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    Title: 優勢觀點為基礎之社會工作者與情感性精神疾病個案雙向復元歷程之探討—穿越生命隧道之旅
    A Study on Mutual Recovery Process of Strengths-based Social Workers and Clients with Mood Disorder
    Authors: 胡孟菁
    Hu, Meng Jing
    Contributors: 宋麗玉
    Song, li Yu
    胡孟菁
    Hu, Meng Jing
    Keywords: 優勢觀點
    情感性精神疾病
    雙向復元
    助人關係
    Strengths Perspective
    Mood/affective Disorders
    Mutual Recovery
    Helping Relationship
    Date: 2013
    Issue Date: 2014-02-10 15:03:18 (UTC+8)
    Abstract: 本研究旨在探討以優勢觀點為基礎之社會工作實施場域中,社會工作者與情感性精神疾病個案助人關係歷程、雙向復元因素與意涵,與不同組織政策與文化對雙向復元之影響,進一步形成實務場域中助人關係與雙向復元之建議與策略。
      本研究運用質性研究深度訪談法與詮釋現象學觀點,採立意與滾雪球抽樣,使用半結構式訪談大綱與研究者於田野之互動與觀察,再現八名受訪者(五名優勢觀點社工、三位情感性精神疾病個案)之生活經驗,回歸現象本質綜觀與探討。
      本研究主要發現如下:
    一、情感性精神疾病的重新詮釋:社會工作者正視個案憂鬱或躁狂發作而產生生理、心理與社會的排除,將疾病常態化、普同化,並經由多面向的宏觀檢視以打破原本負面框架與預設立場,包含:1.給予自殺的生命解套—給予選擇與自我決定;2.賦予反覆訴說的意義—重新詮釋生命的機會。
    二、歷經「隧道」、不斷攀升—助人關係發展之歷程:歸納優勢觀點社會工作者與情感性精神疾病個案發展助人關係之歷程,可分為想像期、建立期、考驗期、合作期與復元期五大階段,形塑「穿越生命隧道之旅」般的助人關係意象,並發現差序格局文化下的助人關係連續體之特色。
    三、雙向復元的實質意涵:由個案「置身死地而後生」與社會工作者「從助人意義中回觀自我」的復元經驗中,歸納「雙向復元」之實質意義與內涵,是一種助人關係與個人內、外在情境三者交互作用而成的超越狀態與主體終極目標,影響成因包含個人、人際與環境三大層面和七個項目。
    四、組織政策與文化對雙向復元之影響:不同組織政策與文化之對雙向復元具有實質之影響,分析受訪社會工作者所屬的機構內部可發現「考驗」與「支持」的態樣,後者不但創造充分的人際支持與成長環境,更能促進社會工作者的復元、提升個案服務品質與績效、穩定社工流動率。
    依據上述研究發現,提出以下建議:
    一、情感性精神疾病個案之助人關係策略:1.增強個體權能:擱置並轉化問題、充分尊重與信任、著力優勢與能力、累積成功經驗、創造選擇性。2.善用關係影響:借重家庭的影響力、保持助人關係中的接觸與等待、建立分享與互惠的彈性關係、善用權力落差形成改變。3.導入環境資源:地緣與文化的親近性、開放的會談地點與時間、連結資源與網絡合作。
    二、正視雙向復元之目標:回歸自身被忽略的正向經驗,賦予生命及工作狀態之意義,個案或社會工作者復元的同時也使對方進一步昇華和復元,像漣漪效應般能擴及旁人,間接影響家庭與社會系統,啟動整體社會文化的善循環。
    三、機構推動優勢觀點模式之建議:瞭解如何有效學習並運用優勢觀點模式、適度激勵並給予充分支持、提供合理的保障與實質誘因。
    四、未來研究之建議:瞭解情感性精神疾病之特性並有所應變、具備接近田野之管道並增加研究對象的多元性、學習與受訪對象共創新的復元價值。
    The study aimed to explore the process, elements and meanings of mutual recovery for social workers and the clients with mood disorder, the organizational influences on the mutual recovery, and to propose strategies for mutual recovery for social workers.
    The methodology adopted in this study was hermeneutic phenomenology. Using purposive/ snowball sampling, the researcher interacted, observed, and in-depth interviewed the participants using a semi-structured interview guide. Though this process, the living experiences of the eight interviewees (five strengths-based social workers and three clients with mood disorder) were represented to reveal the nature of the phenomenon of mutual recovery.
    The major discoveries of this study include:
    1.Re-definition of mood disorder: social workers could recognize the consequence of clients being seriously excluded from the society due to their depressive or manic episode; they helped the clients to normalize their disease, as well as to break their own negative assumptions toward the disorder. The tactics that they used were such as like:a) Providing relief to suicide–personal choice and self-determination, b) giving meaning to repetitive narratives– opportunity to redefine life.
    2.“Tunnel” process, continuing to rise, the process of helping relationship: the process of strength-based social workers in developing relationship with clients with mood disorder could be categorized into five stages: imagination stage, development stage, challenge stage, cooperation stage, and recovery stage. Hence, the nature of helping relationship was like “going through the life tunnel” . The characteristics of such a relationship reflected the differential association continuum among Chinese culture.
    3.Essential meaning of mutual recovery: For the clients, the recovery experiences were as if being brought back to life. For the social workers, they rediscovered of themselves in the meaning of assisting others. The real meaning and essence of mutual recovery could be summed up as the interaction of within a person, internal and external environment, and in turn further shaping the transcendental force to help acquire the life goal. Moreover, those goal were affected by personal, relational and environmental factors.
    4.Organizational influences on mutual recovery: by analyzing the effects of organizational policies and cultures on mutual recovery, we found that “supportive surrounding” creates an environment which was better for the development of interpersonal relationship than an “challenging surrounding”. The former could help facilitate the recovery and performance of social workers, as well as decrease the turnover rate of social workers.
    Based on these findings, we propose:
    1.Strategy for forming the helping relationship with clients with mood disorder: 1) empowering individual: letting go and transform problems into respect, trust, and focusing on advantages, capabilities, and successful experiences to create options. 2) Better utilizing the effects of interpersonal relationship: by using the influences from family, maintaining the contacts in interpersonal relationship, building mutual and flexible relationship, and using the power differentiation to facilitate changes. 3) Introducing resources from surrounding: an open location and timing that connect the clients/social workers with their surrounding and culture, and enabling the linkage of resources and networks.
    2.Emphasizing mutual recovery: stressing the positive experiences that were over sighted previously and finding meaning to life and work status. The recovery of the clients and social workers will further influence their families and the whole social system, and create a benign cycle accordingly.
    3.Suggestions for organizations in promoting the strength-based model: to learn the effective ways of learning and applying strengths-based models, giving adequate encouragement and support, and providing reasonable assurance and incentives.
    4.Recommendations for future research: should understand the characteristics of mood disorder and know how to handle the situations, to expand the sources of participants, and to have the intention of creating the new meaning of recovery with participants.
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    國立政治大學
    社會工作研究所
    98264001
    102
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