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Lorenz-Artz K, Bierbooms J, Bongers I. Unraveling complexity in changing mental health care towards person-centered care. Front Psychiatry 2023; 14:1250856. [PMID: 37779631 PMCID: PMC10536252 DOI: 10.3389/fpsyt.2023.1250856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Mental health care (MHC) needs to shift towards person-centered care to better meet people's individual needs. Open Dialogue (OD) is well-aligned with this perspective and brings it into practice. This study focuses on exploring the change process within a pilot project involving three MHC teams as they transition to a person-centered OD practice. Our aim is to identify and reflect on the challenges faced by MHC professionals in adopting person-centered care, and shedding light on the underlying complexity of these challenges. By gaining a better understanding of these obstacles, we hope to contribute to the adoption of the person-centered approach in MHC practice. Methods Our research employed a qualitative design, involving a total of 14 semi-structured interviews with MHC professionals who were either trained in OD, OD trainees, or MHC professionals without OD training. To analyze the data, we utilized a hybrid approach that combined deductive - and inductive thematic analysis. Results We identified four distinctive challenges: (1) understanding and knowledge transfer, (2) (inter)personal process, (3) emotional discomfort, and (4) the need for multi-stakeholder participation and support. In practice, these challenges intersect and the appearance of and relationships between these challenges are not linear or disentangleable. Conclusion Upon careful consideration of these interdependent challenges, it became evident that embedding a person-centered approach like OD brings about systemic change, leading to an unfamiliar situation X. The research findings indicated that understanding and conveying the concept of person-centered care in practical settings poses significant challenges. The field of knowledge management helps to capture the complexity of understanding and transferring this knowledge. The change process necessitates an (inter)personal process and elicits emotional discomfort, as person-centered OD practice confronts a deeply entrenched paradigm in MHC. Achieving a shared understanding of person-centered care requires dedicated time and attention, while introducing this approach prompts broader discussions on underlying values and human rights in MHC. Current implementation efforts may underestimate or overlook these underlying values, but initiating an open dialogue can serve as an initial step in addressing the complexities.
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Affiliation(s)
- Karin Lorenz-Artz
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Mental Health Care Institute, Eindhoven, Netherlands
| | - Joyce Bierbooms
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Mental Health Care Institute, Eindhoven, Netherlands
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Tavares S, Ribeiro J, Graça S, Araújo B, Puchivailo M, Pereira JG. The first Portuguese Open Dialogue pilot project intervention. Front Psychol 2023; 14:1175700. [PMID: 37767212 PMCID: PMC10520700 DOI: 10.3389/fpsyg.2023.1175700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction In 2020, the Directorate General of Health (DGS), a central service of the Ministry of Health in Portugal, approved and co-financed the first Open Dialogue program in the country. The present report aims to demonstrate the preliminary results of the first year of the project, implemented in the northern interior region of Alentejo. Methods Seven people at the Center of Concern (PCC) and 21 family members/social networks received care through Open Dialogue; four external social workers and psychologists were also involved in the project as members of the support network. A total of 160 network meetings were undertaken, reaching as many as 27 per month in the busiest periods. Based on a previous Italian Research Protocol, developed by Pocobello et al. (non-published manuscript), quantitative and qualitative data were collected in and after the clinical meetings involving PCC and their family/social network, through a multi-method approach: clinical history interview (e.g., generic research on sociodemographic data, duration of untreated symptoms, reasons for requesting help, possible hospitalizations, and/or treatments/therapies) and the following scales applied every five sessions (e.g., CORE-OM, BSI, GAF, and LSNS-6). Results The preliminary results indicate an improvement in global functioning and the enlargement of social network size/support, a decrease in symptoms, and a negative correlation between the number of sessions and the LSNS6. Medication use remained largely unchanged at the end of the project. Discussion In general, even with a small sample, the results are considered satisfactory and seem to be aligned with the vast majority of Open Dialogue studies, which for several decades have consistently pointed toward better recovery rates than treatment as usual as well as increased client satisfaction. We expect that the results presented can boost further research and help strengthen the OD approach.
