| 摘要: | 本研究主要目的在了解高齡照顧者面臨自身老化與照顧議題的心理困擾內涵，以及沙盤治療的介入對於高齡照顧者心理困擾的影響。
本研究參與者共計三位高齡照顧者，共進行八次的個別沙盤治療，每週一次60分鐘。研究者在治療歷程開始前後分別進行一次半結構訪談，並在前訪時搭配老年憂鬱量表進行評估篩選。使用質性研究的內容分析法進行資料分析，研究結果說明如下：
一、參與本研究之高齡照顧者心理困擾之內涵
（一）照顧工作所引起的複雜情緒反應 ，包含：憤怒與無助、沮喪與焦躁不安、羞愧與矛盾、失落；
（二）高齡照顧者的現實困境，包含：體力漸衰、資源有限、沉重的照顧負擔；
（三）照顧工作的社會理解落差與社會互動之困境，包含：難以被理解、遭受質疑的壓力、社交生活的限制；
二、沙盤治療對於高齡照顧者照顧負擔與心理困擾的影響
（一）對自我覺察的增加 ，包含：從要求自我改變到檢視自我狀態與現實、逐漸覺察因照顧負擔引發的心理壓力並嘗試表達、從較高的情緒強度調節至較平靜放鬆的狀態。
（二）由簡要表面的表達到真實深刻的表達，包含：表達難以負荷卻又難以割捨的矛盾情感、坦言被照顧者的不當行為引發羞愧情緒及社交壓力、從簡單表達感受到可說出對自己與家人老化的焦慮、表達更多因照顧負擔而引發的情緒壓力、表達與重要他人共同承擔照顧壓力的焦慮、從表達感恩到坦承對家人親友的失望與真實感受。
（三）開始看到更多彈性因應方式的可能性，包含：從想休息無法放手的兩難到更彈性開放的選擇、從較消極無效應對到更多元的因應方式、從不捨家人的辛苦付出到增加自主性而減少需要幫忙的無助感、從為了照顧負擔影響身心狀態到在雙方需求中取得平衡並憐惜自己、開始看到正向資源的可能性，對事物的二分法開始較放鬆。
總結來說，沙盤治療有助於高齡照顧者增進自我覺察，並協助貼近與表達內在情緒，以及協助意識自我狀態，為現階段困境發展更具彈性的因應策略。本研究依據研究結果提出具體建議，供未來相關研究及實務工作者之參考。
關鍵字：高齡照顧者、心理困擾、沙盤治療
The study aimed to understand the psychological distress experienced by elderly caregivers facing aging and caregiving issues, and to examine the effects of Sandtray therapy intervention on their psychological distress. Three elderly caregivers participated in eight weekly individual 60-minute Sandtray therapy sessions. Semi-structured interviews were conducted before and after the therapy process, along with the Geriatric Depression Scale assessment at the initial interview. Data was analyzed using qualitative content analysis.
Key Findings
1.Psychological Distress Content of Elderly Caregivers:
•Complex emotional responses to caregiving, including anger, helplessness, depression, anxiety, shame, ambivalence, and loss.
•Practical challenges of elderly caregivers, including declining physical strength, limited resources, and heavy caregiving burden.
•Social understanding gaps and interaction difficulties, including feeling misunderstood, pressure from criticism, and social life limitations.
2.Effects of Sandtray Therapy on Elderly Caregivers:
•Increased self-awareness: from self-demanding change to examining personal state and reality, recognizing caregiving-related psychological stress, and emotional regulation.
•Development from superficial to authentic expression: expressing ambivalent feelings, acknowledging shame and social pressure, discussing aging anxiety, and sharing true feelings about family relationships.
•Discovery of more flexible coping strategies: from rigid to more flexible choices, developing diverse coping methods, increasing autonomy, finding balance between caregiving and self-care, and recognizing positive resources.
Conclusion Sandtray therapy helped elderly caregivers enhance self-awareness, express inner emotions, and develop more flexible coping strategies for their current challenges. Based on these findings, specific recommendations were provided for future research and practical applications.
Keywords: elderly caregivers, psychological distress, Sandtray therapy |
