对系统性面质技术的主题分析

Thematic research on systemic confrontation technique

目的:总结中国系统家庭治疗中使用的系统性面质技术及其临床应用要点。方法:选取国内5位家庭治疗师所做的20例个案中39小时的系统家庭治疗录像,用演绎性主题分析对治疗师使用的系统性面质技术及相应目的进行编码,归纳系统性面质的组成要素。结果:系统性面质包含例外提问、悖论技术、改释、直接挑战、支持技术、隐喻、直接建议等7要素;在对6例有自我分化不良或继发性获益表现的患者的家庭治疗中运用了该技术,运用该技术的目的是充权、软化疾病观念、呈现互动和督促改变。结论:系统性面质是一种组合技术,用于向家庭呈现维持问题的互动模式,促进成员自我分化,督促继发获益的个案放弃症状。该技术应用应建立在对家庭关系充分评估、治疗关系稳定的基础上。

Objective： To summarize the systemic confrontation technique used in Chinese systemic family therapy and its clinical use principles. Method： Thirty-nine hours of video-recordings of systemic therapy sessions from 20 cases treated by 5 therapists were purposefully sampled. The systemic confrontation techniques used by therapists and their intentions of using these techniques were coded with the deductive thematic analysis to conclude the elements of systemic confrontation technique. Results： Systemic confrontation technique was composed of 7 elements, including exceptional questioning, paradox technique, reframing, direct challenging, supporting technique, metaphor and direct advising. Nine times of systemic confrontation techniques were found in the therapy sessions for 6 families with identified patients （ IP } who had behavior for secondary-gain and lacked self-differentiation. The intentions with which therapists used systemic confrontation techniques included empowerment, softening the illness-conception, presenting interaction patterns and facilitating changes. Conclusion： Systemic confrontation is a kind of techniques combination used to confront the family members with their interaction patterns maintaining their problems, promote their self-differentiation, and urge them to abandon their secondary gain for which they had to pay too high price. The use of this technique should be based on full evaluation on the family interpersonal relationships and solid therapeutic alliance.