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Affiliation(s)
- Sofia Tavares
- Department of Psychology, Évora University, Évora, Portugal
- Department of Psychology, CIEP, University of Évora, Évora, Portugal
| | - Joana Ribeiro
- Instituto Universitário de Ciências Psicológicas, Sociais e da Vida (ISPA)—Instituto Universitário, Lisbon, Portugal
| | - Sofia Graça
- Romão de Sousa Foundation, Estremoz, Portugal
| | | | - Mariana Puchivailo
- Department of Psychology, FAE University Center, Curitiba, Paraná, Brazil
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3
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Smith SM, Kheri A, Ariyo K, Gilbert S, Salla A, Lingiah T, Taylor C, Edge D. The Patient and Carer Race Equality Framework: a model to reduce mental health inequity in England and Wales. Front Psychiatry 2023; 14:1053502. [PMID: 37215650 PMCID: PMC10196047 DOI: 10.3389/fpsyt.2023.1053502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
The Patient and Carer Race Equality Framework (PCREF) is an Organisational Competence Framework (OCF), recommended by the Independent Review of the Mental Health Act as a means to improve mental health access, experience and outcomes for people from ethnic minority backgrounds, particularly Black people. This is a practical framework that should be co-produced with and tailored to the needs of service users, based on quality improvement and place-based approaches. We aim to use the PCREF to address the longstanding epistemic justices experienced by people with mental health problems, particularly those from minoritised ethnic groups. We will outline the work that led to the proposal, the research on racial inequalities in mental health in the UK, and how the PCREF will build on previous interventions to address these. By taking these into account, the PCREF should support a high minimum standard of mental health care for all.
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Affiliation(s)
- Shubulade Mary Smith
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Amna Kheri
- UCL Medical School, University College London, London, United Kingdom
| | - Kevin Ariyo
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Steve Gilbert
- Steve Gilbert Consulting, Birmingham, United Kingdom
| | - Anthony Salla
- Oxytocin Learning Community Interest Company, Oxfordshire, United Kingdom
| | - Tony Lingiah
- Kingston Hospital, Kingston upon Thames, United Kingdom
| | - Clare Taylor
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
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Sidis A, Bøe T, Karlsson B, Lidbom P, Moore A, Pickard J, Deane F. In defence of loose ends: Psychotherapy process research in the real world. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Sampolahti T, Laitila A. Play and liberty: A brief incursion into some ideological currents in the history of systems-oriented family therapy. FAMILY PROCESS 2023; 62:35-48. [PMID: 36127842 DOI: 10.1111/famp.12819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
We reflect on family therapy and its history from two points of view, as an entity that becomes understood with the help of a twofold concept of a game, and a twofold concept of liberty. Systemic family therapy has always been comprehended with the help of game theory. Its development becomes more properly understood if we keep in mind that game itself is a dualistic concept entailing both a cultural and a logico-mathematical interpretation of a game. We show how cultural ethos has molded the ways how game metaphor have been implemented to systemic thinking. In the same manner we show how Isaiah Berlin's idea of two incompatible concepts of liberty helps to contextualize family therapy in a way that its connections to sociopolitical theories of liberty become obvious. We believe that we have been able to demonstrate, how this twofold recontextualisation enriches the understanding of the ideological history of the family therapy. We claim that our reflections imply that family therapy is essentially a dualistic endeavor, that in the amid of it is a rift that cannot become repaired but only contemplated, that integrity of family therapy requires that we preserve both conflictual views, and don't try to simplify situation by abandoning one or the other. As a result, our article intends to develop further and deepen the idea that is originally presnted in the article "Strategy and intervention or non-intervention: A matter of theory" by Harold Goolishian and Harlene Anderson.
