地域生活をおくる精神障害者の自己概念の変容プロセス—自尊心回復グループ認知行動看護療法プログラム参加者へのインタビューから

The Changes in Self-Concept in People with Mental Disorders Living in the Community: Interviews with Participants in a Nurse-Led Group Cognitive-Behavioral Group Therapy Program for the Recovery of Self-Esteem

要旨

　本研究は，自尊心回復グループ認知行動看護療法プログラムに参加した地域で生活する精神障害者の自己概念の変容過程を明らかにした．対象はプログラム参加者10名であり，半構造面接により過去，現在，未来の流れで自己概念を尋ね，逐語録をM-GTAにより質的帰納的に分析した．その結果，《自己の殻からの心の孵化》をコアカテゴリーとする8カテゴリーが抽出された．発症後に知覚されていた【渦の中での停まり】【価値のない自分】は，【理解者による緊張緩和】を経て，【生活習慣への自負】【人に煩わされない感覚】へと変化していた．そして【新生した自分】の実感が，現在の【充実した生の体感】を導き，未来の自己に向かい【理想像の描写】を見出していた．発症後の否定的な自己概念は，理解者との出会いを契機に肯定的に変容していたことから，同じ体験を有する当事者や疾患を解する人々による安心できる雰囲気のなかで，ありのままの自己を語り，受け入れられる場の必要性が示された．

　This study clarifies the transformation process of self-concept in mentally disabled individuals residing in local communities and enrolled in a group nursing-therapy program on the cognitive behaviour of self-esteem recovery. Ten participants, who attended the programme, were questioned using a semi-structured interview about their self-concept in the past, present and future. Thereafter, the collected data were analysed qualitatively and inductively using the modified grounded theory approach (M-GTA). As a result, eight categories were extracted with ‘hatching of mind from its own shell’ being identified as the core category. Two categories, labelled ‘stagnation in a whirlpool’ and ‘worthless self,’ were perceived after the mental disorder, and they underwent ‘relief from stress through interaction with people who understand you,’ and thereafter transformed into ‘pride in one's own lifestyles’ as well as ‘a sense of not being bothered by people.’ In addition, the realisation of a ‘newborn self’ has led to the realisation of the present ‘solid sense of a fulfilling life’ and discovered a ‘description of an ideal image’ geared towards the future self. The negative self-concept resulting after the onset of illness has changed to a positive one, after meeting people who understand the illness. This shows that mentally disabled individuals need a place where they can speak out about their true selves and be accepted in a secure atmosphere with people sharing similar experiences or understanding the illness.