Demmerle Christina, Gellert Paul, Kessler Eva-Marie
Department of Medical Sociology and Rehabilitation Science, Charite-Universitatsmedizin Berlin.
Department of Psychology, Medical School Berlin (MSB).
J Couns Psychol. 2023 Jul;70(4):403-414. doi: 10.1037/cou0000663. Epub 2023 Apr 10.
This study used qualitative methods to explore psychotherapists' experiences conducting at-home psychotherapy with older adults (60 + years) with long-term care needs and depression. We conducted semistructured interviews with 16 female psychotherapists (26-70 years old) who delivered at-home cognitive behavioral therapy to home-living older adults with long-term care needs and depression. We additionally conducted 10 patient case studies. Using an adaption of the methodology of grounded theory, we iteratively developed a hierarchical model. Results showed that psychotherapists experienced three dilemmas: (a) pushing for change versus acknowledging limitations, (b) providing help versus maintaining boundaries, and (c) being a guest in the patient's home versus the host of a psychotherapy session. The absence of a shared understanding of therapy and confrontation with patients' existential suffering intensified the experience of the dilemmas. The dilemmas generated professional self-doubt and negative emotions, which in turn triggered a reflexive process and ultimately participants' professional development. Participants found a way to integrate drives initially perceived as mutually exclusive, and further developed their professional self-image and therapeutic techniques. We interpret the dilemmas as reflecting difficulty reconciling the "curing" and "caring" treatment paradigms. Practice and support managing the three dilemmas along with reflection on the curing paradigm, views on old age, and fear of existential suffering should be part of qualifications for psychotherapists working with older adults in need of care. Cooperating with other care providers may relieve the pressure on psychotherapists to provide forms of support that could lead to overburden and impede therapeutic progress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
本研究采用定性方法，探讨心理治疗师为有长期护理需求且患有抑郁症的老年人（60岁及以上）提供居家心理治疗的经历。我们对16名女性心理治疗师（年龄在26至70岁之间）进行了半结构化访谈，这些治疗师为有长期护理需求且患有抑郁症的居家老年人提供居家认知行为疗法。我们还进行了10个患者案例研究。通过采用扎根理论方法的改编版本，我们迭代地开发了一个层次模型。结果表明，心理治疗师经历了三个困境：（a）推动改变与承认局限性，（b）提供帮助与保持界限，以及（c）在患者家中做客与作为心理治疗 session 的主导者。对治疗缺乏共同理解以及面对患者的生存痛苦加剧了这些困境的体验。这些困境引发了职业上的自我怀疑和负面情绪，进而触发了一个反思过程，最终促进了参与者的职业发展。参与者找到了一种方法来整合最初被认为相互排斥的驱动力，并进一步发展了他们的职业自我形象和治疗技术。我们将这些困境解释为反映了“治愈”和“关怀”治疗范式难以协调的问题。应对这三个困境的实践和支持，以及对治愈范式、老年观和对生存痛苦的恐惧的反思，应该成为为有护理需求的老年人提供服务的心理治疗师资质的一部分。与其他护理提供者合作可能会减轻心理治疗师提供可能导致负担过重并阻碍治疗进展的支持形式的压力。（PsycInfo数据库记录（c）2023美国心理学会，保留所有权利）