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Heumann K, Kuhlmann M, Böning M, Tülsner H, Pocobello R, Ignatyev Y, Aderhold V, von Peter S. Implementation of open dialogue in Germany: Efforts, challenges, and obstacles. Front Psychol 2023; 13:1072719. [PMID: 36846479 PMCID: PMC9948650 DOI: 10.3389/fpsyg.2022.1072719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/20/2022] [Indexed: 02/11/2023] Open
Abstract
Purpose The Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany. Methods This article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated using a thematic analysis approach. Results While having to adapt to the fragmented German health care system, OD has been mainly implemented from outpatient service providers and stand-alone services. About half of the teams implemented OD under the conditions of cross-sectoral model contracts and, thus, are considerably limited when it comes to OD implementation. Altogether, OD is not implemented to its full extent in each of the institutions surveyed. Similarly, the expert interviews revealed various challenges that mainly relate to the realization of OD's structural principles, whereas the implementation of its therapeutic benefits remains less affected. However, these challenges have managed to lead to great commitment by single teams and a certain level of implementation of OD-related concepts. Conclusion OD in Germany can currently only be fully implemented under the cross-sectoral care model contract system that is often temporary, thus significantly hindering its continuous development. Any evaluation of OD's effectiveness in Germany thus needs to take into account the fragmented nature of the country's health care system and control for the multiple barriers that impede implementation. Reforms of the German health care system are also urgently needed to create more favorable conditions for the implementation of OD.
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Affiliation(s)
- Kolja Heumann
- Integrated Working Group “Mental Health”, Brandenburg Medical School, Brandenburg an der Havel, Germany,*Correspondence: Kolja Heumann, ✉
| | - Mira Kuhlmann
- Integrated Working Group “Mental Health”, Brandenburg Medical School, Brandenburg an der Havel, Germany
| | - Maike Böning
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Helene Tülsner
- Department of Social Work, Alice Salomon University, Berlin, Germany
| | - Raffaella Pocobello
- National Research Council of Italy, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
| | - Volkmar Aderhold
- Department of Psychiatry, Charité University Medicine, Berlin, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
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Mosse D, Pocobello R, Saunders R, Seikkula J, von Peter S. Introduction: Open Dialogue around the world - implementation, outcomes, experiences and perspectives. Front Psychol 2023; 13:1093351. [PMID: 36704667 PMCID: PMC9872833 DOI: 10.3389/fpsyg.2022.1093351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- David Mosse
- Department of Anthropology and Sociology, SOAS University of London, London, United Kingdom,*Correspondence: David Mosse ✉
| | - Raffaella Pocobello
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Rob Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, United Kingdom
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Central Finland, Finland,Department of Psychosocial Health, University of Agder, Kristiansand, Vest-Agder, Norway
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Chmielowska M, Mannocci N, Tansel A, Zisman-Ilani Y. Peer support and shared decision making in Open Dialogue: Opportunities and recommendations. Front Psychol 2022; 13:1059412. [PMID: 36571005 PMCID: PMC9773137 DOI: 10.3389/fpsyg.2022.1059412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Open dialogue (OD) is a person-centred social network model of crisis and continuing mental healthcare, which promotes agency and long-term recovery in mental illness. Peer support workers who have lived experience of mental illness play a key role in OD in the UK, as they enhance shared understanding of mental health crisis as part of the OD model and provide a sense of belonging and social inclusion. These elements are in alignment with the shared decision making (SDM) approach in mental health, which focuses on person-centred communication in treatment decision-making. The previously documented benefits of peer-led SDM include increased engagement with services, symptom reduction, increased employment opportunities, and reduced utilization of mental and general health services. While the contribution of peer support and SDM principles to OD has been acknowledged, there is only a small body of literature surrounding this development, and little guidance on how peer support can enhance treatment decision-making and other aspects of OD. This viewpoint, which was co-authored by people with lived experience of mental illness, clinicians, and researchers, discusses practical implications and recommendations for research and training for the provision of a co-produced OD model grounded in peer support and SDM.
