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本研究主要目的為探討實習諮商心理師的工作壓力、自我照顧重視知覺及自我照顧行為之間的關係。諮商心理師是個工作壓力特殊的行業，需要自我照顧來調節自己的工作壓力及維持專業服務的品質，而實習生是此工作的新手，對於其自我照顧狀態更需被關注。然而國外文獻中指出心理師有自我照顧不足的趨勢，在這樣的長期工作壓力及照顧不足的狀況下，容易令其陷入耗竭、同理疲乏等損傷的狀況。研究者認為若要增加諮商心理師的自我照顧能力或行為，在學習階段將自我照顧的概念或行為放入教育單位或實習單位的訓練中，讓實習諮商心理師知覺到其對自我照顧是重視的，應有助於諮商心理師執行自我照顧行為，此種知覺重視度的概念，稱為自我照顧重視知覺。然而國外的研究報告指出教育單位或實習單位並沒有積極提供自我照顧的相關課程或訓練，國內亦沒有探討實習諮商心理師知覺教育訓練單位對於自我照顧重視度的研究，且有關實習生的自我照顧研究亦不多，因此本研究欲探討此主題。研究者以問卷調查方式收集國內143位全職實習諮商心理師的資料，進一步以差異分析、相關分析及階層迴歸分析等統計方法來了解其現況及工作壓力、自我照顧重視知覺及自我照顧行為三者間的變項關係。 本研究結果指出:1.實習諮商心理師在實習期間有低程度的工作壓力，其中較高的是「專業角色壓力」以及「與督導有關的壓力」，而自我照顧重視知覺及自我照顧行為也皆為中等程度。2.實習於大專院校的實習諮商心理師，工作壓力顯著高於在高中/職及醫療院所實習的實習諮商心理師；另外大學畢業於心理相關科系及非相關科系的實習諮商心理師，其工作壓力顯著高於大學畢業於心理諮商本科系的實習諮商心理師。3.實習諮商心理師的工作壓力與自我照顧重視知覺之間達顯著低度負相關，工作壓力與自我照顧行為達顯著低度負相關，自我照顧重視知覺與自我照顧行為達顯著中度正相關。4.工作壓力在自我照顧重視知覺與自我照顧行為關係中具調節效果。研究者根據上述研究結果進行討論並對實務及未來研究提出建議。 / This study examined the relation between work-stress, perceptions of self-care emphasis, and self-care behavior among a convenience sample of 143 counseling psychology graduate students. Specifically, this study proposed that there would be a relation between graduate trainee’s perceptions of self-care emphasis and graduate trainee’s self-care behavior and that this relation would be modified by work-stress of the graduate trainee. A non-experimental designed examined the linear relations among the 3 variables, which were assessed by two measures modified by the authors (work-stress scale of陳俊任 (2012) and perceptions of self-care emphasis questionnaire of Goncher, Sherman, Barnett, & Haskins (2013)) and the self-care behavior scale of張吟慈 (2008). Results of this study showed that (1) graduate trainees had low level work-stress , moderate level perception of self-care emphasis , and moderate level self-care behaviors during internship , (2) The work-stress of graduate trainee intern in colleges is greater than in high school and in the hospital, and the work-stress of graduate trainees graduated from the department of non-psychology is greater than from the department of psychology , (3) there was a low level significant negative relation between work-stress and perceptions of self-care emphasis positive, a low level significant negative relation between work-stress and self-care behaviors, and a moderate level significant positive relation between perceptions of self-care emphasis and self-care behaviors, (4) The test for modification as outlined by Baron and Kenny (1986) demonstrated support by the survey data as perceptions of self-care emphasis was a positive predictor of self-care behaviors and that this relation was modified by work-stress. Implications for training programs are addressed, and recommendations for individual and systemic changes to promote a culture of self-care within graduate training in professional psychology are provided that should be helpful for promoting enhanced self-care behavior among psychology graduate students.

