諮商心理師與邊緣型人格個案諮商之倫理議題與決策經驗

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Please use this identifier to cite or link to this item: https://irlib.pccu.edu.tw/handle/987654321/51855

Title:	諮商心理師與邊緣型人格個案諮商之倫理議題與決策經驗 Ethical issues and decision-making experience of counselors working with Borderline Personality Disorder client
Authors:	王美華
Contributors:	心理輔導學系
Keywords:	諮商心理師邊緣型人格個案倫理議題倫理經驗
Date:	2022
Issue Date:	2023-03-24 14:54:19 (UTC+8)
Abstract:	本研究主要探究諮商心理師與邊緣型人格個案諮商之倫理議題與決策經驗。本研究共三位研究參與者，三位參與者職業年資皆逾十年以上，其工作場域為醫療院所、大專院校和社區機構。訪談以半結構深度訪談進行，訪談內容依內容分析法進行資料的整理與分析。研究結果如下：諮商心理師與邊緣型人格個案諮商時所面臨的倫理議題為「高風險衝動行為」、「不穩定的諮商架構」、「界線管理困難」、「不穩定的諮商關係」、「諮商倫理認知差距」。「高風險衝動行為」中受訪者經歷驚嚇緊張與壓力的情緒，以維護個案生命為主要原則並進行多重考量的態度，進行專業評估並結合周邊資源依階段的不同提供不同介入。「不穩定諮商架構」中受訪者經歷無能為力的情緒，展現尊重個案並接納現況的態度，盡力維持架構但保持彈性。「界線管理困難」中受訪者經驗兩難無力的情緒，同理個案跨越界線的行為，但仍秉持堅持界線的態度，並尋求專業系統合作與諮詢的協助。「不穩定諮商關係」中受訪者產生自我懷疑及反移情等感受，反移情部分藉由督導等專業資源處理。「諮商倫理認知差距」中受訪者與個案自傷通報的認知有極大的差距，個案認為通報成為控制，而受訪者認為通報為履行工作承諾。經歷倫理經驗後受訪者的反思為「重新思考諮商價值觀」、「強調系統合作」和「自我信念的再確認」。本研究依據研究結果提出研究建議及實務建議，供未來相關研究或心理實務工作者參考。 This study mainly explores the ethical issues and decision-making experiences of counselors working with Borderline Personality Disorder clients. There are three research participants who have ten more years of professional working experience at a medical institution, university and community organization in this study. Data were collected in semi-structured interviews, and were analyzed by content analysis. The results are as follows: Counselors are faced with Ethical issues when they are working with Borderline Personality Disorder clients, such as "High-Risk Impulsive Behavior", "Unstable Counseling Framework", "Difficulty in Boundary Management", "Unstable Counseling Relationships" and "Discrepancy of ethics between counselor and client's understanding". "High-Risk Impulsive Behavior" refers to the feelings of panic, nervousness and stress which participants experience. Maintaining a clients’ life as the main principle, participants conduct professional assessments and provide different interventions according to different stages in combination with surrounding resources and a multi-consideration attitude. "Unstable Counseling Framework" refers to the feelings of powerlessness which participants experience. However, the participants still maintain the attitude that they respect the clients’ decision and accept it as it is. They try their best to maintain the framework with flexibility. "Difficulty in Boundary Management" refers to the experience of dilemma and the feelings of powerlessness. The participants empathize with the behavior of clients crossing the boundary which they stick to and seek the assistance of a professional system of cooperation and consultation. "Unstable Counseling Relationships" refers to the feelings of self-doubt and countertransference. The countertransference is handled by professional resources such as counseling supervision. In "Discrepancy of ethics between counselor and client's understanding", there is a huge gap in the perception of suicide prevention strategy between the counselors and the clients. The clients consider that the suicide prevention strategy deprives them of their rights, while the counselors believe that the suicide prevention strategy is fulfilling their working commitments. After the experience of ethical issues which participants have been through, their reflections on the experience include "Rethinking Counseling Values", "Emphasize Systematic Cooperation" and "Reconfirming Self-belief". Based on the results, this study puts forward suggestions for related research or psychological practitioners.
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