対象関係の変化と二面性への配慮—導入期に病室を訪問した症例

Two purposes for visiting the hospital room

要旨：作業療法がどのような「場」で行われるか，場が治療経過や結果に影響を与える．病室という場を訪問することは，「治療者としての関心を示す」という治療的な意味合いと「不用意な侵襲」という二面性を併せ持っている．本稿では作業療法の導入期に病室を訪問した症例を通して，治療経過における対象関係の変化を治療構造の視点からまとめ，病室という場を訪問する二面性と，その二面性を生かす配慮について検討した．症例は，約20年間未治療のまま自宅で自閉的に過ごし，作業療法の関わりを通して関係性と生活の場が拡がり，グループホームへの入所が決まった女性である．

　The purpose of this paper is to show the change of the object relationship and the start of the change. The case is 37-years-old woman with schizophrenia. She had been in her house for about twenty years and had not seen a doctor. She had withdrawn into her shell and won't open her heart to anyone in the hospital. I visited her hospital room to built up the therapeutic ralationship because the doctor in charge prescribed to communicate her.

　The visiting a hospital room has opposite two meanings, "to show therapeutic cares to patient" and "to invade the patient's mind territory". In the case, I could build the therapeutic relationship because of visiting with consideration. When visiting, I didn't talk her to come to the occupational therapy room. I didn't talk her to make something or to do something too. I only devoted enough time to the patient to watch me. After several visits she came to the occupational therapy room by herself.