心理師提供犯罪被害遺族到宅心理輔導服務經驗初探

Psychologists' Experiences on Home-based Mental Health Services for the Bereaved Crime Victims

犯罪被害保護協會在執行被害遺族的心理輔導服務經常採取到宅服務輸送模式，然未曾接觸過此服務模 式之心理師對此相當陌生。本研究旨在探究心理師對被害遺族到宅輔導的在地經驗，了解其觀點、知覺 的挑戰及因應策略。本研究以發現式研究取向針對12位兩年以上提供被害遺族到宅輔導經驗的心理師， 透過半結構式深度訪談蒐集資料，採用紮根理論研究的資料分析方式。結果發現心理師對於到宅輔導的 觀點可分為四:一是到宅輔導源自提高服務輸送量，持續服務則因專業認同與社會責任;二是有關優 勢:豐厚理解、自然建立關係、有利情緒催化與覺察;三是需做的調整:彈性配合案主需求、即時調整 架構;四為成效與原因:成效好來自可處遇實際生活議題、成效自然落實生活中，成效有限與案主準備 不足、心理師主導權不足，及環境干擾影響會談深度有關。心理師知覺的挑戰有兩主題，一輔導工作慣 性的顛覆:包含安全感喪失、會談結構難掌控;二專業角色與界線的模糊:包含專業角色模糊、界線逾 越。在因應挑戰上，心理師發展出多元策略來確保人身安全、會談結構，以及平衡關係的情感連結與界 線。本研究認為被害遺族的到宅輔導具有社會正義的意涵，其成效可能與被害遺族的喪慟歷程有關，而 到宅輔導強化情感連結，心理師在設定界線上會考量維繫連結。最後依研究結果，對犯保協會及未來研 究提出建議。

 

The mental health issues caused by violent death of family members have attracted a lot of attention, and the bereaved ones may experience both symptoms of trauma and grief, and high mental health risks, such as depression, post-traumatic stress disorder, and complicated grief would also be derived from these incidences. In Taiwan, The Association for the Protection of Crime Victims (AVS) is the main unit that provides psychological trauma recovery services for the victims. This AVS often adopts home-based mental health service delivery mode. However, the home-based mental health service model is not common to the psychologists who have always accepted the office treatment training model. This research is to explore the psychologists’ views on the home- based mental health services regarding the bereaved families of crime victims, as well as the challenges perceived during the services and coping strategies.

In this study, a qualitative research method of discovery orientation was used to collect the experiences in home-based mental health service of 12 psychologists (including 4 clinical psychologists, 8 counseling psychologists, a total of 5 males and 7 females) who have more than two years of experience in providing services in a semi-structured interview. The data analysis method adopts analysis strategies such as open coding, axial coding and selective coding based on grounded theory research.

The results indicated that these psychologists’ views on home-based mental health services can be divided into four aspects: (1) The origin of home counselling and the meaning of continuous services for psychologists. The origin is to increase the volume of service delivery, and the psychologists are willing to continue to serve because of professional recognition and social responsibility; (2) Advantages of home counseling, including empathy and deep understanding, easy to build relationships naturally. It is beneficial to facilitate emotion and awareness; (3)Adjustments to home-based mental health services, including flexibility to meet client needs and background, immediate adjustment and maintain the treatment structure; (4) The effectiveness and reasons of service, which refer to good counseling effectiveness from being able to manage real life issues and the effectiveness is naturally implemented in life; the limited effectiveness of counseling is related to the lack of preparation of the client, the insufficient dominant power of the psychologist, and the interference in the house environment that affects the depth of the session.

Psychologists perceive the challenge of home counseling with two themes. First of all, the subversion of the inertia of counseling work, including loss of safety and familiarity, and difficulty in controlling the structure of the interview. Second, the blurring of professional roles and relationship boundaries which includes blurred professional roles and the crossing of professional boundaries. In response to challenges, psychologists have developed multiple strategies to ensure personal safety, the structure of meetings, and balance the emotional bond and boundaries of relationships.

Although the origin of home-based mental health services is to increase the rate of service received by bereaved victims, this study believes that the home-based mental health services has the meaning for social justice. The effectiveness of home-based mental health services may be related to the traumatic bereavement process and preparation of the victims. Such service also strengthens the emotional bond between the psychologists and clients.

In addition, it also makes psychologists caught in the pull of emotional bond and boundary. Psychologists would consider maintaining the emotional bond between each other while setting boundaries. This has also prompted researchers to reflect on the norms of therapeutic relations and boundaries under Western counseling education.