當前有關兒童創傷諮商的理論主要是依據心理學的原理而建立，較未探討與創傷的神經機制之關係，因此關注於不同的諮商技術或原理是否會因為與神經機制相悖離而減低諮商效果。本文從神經系統因應壓力的機制，整合心智化治療的觀點來理解兒童創傷的形成與發展，企圖建立兩者間一致性的處遇原則而使諮商效果得以提升，並整理出兒童創傷諮商指引，主要內容為：1.由下而上 （button-up）的創傷處遇方向；2.首要建立安全信任的依附基石；3.提供支持性的人際社交經驗；4.運用以感覺為基礎的創傷介入方式。並在此基礎上融入創傷後成長的復原觀點，並運用表達性藝術治療為媒介，構建兒童創傷的整合性諮商架構—「侵入性反芻（Intrusive Rumination, IR）→運用表達性藝術治療 （Expressive Art Therapy, EAT）為媒介→轉化為精緻性反芻（Deliberate Rumination, DR）」，意指藉由表達性媒材或方式為媒介，促使侵入性反芻轉化為精緻性反芻，其中轉化的機制源自於表達性藝術治療相應於神經系統的感覺 運作形式，能夠成為兒童創傷之載體，協助兒童表達情緒，進而達成修正認知、重構意義之橋接功能，達到提升心智化的能力，協助調節情緒與創傷復原。

The current theories related to children's trauma counseling are mainly based on psychological principles, and they rarely explore the relationship with the neurological mechanisms of trauma. Therefore, attention is placed on whether different counseling techniques or principles might conflict with these neurological mechanisms, potentially reducing the effectiveness of counseling. This paper seeks to understand the formation and development of children's trauma by integrating the mechanisms of the nervous system's response to stress with the perspective of mentalization-based therapy. The goal is to establish consistent intervention principles to enhance counseling effectiveness. The following guidelines for children's trauma counseling are outlined: 1. A bottom-up (button-up) approach to trauma intervention. 2. Prioritize building a foundation of secure and trusting attachment. 3. Provide supportive interpersonal and social experiences. 4. Utilize sensory-based trauma interventions. On this basis, the concept of post-traumatic growth and recovery is incorporated, using expressive arts therapy as a medium. This approach constructs an integrative counseling framework for children's trauma: "Intrusive Rumination (IR) → Expressive Arts Therapy (EAT) as a Medium → Deliberate Rumination (DR)." This framework suggests using expressive materials or methods to transform intrusive rumination into deliberate rumination. The mechanism of this transformation stems from the sensory operations of expressive arts therapy, which align with the nervous system and can serve as a vehicle for children's trauma. This method helps children express emotions, facilitating cognitive correction and meaning reconstruction. Ultimately, this enhances mentalization capabilities, helps regulate emotions, and supports trauma recovery.

心智化治療;兒童創傷;多重迷走神經理論;表達性藝術治療

Mentalization-based treatment; childhood trauma; polyvagal theory; expressive arts therapy; trauma counseling