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附錄一
知後同意書 您好：
我是政治大學輔導與諮商碩士學位學程的學生，目前正在從事情緒焦點治療取向 之研究，本研究旨在探討治療者如何藉由情緒焦點治療取向，與具有兒時創傷的個案 進行諮商工作，並促進其心理健康。您的參與對本研究深具價值與重要性，請在充分 閱讀後後同意以下事項：
您將接受由諮商專業研究所的學生與您進行完整的個別晤談，預計進行 10 到 20 次，每次 50 分鐘，晤談過程將全程錄音。諮商進行方式為一對一、面對面對談。整個 諮商過程您不需負擔任何費用。
諮商過程的資料將作為研究分析的素材，不過，在呈現研究結果之前，您的身份、
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您擁有終止諮商晤談的權利與自由，如果有任何疑問，也可以要求研究者進一步 說明。研究者期望您在終止諮商之前告知，讓彼此有機會對提前結束做些澄清。
我已閱讀過上述資料，清楚地知道我所享有的權利與應當擔負的義務，並同意 參與本研究。
同意人：_________________ 研究者：_________________
時 間：民國______年_____月_____日
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計分與兒時逆境經驗的判定方式：
情緒虐待：第1 題、第 2 題任一填答「常常」或「總是」，即符合情緒虐待的標準。
肢體虐待：第3 題填答「常常」或「總是」，或是第四題填答「有時」、「常常」或
「總是」，即符合肢體虐待的標準。
性虐待：第5 至題任一填答「有時」、「常常」或「總是」，即符合性虐待的標準。
情感忽視：第9 題至 13 題中，「從未如此」計 1 分，「總是如此」計 5 分，5 題累積 得分達15 分或以上，即符合情感忽視的標準。
肢體忽視：第14 題至 18 題中，「從未如此」計 1 分，「總是如此」計 5 分，5 題累積 得分達10 分或以上，即符合肢體忽視的標準。
媽媽被暴力對待：第19 至 20 題任一填答「有時」、「常常」或「總是」，或是第 21 至22 題任一填答「一、兩次」、「有時」、「常常」或「總是」，即符合媽媽被暴力 對待的標準。
家中物質成癮、家中精神疾患、分居或離婚、入獄：第23 至 27 題若答是，即符合對 應的兒時逆境經驗類別。
21. 你的媽媽（或是繼母）多常被爸爸（或是繼 父）毆打持續數分鐘？
22.你的媽媽（或是繼母）多常被爸爸（或是繼 父）持刀槍威脅或以刀槍傷害？
否 是 23.同住的人曾有酒精成癮的問題。
24. 同住的人曾有藥物毒品成癮的問題。
25.同住的人曾有憂鬱症或其他心理/精神疾病，或是有人曾試圖自 殺。
26.你的雙親曾經分居或離婚。
27.同住的人曾入獄服刑。