丧亲青少年哀伤的质性研究及箱庭干预

丧亲青少年哀伤的质性研究及箱庭干预答辩日期：2008.06.06 著者:徐洁导师:张日昇【关闭窗口】英文标题：研究方向：学校心理咨询关键词:青少年; 丧亲; 哀伤; 丧亲之影响; 哀伤过程; 质性研究; 哀伤咨询; 整合式箱庭疗法中文摘要青少年是人生的关键时期，本身有其重要的发展任务需要完成。

如果在这一时期遭遇丧亲(Death of Parent)的重大丧失（Loss），将对青少年产生巨大的影响。

了解丧亲对青少年产生的影响、青少年丧亲后的哀伤（Bereavement）过程以及哀伤过程的影响因素将为青少年哀伤咨询（Grief Counseling）的临床实践提供理论依据。

本研究采用质性研究方法，首先以8名丧亲者为预访谈被试，然后选取18名在9-18岁期间一方父母去世的丧亲者为正式被试对他们进行深度访谈，采用扎根理论的逐级编码、主题分析方法以丧亲主体的视角建构了丧亲对青少年之影响的结构、青少年哀伤过程主题、哀伤过程影响因素的结构，获得了为青少年进行哀伤咨询的重要理念。

以此为基础，结合已有的理论和研究者的思考，以10名丧亲个体为预试验被试，验证了将箱庭疗法与哀伤咨询结合的可行性，然后发展出整合式箱庭疗法的干预方案，用于对一名具有复杂哀伤的12岁丧亲青少年的干预。

最后本研究获得以下研究结论： 1. 丧亲对青少年的影响面非常广泛，不仅直接影响青少年的个体功能（学校适应、生活方式、情绪、人格、人际关系、价值观），还通过影响青少年的家庭功能（家庭环境、家庭结构、家庭沟通）间接影响其个体功能。

2. 丧亲对青少年之影响可能是长期的，与青少年自身的发展任务交互作用。

3. 丧亲对青少年之影响既有负面影响，又为其带来成长的动力。

在程度、过程、影响因素方面具有个体差异性。

4. 丧亲青少年的哀伤过程有四个共同主题，面对生活的巨变（强烈的反应、否认与逃避、生活秩序的骤变、卷入家庭系统的重组）；体验丧亲的痛苦与失落（承受告别的痛苦、未完成事件的遗憾、强烈的思念与呼唤、承受死亡的真实）；在哀伤中继续生活（独自哀伤的需要、对哀伤的反思、寻找应对的方式、哀伤的反复）；重新诠释死亡（将死亡合理化、与逝者建立联结、建立死亡的意义、哀伤的超越与转化）。

5. 青少年哀伤过程的影响因素包括个人背景（人口学变量、丧亲年龄）、事件性质（死亡类型、死亡父母特点、丧葬文化、丧亲时间、次级丧失）、环境背景（继存父母特点、社会支持）。

6. 整合式箱庭疗法能提高丧亲青少年的个体功能（学校适应、自我概念、问题行为）、家庭功能（亲子关系），促进青少年个体和家庭哀伤任务的完成，个案的复杂哀伤转化为正向的成长力量。

7. 个案的个体箱庭经历了在混乱重复中寻找秩序、重建自我、转化与整合、自我治愈力展现四个阶段。

通过近3个月19次连续的个体箱庭，个案的自我力量逐步增强，由创伤走向治愈。

8. 随着自我力量的增强，个案经历了“在治疗者促进下分享—象征性表达—主动地象征性表达—直接而主动表达”哀伤的改变过程，最终获得了哀伤任务完成。

9. 整合式箱庭疗法进行哀伤咨询的治疗机制：沙、箱、玩具能够激发哀伤反应；提供安全表达哀伤经验的空间；呈现心理问题；激发自我治愈力的发挥；通过仪式完成对逝去亲人的未完成事件；建立与逝去亲人之间的联结；通过象征促进思考生死问题，建立死亡的意义；联结过去、现在、未来，实现自性；处理家庭哀伤。

