目的：思覺失調症為心理疾患中盛行率極高的一個疾病，常伴隨社交功能之障礙。已有研究顯示此族群的非口語表達行為有不同於常人之傾向，此行為表現可能與人際關係建立、人際互動網絡維持等社會成果 (social outcomes) 相關。思覺失調症過去文獻相對較少探討非口語表達行為，而且許多研究採用實驗室情境。故本研究於臨床面談下錄影思覺失調症個案，將非口語行為進行客觀評量，然後比較在不同話題下的差異，並探討個案與治療師、個案與旁觀者對於會談中之治療性關係狀態評價上的認知同意度與差異。方法：本研究採方便取樣，以接受復健中之慢性思覺失調症個案 28 名為研究對象。個案與熟識之職能治療師會談並錄影，引導個案分享近期負面與正面生活經驗；個案與會談者於會談後填寫人際關係印象之評量。會談之影片透過切片方法 (thin-slices methodology) 取得每個個案負面與正面話題下之代表性片段各 20 秒；3 位研究人員則根據代表性影片，將非口語行為做量性評量；6 位招募之大學生根據代表性片段，對個案在正面與負面話題下的治療性關係進行量性評量。研究假設為：(1) 個案於分享正向話題和負向話題時之非口語行為表現有顯著不同；(2) 個案與治療師彼此關係好壞的認知同意度達中度正相關；(3) 個案與陌生旁觀者對於關係好壞的認知同意度僅達低度正相關；(4) 個案與治療師的關係認知無顯著差異；個案與旁觀者的關係認知有顯著差異。所收資料進行描述性、皮爾森相關、係數配對 t 檢定統計。結果：研究結果發現，個案在正向話題情境下，除臉上半部動作與非溝通類表達外，非口語行為外顯程度顯著高於負向話題情境。關係印象同意度上，個案自評與治療師評之關係達高度正相關；自評與旁觀者評之分數則未達顯著相關；自評之關係分數顯著大於與旁觀者評之分數。結論：此研究結果顯示，未來於臨床應用或研究中需注意不同話題情境下，個案可能會有不同之非口語行為。個案與不熟識之旁觀者，在人際印象看法上較難達到共識。此類之證據未來可用來回饋個案，提升其人際互動的自覺以及作為訓練之內容；也可衛教臨床工作者與社會大眾，降低汙名化。

Objective: Changes in nonverbal behaviors in schizophrenia may have a negative impact on social outcomes. This study investigated whether conversation contents influence nonverbal behaviors in individuals with schizophrenia, the agreement regarding perceived rapport between the individuals with schizophrenia, the therapist, & the observers; and the differences among these three viewpoints. Methods: Participants received a semi-structured videotaped interview with an acquainted therapist. After the interview, the participants and the therapist rated their impressions about rapport respectively. Three research assistants reviewed excerpts of interviews based on the thin-slice methodology to provided ratings on nonverbal behaviors. Six observers reviewed the excerpts to provide ratings on the impressions about rapport. Results: Twenty-eight participants were recruited through the convenient sampling method. The ratings of nonverbal behaviors were significantly higher during the conversation of positive experience, except for movements in upper face and non-communicated expressions. There was a high degree of agreement on rapport impressions between self-reports and therapist’s perception. The agreement between self-reported and observers were non-significant, and the magnitudes were near zero or even in a negative direction. Self-reported rapport was significantly higher than observers’ perception. Conclusion: Our results suggest that individuals with schizophrenia show different levels of nonverbally expressive behaviors in different conversation contexts. Individuals with schizophrenia tend to overestimate the degrees of rapport as compared to unfamiliar observers. Researchers and therapists should deliberately include social contexts as an important factor that influence clients’ nonverbal behaviors in future studies and clinical practice. This study provides insightful evidence for improving current social skill intervention for individuals with schizophrenia. The evidence could also be used for public education to reduce social stigma.