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Affiliation(s)
- Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- North East London NHS Foundation Trust Research and Development Department, London, United Kingdom
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Nell Mannocci
- North East London NHS Foundation Trust Research and Development Department, London, United Kingdom
| | - Alexander Tansel
- North East London NHS Foundation Trust Research and Development Department, London, United Kingdom
| | - Yaara Zisman-Ilani
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, United States
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9
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Bergström T, Seikkula J, Alakare B, Kurtti M, Köngäs-Saviaro P, Löhönen E, Miettunen J, Mäkiollitervo H, Taskila JJ, Virta K, Valtanen K. The 10-year treatment outcome of open dialogue-based psychiatric services for adolescents: A nationwide longitudinal register-based study. Early Interv Psychiatry 2022; 16:1368-1375. [PMID: 35332989 PMCID: PMC10078679 DOI: 10.1111/eip.13286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 01/15/2023]
Abstract
AIM To evaluate the 10-year treatment outcomes and cost-effectiveness of adolescents' mental health treatment initiated under the social network-oriented open dialogue (OD) approach. METHODS This longitudinal register-based study included all persons who, for the first time, received psychiatric treatment in Finland during the period 1 January 2003-31 December 2008, and who were aged 13-20 at onset (n = 44 868). The OD group included all persons whose treatment commenced in the Western Lapland catchment area (n = 780), this being the only region in Finland where OD covered the entire mental healthcare service at the time of inclusion. The comparison group (CG) included the rest of Finland (n = 44 088). The primary outcome variables were psychiatric treatment and/or disability allowances at the end of the 10-year follow-up, or death. The secondary outcome variables were treatment and disability expenses. Generalized linear models weighted by inverse probability of treatment were used to study the association between OD and the primary outcomes. Population proportions were used to evaluate the cost-effectiveness of the approaches. RESULTS Treatment that commenced outside OD was associated with higher odds of continuing to receive treatment (adjusted odds ratio [aOR] 1.4; 95%CI 1.2-1.6) and disability allowances (aOR 1.6; 95%CI 1.2-2.1) at the end of the 10-year follow-up. No significant difference in the mortality ratio emerged. The cumulative 10-year expenses per capita were lower under OD. CONCLUSIONS OD associated with favourable long-term outcomes, but due the observational design and possible residual confounding, further studies with a more robust research design are required.
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Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.,Faculty of Health and Sport, University of Agder, Kristiansand, Norway
| | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Mia Kurtti
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | | | - Elina Löhönen
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | - Jyri J Taskila
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Katriina Virta
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Kari Valtanen
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
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Sidis AE, Moore A, Pickard J, Deane FP. “Always opening and never closing”: How dialogical therapists understand and create reflective conversations in network meetings. Front Psychol 2022; 13:992785. [PMID: 36275250 PMCID: PMC9580692 DOI: 10.3389/fpsyg.2022.992785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Tom Andersen’s reflecting team process, which allowed families to witness and respond to the talk of professionals during therapy sessions, has been described as revolutionary in the field of family therapy. Reflecting teams are prominent in a number of family therapy approaches, more recently in narrative and dialogical therapies. This way of working is considered more a philosophy than a technique, and has been received positively by both therapists and service users. This paper describes how dialogical therapists conceptualise the reflective process, how they work to engage families in reflective dialogues and how this supports change. We conducted semi-structured, reflective interviews with 12 dialogical therapists with between 2 and 20 years of experience. Interpretative Phenomenological analysis of transcribed interviews identified varying conceptualisations of the reflecting process and descriptions of therapist actions that support reflective talk among network members. We adopted a dialogical approach to interpretation of this data. In this sense, we did not aim to condense accounts into consensus but instead to describe variations and new ways of understanding dialogical reflecting team practices. Four themes were identified: Lived experience as expertise; Listening to the self and hearing others; Relational responsiveness and fostering connection; and Opening space for something new. We applied these themes to psychotherapy process literature both within family therapy literature and more broadly to understand more about how reflecting teams promote helpful and healing conversations in practice.