外文摘要Adolescence, the critical period of life, had its own important developmental tasks. If during this period adolescent experienced the death of a parent, such significant loss would bring a great impact on them. Understanding deeply the bereavement’s impacts on adolescent, adolescent’s bereavement process following the death of a parent and the factors of bereavement process could provide the theoretical basis for grief counseling for the bereaved adolescent. With qualitative research methods, at first, we interviewed eight bereaved persons for the pre-trial and then interviewed in-depth with 18 persons who lose their one parent when they were during 9-18 year-old for formal study. By using grounded theory analysis methods, line-by-line coding analysis and theme analysis, the structure of the bereavement’s influence on adolescent, the theme of bereavement process and the structure of factors of bereavement process were explored. At the same time some important concept about grief counseling for bereaved adolescent were concluded. On this basis, combining the past theory with researcher own thinking about grief counseling, 10 bereaved persons took part in the pre-trial, which verified the feasibility of sandplay therapy being applied into grief counseling for bereaved adolescent. Then, a case study was done in which a 12 year-old girl with complex grief accepted the integrated sandplay therapy intervention program. Finally this study got the following findings: 1. Bereavement impacted on adolescent very extensively, not only directly affected their individual functioning (school adaption, way of life, emotions, personality, interpersonal relationship, values), but also by its impact on family functioning (family environment, family structure, family communication) impacted indirectly on their individual functioning. 2. Bereavement’s impact on adolescent could be long-term and had interacted with their own development tasks. 3.Bereavement impacted on adolescence not only with negative effects but also made them get growth strength. The extent, process and factors of bereavement’s impact on adolescent had individual differences. 4. Bereaved adolescent’s bereavement process had four common themes : facing life/s big changes (strong reactions; denying and avoiding; life order’s sudden changes; involvement in the reorganization of the family system); experience of suffering and loss (bearing the pain of farewell; regretting for unfinished business; strong yearning and missing; bearing the death’s truth); continuing to live in grief (the needs to bereave lonely; reflection with grief; looking for the coping strategies; the repeated bereavement); Re-interpretation of death (rationalization of death; to establish links with the deceased; establishing the meaning of death; bereavement’s transformation and transcendence). 5. The factors of adolescence’s bereavement process included that personal background factors (demographic variables, bereavement age); the feature of the incident (death types; characteristics of died parent; funeral culture; bereavement time; secondary loss); environmental background (characteristics of living parent; social support). 6. Integrated sandplay therapy could promote bereaved adolescent’s individual functioning (school adaption, self-concept, problem behaviors) and family functioning (parent-child relationship) to more positive development. It also could promote the individual and family bereavement task to be finished. After intervention, the case’s complex grief was transcended into positive growth strength. 7. The case’s individual sandtrays experienced four stages: searching for order in chaos and repeat; reconstructing ego; transformation and integration; showing of self healing. For about three months through 19 consecutive individual sandtrays, the case’s ego power gradually strengthened from trauma to healing.8. With the ego power being strengthened, the case’s bereavement experienced the changing process gradually: expressing under counselor’s promoting—symbolic expression - initiative to symbolic expression - direct and active expression of grief experience, eventually her bereavement task was finished. 9.Integrated Sandplay Therapy application in grief counseling for bereaved adolescent had its own mechanisms: sand, boxes, toys could stimulate the bereavement reaction; provide a space to express bereavement safely and freely; present psychological problem; promote self-healing; finish the unfinished businessby symbolic ritual; build the link with the died parent; reflect a question for discussion about life and death symbolically and construct the meaning of death; link the past, present, future and Self realization; dealing with family grief Key Words: Adolescent; Bereavement; Bereavement Process; Qualitative Research Method; Grief Counseling; Integrated Sandplay Therapy。