研究目的：本研究使用共通信念模式，以瞭解第二型糖尿病患者持有的疾病表徵對自我照護行為的預測關係。過去的研究顯示，糖尿病患者的「控制」表徵能夠有效預測患者的自我照護行為和糖化血色素值；也就是，患者相信疾病能被控制的程度愈高，在自我照護行為的表現愈好，糖化血色素值愈低。但是，「結果」表徵與「情緒」表徵無法顯著一致的預測患者的自我照護行為。透過回顧與健康行為相關的理論發展與文獻，考量慢性疾病的自我調節歷程中，除了疾病表徵以外，還需要納入與自我意識有關的人格特質。為此，本研究目的有四:(1)先檢驗在台灣糖尿病患者的疾病表徵建構，是否與國外使用疾病共通信念模式的研究結果一致，有相同的因素結構。(2)檢定台灣第二型糖尿病患者，其持有的疾病表徵對自我照護行為與血糖控制的預測，是否與Harvey和Lawson(2009)的研究結果一致。(3)評估糖尿病患者的人格特質對自我照護行為與糖化血色素值的影響。(4)探索第二型糖尿病患者反芻反思特質，在疾病表徵影響自我照護行為上的調節效果。 研究方法：本研究以立意取樣的方式，邀請新竹某教學醫院門診的第二型糖尿病患者為受試。排除漏答與亂填者，共有142位符合資格的受試者；每位受試者皆需完成受試者同意書、背景資料、糖尿病自我照護量表、疾病表徵問卷與中文版反芻反思量表。根據研究目的，以階層回歸和羅吉斯回歸分析等統計方法進行假設考驗。 研究結果：(1)臺灣第二型糖尿病患者的疾病表徵結構與國外患者相似，共包含：「認同」、「病因」、「時間感急慢性」、「時間感循環性」、「結果」、「情緒」和「控制」表徵。(2)研究結果與Harvey和Lawson(2009)的研究結果一致，「控制」表徵可以顯著預測整體自我照護行為和糖化血色素值。(3)第二型糖尿病患者的反芻反思特質，無法單獨預測自我照護行為與糖化血色素值。(4) 第二型糖尿病患者的反芻反思特質會與病表徵產生交互作用，共同調節各種自我照護行為的表現。 結論：本研究資料與其他使用共通信念模式的研究資料一致，亦即控制表徵能預測自我照護行為和糖化血色素值。此外，本研究發現，不同自我照護行為會受到疾病表徵與反芻或反思特質的交互作用而影響。由於，增加自我照護行為的執行度，是目前糖尿病治療與衛教的首要目標。建議未來從事糖尿病照護的實務工作者，能提供疾病表徵與反芻反思特質的專業心理評估；以協助建立個別評估與個別介入的個別化治療方案，進而提高患者在自我照護行為的執行度、增加臨床治療的效果。 / Background and Aims. It is increasingly being used to understand and predict individuals' coping with and subsequent self-care of chronic illness is Leventhal and colleagues' the common sense model. This model postulates that it is the individual's illness representation is the proximal determinant of coping behavior. The role of personality in determining self-care behavior has been relatively ignored, possibly because of the lack of convergence in concepts and measures. Due to the lack of research in the area of interest, the present study attempt to resolve this issue. We investigated, (a) using subjects of Type-II diabetes in Taiwan, are the results of present study similar as others studies directed by common sense model to identify the factors of illness representation, (b) discussing the influences of illness representation to self-care behavior and glycemic control (HbA1c); like as Harvey and Lawson(2009)’s study, (c) assessing whether traits of normal personality are associated with variations in self-care behavior and glycemic control in patients with type 2 diabetes, (d) examining whether personality moderate the relationships between illness representations and self-care behavior. Methods. Patients were eligible if they had Type 2 diabetes, were aged 20 years or more at diagnosis. Before we collect data, a physician will invite patient to enter the study. Patient want to join this study, they be giving an informed consent and be asked to complete four questionnaires. A total 142 patients completed the demographic survey ( age, educational level, diabetes duration et al.), Diabetes Self-Care Scale, the Revised Illness Perception Questionnaire(IPQ-R), the Chinese version of Rumination- Reflection Questionnaire. Analysis were concluded using multiple regression analysis, logistic regression and so on. Results. The results revealed that: (1) as our hypothesis, the structures of the IPQ-R in type 2 diabetes in Taiwan were similar as other foreign studies directed by common sense model. (2) Control representation can induce main effect on self care behavior. Higher control representation was significantly positive associated with self care behavior, and it was significantly negative associated with HbA1c. (3) Self reflection and self rumination were inconsistently associated with self care behavior and HbA1c. (4) Personality moderated the relationships between illness representations and self-care behavior. Conclusions. This study supports the Common Sense Model (CSM) of illness representation when considering type 2 diabetes in Taiwan. Based on our results, we found personality traits may offer new insights in to variations in self-care in patients with type 2 diabetes undergoing standard management. Personality refers as self-reflection and self-rumination which moderated the relationships between illness representations and self-care behavior. Therefore, CSM could become the theoretical framework for psychological interventions in type 2 diabetes. Furthermore, according to the study result, we suggested the practitioners paying attention to the different interaction when representation and personality are together in diabetes’ each self-care behavior.

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