難以承受之重：被照顧者的自覺負擔現象與心理諮商協助

Unbearable Burden: The Caretakers’Self-Perceived Burden and Counseling Interventions

對被照顧者而言，因為自己的疾病或年齡等因素，而需要接受家人長期照顧，使得家人為此承擔各種照顧壓力，甚至造成健康問題，常會帶給被照顧者心理困擾，稱為被照顧者的「自覺負擔」。自覺負擔普遍存在於接受長期照顧的被照顧者身上，並造成其心理困擾，影響生活品質，憂鬱、焦慮等，甚至因而增加自殺的可能；或也影響醫療決策，使得被照顧者為避免繼續成為家庭負擔而忽略自身意願，影響其醫療介入方式的決定、照護或醫療地點的選擇，或隱匿身體狀況，造成照顧者或醫療人員的誤判等。凡此種種，都顯示自覺負擔困擾威脅被照顧者的身心健康，也讓家人與醫療人員無法及時協助。研究者結合相關研究與實務經驗，提出自覺負擔現象的諮商介入方向：（一）基本架構：聚焦於關係、催化與經營開放性談話、代位開啟照顧負擔議題；（二）照顧困境的澄清與面對：照顧者的實質照顧負擔、澄清被照顧者對於照顧負擔的臆測；（三）因應自覺負擔的心理困境：拓展實質公平為心理公平、賦權自我價值。最後，針對自覺負擔現象提出未來研究方向與實務建議。

The need for long-term care can have a profound impact on the serious illness patients and elderly individuals as well as their families. The empathic concern for one’s family often induces feelings of guilt, depression, and anxiety. Psychologists refer to this condition as the self-perceived burden. It has been shown to influence one’s medical decisions, such as the selection of a care facility. Some individuals under the effects of self-perceived burden have also been shown to hide their pain or avoid divulging ailments to others. In some extreme cases, it has even led to suicide attempts. This paper presents a number of counseling strategies to avoid the self-perceived burden, based on relevant research and practical experience dealing with the serious illness patients and the elderly. 1. Basic foundation: a) focus on the familial relationship, b) facilitate and maintain open dialogue among family members, and c) initiate discussions on the issues of burden of care. 2. Clarifying and working through the burden of care: a) process the real burden of caring, and b) process the subjective burden of caring. 3. Coping with psychological distress induced by self-perceived burden: a) move away from a sense of fairness in quantitative terms toward the psychological assessment of fairness, and b) empower patients by instilling in them a sense of self-worth. This paper also provides suggestions pertaining to further research in this area.