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中文摘要
EMDR是一項緣起於西方國家的新興治療方法，目前已有許多研究證實其對創傷之療效，然而臺灣地區缺乏相關研究，故本研究試圖應用EMDR於國內之臨床心理治療實務、進行一個探索性的個案研究，藉此瞭解PTSD案主在參與EMDR治療過程中的經驗，以及評估PTSD案主在接受EMDR介入過程及治療前後的差異，企盼國內應用EMDR的起點自此開啟。
本研究之PTSD案主在接受美國總會認可之EMDR治療師參與治療，於結案後，由研究者邀請成為研究參與者。研究者於EMDR治療結案後四個月及六個月，與研究參與者及其太太進行訪談、並進行觀察，並在徵得研究者參與者同意之情況下，蒐集治療過程中的相關紀錄以及案主自我觀察紀錄。研究者將PTSD案主於接受EMDR介入前後之歷程撰寫成為一治療案例，並且將有關資料進行整合與分析，歸結出 PTSD 案主在參與 EMDR 治療過程中的經驗，以及 PTSD 案主在接受EMDR 介入過程及治療前後的差異，並進一步討論PTSD案主使用精神用藥之影響。
本研究之整理與發現如下：
一、本案例之PTSD案主與太太共同參與前後為期四個月、共計19次的療程，期間透過EMDR處理了三項創傷事件，案主的身心狀況獲得大部分的舒緩，因此結束EMDR療程，在後續的追蹤亦發現案主的身心適應狀況相當穩定，並無嚴重的復發情形。
二、本案例之PTSD案主在參與EMDR治療過程中的認知想法轉換為正向、情緒感受則消除了負向情緒；案主在EMDR治療過程中的生理感受較不敏銳，但在治療結束時皆能進入放鬆之狀態。
三、經歷嚴重發病及EMDR治療之後，本案例之PTSD案主大多數的症狀已經解除，在身心警覺度和生活功能方面，相較於發病前的程度是有差別的；然而在面對生活中的壓力源時，案主能夠運用EMDR治療過程學習到的新技巧進行自我安撫以恢復身心狀態的平衡。
四、本案例顯示出EMDR的介入以及精神藥物造成PTSD案主的身心症狀改善情況是二者相輔相成造成的效果； EMDR治療師與案主所建立的信任關係開啟了案主穩定接受身心合併治療之契機。
針對上述研究結果，研究者進行以下討論：
(1) 案主「發病」後的生理症狀及求助管道，反應出國人的壓力反應及求助行為；
(2) 本案例之EMDR介入過程，協助案主正視與處理創傷議題，且介入過程符合創傷療癒之原則與策略；
(3) EMDR之介入，有效協助臺灣地區案主解除情緒和生理症狀，並造成認知上的轉換，顯示EMDR具跨文化之效用，且案主之改善情況符合國際創傷性壓力研究學會治療指導手冊所提醒治療目標新興之關注面向；
(4) EMDR合併藥物治療，打破案主生心理的惡性循環；(5) EMDR介入與案主自陳之進步情形，療效呈現一致上升的現象。
研究者針對研究結果及相關討論，建立一則以EMDR介入治療PTSD之邏輯模型，並進一步提出有關實務及研究上的建議，以供後續參考。
關鍵字：眼動減敏與歷程更新治療、創傷後壓力疾患
The Efficacy of EMDR in the Treatment of PTSD: A Case
Study
Hsin-Yi Hsieh
Abstract
Regarded as one newer therapy originated
from Western countries, Eye
Movement Desensitization and Reprocessing (EMDR) has been proven efficient by
numerous researches. However, due to the
fact that there is not much related research in Taiwan,
this study aims at a psychological therapy practice applying EMDR in Taiwan
for the future exploration. Via a client’s
positive result from the therapy and the comparison before and after the intervention
of EMDR to the Post Traumatic Stress Disorder (PTSD) therapy, it is anticipated
that EMDR will be practiced more in the psychotherapeutic field and thus dispersed
in Taiwan.
The
researcher invited the interviewee for this study after the closure of his therapy with an EMDR therapist certified in the USA.
