思覺失調症患者家庭成員知覺家庭韌力之敘事研究

Abstract

本研究旨在探討思覺失調症患者家庭成員知覺家庭韌力發展之經驗，包含家庭韌力的發展歷程、家庭面對的困境與挑戰，以及家庭韌力的特質。研究採敘事研究取向，以半結構深度訪談法，針對四位思覺失調症患者家庭成員搜集資料，以「整體—內容」、「類別—內容」進行資料分析。研究結果如下：本研究四位研究參與者的家庭韌力發展經驗可分為五階段，分別為：困境出現、家庭韌力醞釀到形成、家庭韌力受到挑戰、家庭韌力鞏固再發展、家庭韌力帶來家庭轉化，而本研究四名研究參與者的家庭所遭遇到的困境與挑戰，分別為：精神疾病的困難照顧、沈重的家庭照顧負擔、情緒與關係的傷害、疾病污名下的家庭孤立、隱晦的表達使溝通受阻。本研究四名研究參與者的家庭韌力特質可歸納為四大類別共十六項家庭韌力特質，分別有（一）克服逆境的正向信念，包含對家庭的愛與認同、接受且為逆境賦予意義、迎向未來的正面展望、信仰與靈性的超越力量；（二）彈性的家庭組織，包含替代角色的功能、強而有力的領導與決策、相互支持與合作、關係的連結與凝聚、允許離家的彈性界線；及（三）積極的溝通與問題解決，包含清晰直接的溝通、坦白的情感分享、同理與接納、因應疾病的問題解決；以及（四）家庭外的資源與幫助，包含親屬與大家族成員的支援、社區鄰里與學校師長提供幫助、醫療專業與社區資源的支持。最後，根據研究結果，提出對於國家政策、臨床工作者與未來研究的建議。The aim of this study was to explore the development of family resilience by family members of schizophrenic patients, focusing on the developmental process of family resilience, the difficulties and challenges faced by families, and the traits of family resilience. This research adopts a narrative research orientation and uses semi-structured interviews to collect data from four family members of patients with schizophrenia. The data were then analyzed in terms of “holistic content” and “categorical content.” The results of this study are as follows:The development of family resilience for the four research participants in this study can be divided into five stages: The emergence of difficulties, the formation of family resilience, the challenges of family resilience, the consolidation and redevelopment of family resilience, and the family transformation brought out by family resilience. Difficulties and challenges encountered by the families of the four research participants in this study includes: difficulty in caring for mental illness, heavy family burdens, harmful emotions and relationships, communication barriers caused by implicit expressions, and family isolation caused by social stigma.The family resilience traits of the four research participants in this study can be classified into four categories with a total of 16 traits. (1) Positive beliefs: love and recognition towards family, meaning making of adversity, stimulation for a positive outlook, transcendence through religion or spirituality; (2) Flexible family structure: alternating roles, strong authoritative leadership, mutual support and cooperation, connection and cohesion, flexible boundaries for escape; (3) Active communication and problem solving: clear and direct communication, open emotional expression, empathy and acceptance, problem solving in response to illness; and (4) Social resources: support from extended family members, neighbors, school teachers, medical professionals, and community resources.The suggestions were based on the research results and will be provided to national policy, clinicians, and future researchers.