学校適応障害に関する研究 －神経症的登校拒否児の心理治療過程の分析－
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There have been a lot of discussion made concerning school phobia, or neurotic school refusal cases, with much emphasis upon the etiology, syndrome types, and the therapy. Although some reported that psychotherapy with those cases was quite effective and successful, only little was known about the detailed psychotherapeutic process. The aim of the present study is to explore and clarify the process and the prognosis, with play-therapy technique for younger children. Subjects for this study are 26 patients who were referred to Nara Child Guidance Center between April, 1961 and March, 1965. Among them, there were two kindergarten children, seven elementary school children, thirteen junior-high school pupils and four senior-high school pupils-10 residential treatment cases and 16 out-patients. Period of psychotherapy ranged from 5 times to three years and a half. These cases were classified into four types based on the self-theory and the introjection theory. They were Type I (6 cases), Type II (6 cases), Type III (4 cases), and Type IV (10 cases).Analysis revealed the following findings: (1) a. Psychotherapeutic process Stage I. Patients showed rigid attitude, withdrawal behavior and were highly defensive or negativistic. Therapuetic situation presented threat to the patients. Stage II. Patients began to speak about their own syndromes and problem behavior, though superficially. Negative and perfunctory responses were generally seen to the therapist. But, gradually they moved, and the sense of threat was reduced in the therapeutic situation with the resulting establishment of effective therapeutic relationships. Stage III. Patients began to tell about their family relationship, and school problems. Though still egocentric, patients began to look for the relationship between those and themselves. Stage IV. Extrapunitive attitudes to others turned into those of self-orientation. Stage V. Patients' conscious and verbalized experience turned into actual behavior, and patients attempted to face squarely and slove the problems. Self-concept of them became quite flexible and patients accepted the reality experience naturally. b. Play-therapeutic process Stage I. Patients were highly defensive and passive-oriented, and sometimes, they showed rejection and antagonism. Self-concept was quite rigid. Stage II. Patients began to recognize that the therapeutic situation was not threatening and their behavior become active. They released their feelings of internal tension toward objects at first, and, then, toward the therapist. They began to examine the therapist's acceptance of them. Stage III. Patient's defense disappeared due to the permissiveness shown by the therapist, and therapeutic regression came to emerge. Dependence upon the therapist was shown. Stage IV. Warm interpersonal relationship was experienced through the therapist's acceptance of the dependent attitude shown by the patient. Thus, quite gradually, patients began to show independence and autonomy. Stage V. Patients became to express themselves quite freely, and their interpersonal relationships were characterized by flexibility. c. Therapeutic interview process with patient's mother Stage I. Mother's self-concept was confused, self-centered, and inconsistent. Over-dependence upon the therapist was conspicuous. Stage II Mother looked back upon her past, and, her statements about family relationship, patient's life history, and factors of the syndrome formation increaced. She tried to understand the cause for herself, but she was still sgo-defensive. Stage III. Mother began to tell about the relationship between the patient and herself, and look into herself. Stage IV. Mother began to look into her way of living and her view of life. She explored into her inner life. Stage V. Re-integration of the mother's self was at last achieved. Growth of self was shown. (2) Effect of therapy a. In relation to types, 100% therapeutic effect was recognized in Type I and Type II. Interrupted cases were remarkable in Type IV b. In relation to age levels, 89% theapeutic effect with elementary school children, 75% with senior-high school pupils, 69% with junior-high school pupils, were found. It was quite evident that the therapy with junior-high school pupils was rather difficult. c. There was no difference among varied types of treatments. This might be due to the fact that we motivated the residential treatment cases to become out-patients.
- 1969-11-29
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