy.
3. Parental emotional warmth, mothers'punishment and rejection of EMBU have positive change at post-therapy.
4. The change of SSFD relates to the change of EMBU. The difference of parental emotional warmth negatively correlates to the difference of family atmosphere. The difference of parental punishment and rejection positively correlate to the difference of family atmosphere. The difference of mothers'warmth negatively correlates to the difference of individuation and the difference of mothers'punishment positively correlates to the difference of individuation.
5. The change of FES-CV relates to the change of EMBU. The difference of parental emotional warmth positively correlates to the difference of cohesion, intellectual orientation and active-recreation orientation. The difference of parental emotional warmth negatively correlates to the difference of contradict. The difference of mothers'punishment and rejection positively correlates to the difference of contradict. The difference of parental rejection negatively correlates to active-recreation orientation. The difference of mothers'punishment negatively correlates to organization.
6. The differences in age, gender and number of sessions of adolescents with emotional disorder don't have significant differences in efficacy.
7. The values of adolescents with emotional disorder and their parents have a positive change after narrative therapy.
8. The qualitative research indicates that narrative therapy is effective on the positive change of emotion, family relationship, interpersonal relationship, preferred values, personal agency, unique outcome and alternative stories. The shortcoming of therapy includes confused questions, insufficient time for each session and slow positive change.
9. Narrative therapy needs to be adjusted to local culture and metaphors and make correlatively change in the process of localization.
作为家庭治疗的后现代流派,叙事治疗从社会文化的广阔视角,关注主流文化价值观如何影响家庭成员的互动,从而导致心理问题的产生。叙事治疗帮助个体解构问题故事和价值观,发展偏好故事和价值观,探索解决问题的知识和技能,并建构积极的身份认同。
本研究以有效样本30例儿童情绪障碍患者及其父母为研究对象,采用系统家庭动力学量表(SSFD)、父母养育方式量表(EMBU)和家庭环境量表(FES-CV)比较治疗前后家庭动力学、父母养育方式和家庭环境的变化。采用访谈法对4例儿童情绪障碍患者进行访谈,了解他们对叙事治疗的体验、治疗的获益和治疗不足之处,以促进治疗方法的改进。采用个案研究探索具体个案的转变过程和疗效。研究结论如下：
1.治疗后儿童情绪障碍患者家庭动力学的家庭气氛和个性化维度有显著改善,治疗后儿童情绪障碍患者的母亲家庭动力学的家庭气氛、个性化和系统逻辑等维度有显著改善,治疗后儿童情绪障碍患者的父亲家庭动力学各维度无显著变化。
2.治疗后儿童情绪障碍患者的家庭环境在亲密度、矛盾性、知识性、娱乐性和组织性等因子上有显著改善。
3.治疗后儿童情绪障碍患者的父母养育方式中的父亲情感温暖理解、母亲情感温暖理解、惩罚严厉、拒绝否认等因子有显著改善。
4.儿童情绪障碍患者的父母养育方式治疗转变同家庭动力学的治疗转变具有相关性。父亲情感温暖理解、母亲情感温暖理解差值同家庭气氛差值呈负相关,父亲惩罚严厉、父亲拒绝否认、母亲惩罚严厉、母亲拒绝否认同家庭气氛差值呈正相关。母亲情感温暖理解差值同个性化差值呈负相关,母亲惩罚严厉差值同个性化差值呈正相关。
5.儿童情绪障碍患者的父母养育方式治疗前后变化同家庭环境治疗前后变化具有相关性。父亲情感温暖理解、母亲情感温暖理解差值同亲密度、知识性、娱乐性差值呈正相关；父亲情感温暖理解、母亲情感温暖理解差值同矛盾性差值呈负相关；母亲拒绝否认、母亲惩罚严厉差值同矛盾性差值呈正相关；父亲拒绝否认、母亲拒绝否认差值同娱乐性差值呈负相关；母亲惩罚严厉差值同组织性差值呈负相关。
6.儿童情绪障碍患者不同年龄、治疗次数、性别在疗效上没有显著差异。
7.儿童情绪障碍患者及其父母的问题价值观在治疗前后有显著转变。
8.质的研究表明叙事治疗对儿童情绪障碍患者的情绪改善,家庭及人际关系改善、偏好价值观、个人主权、闪光事件或替代故事等方面有较好疗效,治疗存在提问不够清晰、治疗时间不够长、部分个案起效慢等不足。
9.叙事治疗在本土化过程中,需要考虑本土隐喻和传统文化,治疗实践应做出相应的调整。
Currently, the negative influence of emotional disorder on children has already been a great concern among teachers and therapists. This study attempts to explore the effect of narrative therapy on family dynamic, parental rearing pattern and family environment in adolescents with emotional disorder and provide psychological theory and experimental proof for the localization of narrative therapy and the new comprehensive intervention for adolescents with emotional disorder.
As the post-modern branch of family therapy, narrative therapy focus on how dominant culture influence the interaction of familiy member and creat psychological problems from a social-culture perspective. Narrative therapy assists people to deconstruct problematic stories and values, develop preferred stories and values, explore knowledge and skills that could solve problems and construct positive indentity.
The subjects for the study are30adolescents with emotional disorder and their parents. Family dynamics, parental rearing pattern and family environment were assessed using Self rating scale of systemic family dynamics (SSFD), Egma Minnen av Bardndosnauppforstran (EMBU) and Family Environment Scale-Chinese Version (FES-CV) and were compared between pre-and Post-therapy. Four adolescents with emotional disorder were interviewed in order to explore their experience of narrative therapy, the benefit and shortcoming of narrative therapy and promote the improvement of narrative therapy. The case study was used to explore the process of change and effect on specific cases.The following conclusions are reached.
1. Family atmosphere and individuation of adolescents'SSFD have positive change at post-therapy. Family atmosphere, individuation and systemic logic of mothers'SSFD have positive change at post-therapy. The fathers'SSFD has no significant change between pre-and post-therapy.
2. The cohesion, contradict, intellectual orientation, active-recreation orientation and organization in FES-CV have positive change at post-therapy.
3. Parental emotional warmth, mothers'punishment and rejection of EMBU have positive change at post-therapy.
4. The change of SSFD relates to the change of EMBU. The difference of parental emotional warmth negatively correlates to the difference of family atmosphere. The difference of parental punishment and rejection positively correlate to the difference of family atmosphere. The difference of mothers'warmth negatively correlates to the difference of individuation and the difference of mothers'punishment positively correlates to the difference of individuation.
5. The change of FES-CV relates to the change of EMBU. The difference of parental emotional warmth positively correlates to the difference of cohesion, intellectual orientation and active-recreation orientation. The difference of parental emotional warmth negatively correlates to the difference of contradict. The difference of mothers'punishment and rejection positively correlates to the difference of contradict. The difference of parental rejection negatively correlates to active-recreation orientation. The difference of mothers'punishment negatively correlates to organization.
6. The differences in age, gender and number of sessions of adolescents with emotional disorder don't have significant differences in efficacy.
7. The values of adolescents with emotional disorder and their parents have a positive change after narrative therapy.
8. The qualitative research indicates that narrative therapy is effective on the positive change of emotion, family relationship, interpersonal relationship, preferred values, personal agency, unique outcome and alternative stories. The shortcoming of therapy includes confused questions, insufficient time for each session and slow positive change.
9. Narrative therapy needs to be adjusted to local culture and metaphors and make correlatively change in the process of localization.
引文
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