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Affiliation(s)
- A. E. Sidis
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- *Correspondence: A. E. Sidis,
| | - A.R. Moore
- School of Humanities and Social Inquiry, University of Wollongong, Wollongong, NSW, Australia
| | - J. Pickard
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - F. P. Deane
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Jauhar S, Lawrie SM. What is the evidence for antipsychotic medication and alternative psychosocial interventions for people with acute, non-affective psychosis? Lancet Psychiatry 2022; 9:253-260. [PMID: 35114137 DOI: 10.1016/s2215-0366(21)00293-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/21/2021] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
In this Personal View, we critically appraise and summarise evidence for antipsychotic drugs and alternatives to drug treatment, with a focus on people in their first episode or acute relapses of schizophrenia and related conditions within the first 5-10 years of illness. There is a large body of generally moderate quality evidence from randomised controlled trials for antipsychotics in both treating acute psychosis and reducing relapse, in thousands of people in their first episode and in established illness. There is a much smaller evidence base, of generally low quality, in a few hundred people, for potential benefits of non-drug interventions, such as cognitive behavioural therapy, Open Dialogue, Soteria, and psychoanalytic psychotherapy.
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Affiliation(s)
- Sameer Jauhar
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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12
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Tironi E, Barrett D, Rayner D, Dillane S, Trapolini T, Hewitt R, Henry E, Rhodes P. Worlding Eco-psychology: a Collective Bio-ethnography. HUMAN ARENAS 2022. [DOI: 10.1007/s42087-022-00274-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractIn this paper, eight practicing psychologists, a dog (Oscar), white cockatoos, crimson rosellas, blue gums, plum blossoms, the words of theorists of eco-psychology and post-humanism joined together for two days with the mountains of the Darug and Gundungurra peoples, to explore questions about psychology and its capacity to respond to the climate crisis. We designed a series of psychoterratic exercises for this purpose: (1) a bio-graphical definitional ceremony, (2) a series of short lectures and readings set to the poetics of open dialogue, (3) a sympoietic vegetal-thinking exercise, (4) a bush-psychogeography and (5) a final reflection on praxis. We present our findings, written in bricolage, a compost of experiences and ideas both horizontal and vertical, written, drawn and photographic.
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Pilling S, Clarke K, Parker G, James K, Landau S, Weaver T, Razzaque R, Craig T. Open Dialogue compared to treatment as usual for adults experiencing a mental health crisis: Protocol for the ODDESSI multi-site cluster randomised controlled trial. Contemp Clin Trials 2021; 113:106664. [PMID: 34958932 PMCID: PMC8844585 DOI: 10.1016/j.cct.2021.106664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022]
Abstract
Background ‘Open Dialogue’ is a social network model of crisis and continuing mental healthcare which involves elements of service delivery such as immediate response and a style of therapeutic meeting called network meetings. Although there are indications from non-randomised studies that it may help people in their recovery from severe mental health crises and improve long-term outcomes, this has yet to be tested in a randomised controlled trial. Methods This paper outlines the protocol for a multi-site cluster-randomised control trial assessing the clinical and cost-effectiveness of Open Dialogue compared to treatment as usual (TAU) for individuals presenting in crisis to six mental health services in England. The primary outcome is time to relapse, with secondary outcomes including measures of recovery and service use. Participants will be followed-up for two years, with data collected from electronic medical records and researcher-led interviews. The analysis will compare outcomes between treatment groups as well as investigating potential mediators of effect: shared decision-making and social network quality and size. Carers of a subsample of participants will be asked about their experiences of shared decision-making, carer burden, and satisfaction. Discussion This trial will provide evidence of whether Open Dialogue services implemented in the English mental health system is an effective alternative to current care and may have important implications for the organization of community mental health services. Trial registration: retrospectively registered (108 participants recruited of 570 target) on 20/12/2019, ISRCTN52653325.
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Affiliation(s)
- Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Pl, London WC1E 7HB, UK.
