精障病友家屬團體與專業之權力互動－兼論社工之介入策略

Abstract

權力(power)原屬社工專業關係的核心要素，但專業人員卻常不自覺的忽略了案主與專業間不平權的處境，更遑論發展能引發案主潛能的充權策略了。由於精神病患及其家屬是所有身心障礙類型案主中較少受社工專業關照的一群，故而精障家屬自助團體的研究，不啻提供了一個理想的場域來檢視專業與案主的權力互動關係。台灣地區的精神病友家屬團體到底如何興起？而專業人員在這些家屬團體發展的各階段又扮演什麼角色？本研究採Hasenfeld在1992年所提出的「政治經濟」觀點，先瞭解台灣地區精神病友家屬團體的發展，然後以「權力依賴」觀點剖析其間專業人員與這些案主群的互動關係。透過量化資料(所有精神病友家屬團體問卷調查)及質化資料(深入訪談、參與觀察、及家屬自助團體檔案分析)的蒐集，完成以下研究目的：(1)瞭解台灣地區精神病友家屬(自助)團體整體的形成動力及發展過程，(2)探討精神病友家屬(自助)團體之運作策略，(3)剖析不同專業與精神病友家屬(自助)團體之互動，期能發展出一些「充權策略」。結果發現精障家屬團體之興起可歸納為自發性、衛生局拉拔、或醫院代組三種類型，在其形成動力及其後組織的結構及規模都有較明顯歧異；至於在組織的生存邏輯、及與各專業的競合上，雖未必截然劃分，卻也有其特色。最後根據以上發現，再剖析相關學者論述中較具體可行的充權策略，供台灣地區有志服務精障家屬團體的社工人員參考。

Disregarding the core role of "power" in the social work professional relationship, the imbalanced power structure between the profession and their clients has been long ignored. Accordingly, the empowerment strategies to activate the client's potentials have not been well developed. Since the needs of the mentally ill and their families have been less cared by the social work profession in Taiwan, studying the self-help groups with mentally ill family members in Taiwan will serve as a perfect opportunity to examine the power dynamics between the professions and their clientele. How have the self-help groups with mentally ill family members in Taiwan been emerging by different forces? What roles have the professions played at different stages of self-help group development? Hasenfeld's political-economy perspective has been based to understand the development of the self-help groups with mentally ill family members in Taiwan, and the interaction between each profession and clientele was analyzed with reference to "power dependence". Combining both quantitative (survey questionnaire of all 21 existing self-help groups with mentally ill family members) and qualitative data (in-depth interview, participant observation, and inside documents of self-help groups), the researcher has accomplished the following goals: (1)To understand the formulation dynamics and development of these self-help groups in Taiwan, (2) To explore their operation strategies, (3) Based on the interaction between different professions and these self-help groups to generate some empowerment strategies. It is found that the emergence of these self-help groups could be attributed to three forces: self-initiation, subordinate to the local health unit or hospital. They have very different formulation dynamics, structures and sizes. As to their operation logics and interacion with different professions, not mutually exclusive, but unigue stragtegies could be observed. Based on the above findings, feasible empowerment principles have been generated from some scholars' discourses to help the social work professionals who are committed to work with these groups.