The researcher interviewed the interviewee and his wife after the closure of the
therapy had passed four months and six months respectively. With the
interviewee’s permission, all related records to the process and the interviewee’s
self-observation are collected as the reference material for this study. The case
description developed by the researcher contains the process before and after the
intervention of the EMDR therapy. The research has also collaborated pertinent
materials to analyze the interviewee’s experience during the process of therapy
and to distinguish all differences
before and after the intervention of the EMDR therapy, as well as to discuss the
effects caused by psychiatric medication to the interviewee.
The procedure and the findings of this
study are listed as follow:
1.
The interviewee and his wife had totally been through a four month
therapy with nineteen sections, in
which three traumas the interviewee had experienced were targeted by the EMDR
therapy. During the therapy, the
interviewee stably adjusted and benefited a lot. In the follow-up tracking, the interviewee
was found to have adapted and recovered well afterward.
2.
Also during the therapy, the interviewee’s cognition turned positive
along with the ease of the negative motions. The interviewee was insensitive
but could usually relax himself when the section came to an end.
3.
After the interviewee went through the severe morbidity and underwent the
intervention of the EMDR therapy, most of the interviewee’s symptoms were eased
even though the aspects of physical arousal and daily functions differed from
those before the morbidity. However, when facing the source of pressure, the
interviewee could adopt new skills learned from the EMDR therapy to comfort and
balance himself both mentally and physically.
4. The
case study has revealed that that the interviewee’s improvement is an effect
mutually caused by the intervention of EMDR and the psychiatric medication; the key to the success of this case
should be attributed to the trust
established between the EMDR therapist and the interviewee that serves as a
critical turning point for the interviewee to accept the combined treatment
from psychological and pharmaceutical therapies.
Based on the result mentioned
above, the researcher has proposed the following discussions:
1. The interviewee’s physical condition and
consultation channel reflect the Taiwanese people’s reactions to pressure and
help-seeking behaviors.
2. The intervention of EMDR helps the
interviewee face and deal with the trauma, and the process of the intervention meets
the principles and strategies of the trauma remedy.
3. The intervention of EMDR not only effectively
helps the clients in Taiwan
ease emotional
and physical symptoms, but also significantly leads to the clients’ cognitive
transformation. This explains that EMDR contains cross-cultural effects. In
addition, the improvements seen on the interviewee meet the treatment goal and the
new issues mentioned in Practice
Guidelines for the International Society for Traumatic Stress Studies.
4. The combination of the interventions of EMDR
and medication breaks the vicious stress cycle between the interviewee’s body
and mind.
5. The interventions of EMDR and the self claims
by the interviewee have shown the consistent positive effect.
Based on the study result and
pertinent discussions, the researcher has established a logic model for the
intervention of EMDR to the PTSD therapy and proposed further academic and
clinical suggestions for future study.
Keywords: EMDR, PTSD
本研究的目的在於探討EMDR療法對有個人失落之當事人的介入效果，藉由深入瞭解當事人在治療過程中的主觀經驗與改變歷程，試圖釐清EMDR療法如何幫助當事人走出個人失落，展現自信與活力。研究者邀請一位願意分享個人生命經驗與EMDR治療經驗的研究參與者，利用半結構式訪談大綱進行訪談，並在研究參與者的同意之下，取得相關治療紀錄。研究者將各類資料彙整後，將研究參與者的生命經驗撰寫為一治療案例，呈現研究參與者接受EMDR療法的經驗。隨後研究者將相關資料進行分析，歸納研究參與者在EMDR治療介入過程中的改變歷程，並進行競爭性解釋之討論。
本研究的研究結果如下：
一、 本治療案例之當事人，接受EMDR治療介入為期約12個月、共42次的療程，期間透過EMDR處理11項事件，當事人身心不適之症狀大部分已獲得改善。其後在當事人的要求下進行為期約6個月的後續追蹤。
二、在EMDR治療介入過程中，採BLS處理事件時，當事人的（1）負向認知想皆由正向認知或新詮釋取代；（2）負向情緒大部分能全數消除，或由負向情緒轉為正向情緒；（3）身體不適的感受大多能獲得紓解，進入放鬆而舒服的狀態。
三、當事人在EMDR介入後，對過去的失落經驗已能釋懷，對自己充滿信心，情緒轉為穩定，並能主動維繫夫妻關係。當事人的解離症狀與各種生理不適的症狀幾乎完全消失，在工作上感到游刃有餘，並能運用各種方法安撫自己。
四、本研究無法完全排除其他心理治療介入與精神醫療介入對當事人身心狀態轉變之影響，可看見不同領域的心理助人工作者齊頭並進的幫助當事人。
針對本研究之結果，研究者進行以下討論：（1）失落經驗影響當事人的內在運作模式，進而改變其行為反應；（2）本研究之治療案例，突顯個體適應中年期之重要性；（3）當事人經由身心症狀反映自我保護的需求，治療師對當事人身心症之處遇，符合Van Rood與De
Roos（2009）之觀點；（4）治療師是當事人重要的情感支持來源；（5）本研究治療案例之EMDR介入過程，治療師對當事人解離症狀的處遇，符合Forgash與Knipe（2008）、以及Van
der Hart、Nijenhuis與Steele（2006）對治療解離症狀的觀點；（6）本研究之EMDR介入過程中，當事人自覺身心不適症狀獲得紓解，生活適應功能逐漸恢復；（7）依據研究結果與上述討論內容，建立本研究之邏輯模型。最後研究者依據上述研究結果與討論，針對未來研究及實務工作提出進一步建議，以供參考。
Pin-Chieh
Chu
Abstract
The purpose of this study is to explore the treatment outcomes from
the intervention of Eye Movement Desensitization and Reprocessing (EMDR) with
personal loss. Through in-depth understanding of the client’s subjective
experiences and changing courses throughout the entire therapeutic process, the
researcher intends to prove that EMDR therapy has efficaciously helped the
client overcome the trauma from personal loss and regain confidence and
vitality. The researcher has interviewed a client who is willing to share his
life and EMDR therapy experiences through a semi-structured questionnaire. With
the client’s permission, the researcher has obtained the client’s clinical
records. After methodically synthesizing the various data, the researcher has
developed a case description presenting both the life experience and the
intervention of EMDR therapy of the client. The researcher has analyzed the
data, generalized the client’s adaptive coping processes throughout EMDR
therapy and discussed the effects from the psychiatrist’s and other counselors’
interventions.
The research has found that:
1. The client underwent eleven out of forty-two sessions with the
intervention of EMDR therapy over a twelve-month period and achieved
substantial relief. Upon the client’s request, a follow-up tracking has
proceeded for six months.
2. During the EMDR therapy process, the client was helped through the
bilateral stimulation (BLS) to deal with the trauma, and the client’s (1)
negative cognition either turned to positive or was replaced by new
interpretations; (2) negative emotions were removed or turned to positive; and
(3) physical symptoms were eased, which provided relief and comfort to the
client.
3. After the intervention of EMDR therapy, the client has become able
to accept his personal loss, felt confident in himself, and been stable in
emotion, as well as has maintained his marital relationship wholeheartedly.
Relieving from the dissociation and physical symptoms, the client feels
competent on his job and can now use a variety of ways to comfort himself.
4. The research cannot completely eliminate the effects from the
interventions of psychological and psychiatric therapies. As a result, the
research indicates that helpers from different domains all work hard to help
the client.
Based on the findings, the researcher proposes the following
analyses:
1.
The experience from personal
loss influences the client’s internal function model and thus transforms the
client’s behavior.
2.
The case study illustrates the
importance of adaptation in the middle age.
3.
The somatic and psychological symptoms reflect the
client’s needs for self-protection. The intervention of EMDR therapy thus fits Van Rood and De Roos’s
perspectives (2009).
4.
The EMDR therapist is an
important emotional-support source for the client.
5.
During the intervention of EMDR
therapy, the therapist’s handling of the client’s dissociative symptoms fits
the perspectives of Forgash & Knipe (2008) and Van der Hart, Nijenhuis, & Steele
(2006) in treating dissociation.
6.
During the process of EMDR
therapy, the client feels relief from his somatic
and psychological symptoms and regains his life function.
7.
The researcher has established
a logical model for the intervention of EMDR therapy in the cases of personal
loss.
In conclusion, based on the research outcomes and analytic
discussion above, additional suggestions for future research and practice are
proposed.
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