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Pl, London WC1E 7HB, UK
| | - Georgie Parker
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Pl, London WC1E 7HB, UK
| | - Kirsty James
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Sabine Landau
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Timothy Weaver
- Middlesex University, Department of Mental Health & Social Work, Room TG70, Ground Floor Town Hall, School of Health and Education, The Burroughs, London NW4 4BT, UK
| | - Russell Razzaque
- North East London Foundation Trust, Research and Development Department, 1st Floor Maggie Lilley Suite, Goodmayes Hospital, Barley Lane Ilford, IG3 8XJ London, UK
| | - Thomas Craig
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8AB, UK
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von Peter S, Bergstrøm T, Nenoff-Herchenbach I, Hopfenbeck MS, Pocobello R, Aderhold V, Alvarez-Monjaras M, Seikkula J, Heumann K. Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach. FRONTIERS IN SOCIOLOGY 2021; 6:806437. [PMID: 35004940 PMCID: PMC8727686 DOI: 10.3389/fsoc.2021.806437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 06/01/2023]
Abstract
In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD's internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.
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Affiliation(s)
| | - Tomi Bergstrøm
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Mark Steven Hopfenbeck
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Raffaella Pocobello
- National Research Council of Italy, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Volkmar Aderhold
- Department of Psychiatry, Charité University Medicine, Berlin, Germany
| | - Mauricio Alvarez-Monjaras
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jaakko Seikkula
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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Der Offene Dialog – Netzwerkgespräche als Leitidee therapeutischen Handelns. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Lorenz-Artz K, Bierbooms J, Bongers I. Integrating eHealth within a Transforming Mental Healthcare Setting: A Qualitative Study into Values, Challenges, and Prerequisites. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10287. [PMID: 34639587 PMCID: PMC8508136 DOI: 10.3390/ijerph181910287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 11/23/2022]
Abstract
Mental health care is shifting towards more person-centered and community-based health care. Although integrating eHealth within a transforming healthcare setting may help accomplishing the shift, research studying this is lacking. This study aims to improve our understanding of the value of eHealth within a transforming mental healthcare setting and to define the challenges and prerequisites for implementing eHealth in particular within this transforming context. In this article, we present the results of 29 interviews with clients, social network members, and professionals of an ambulatory team in transition within a Dutch mental health care institute. The main finding is that eHealth can support a transforming practice shifting towards more recovery-oriented, person-centered, and community-based service in which shared-decision making is self-evident. The main challenge revealed is how to deal with clients' voices, when professionals see the value of eHealth but clients do not want to start using eHealth. The shift towards client-centered and network-oriented care models and towards blended care models are both high-impact changes in themselves. Acknowledging the complexity of combining these high-impact changes might be the first step towards creating blended client-centered and network-oriented care. Future research should examine whether and how these substantial shifts could be mutually supportive.
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Affiliation(s)
- Karin Lorenz-Artz
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (J.B.); (I.B.)
- Mental Health Care Institute Eindhoven, 5626 ND Eindhoven, The Netherlands
| | - Joyce Bierbooms
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (J.B.); (I.B.)
- Mental Health Care Institute Eindhoven, 5626 ND Eindhoven, The Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (J.B.); (I.B.)
- Mental Health Care Institute Eindhoven, 5626 ND Eindhoven, The Netherlands
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17
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Hestmark L, Heiervang KS, Pedersen R, Hansson KM, Ruud T, Romøren M. Family involvement practices for persons with psychotic disorders in community mental health centres - a cross-sectional fidelity-based study. BMC Psychiatry 2021; 21:285. [PMID: 34078306 PMCID: PMC8170939 DOI: 10.1186/s12888-021-03300-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement. METHODS We employed three fidelity scales, with 12-14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales. RESULTS The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale. CONCLUSIONS The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.
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Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway.
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
| | | | - Torleif Ruud
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
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Cunha C, Figueiredo C, Salgado J. “Let’s Dance”: A Dialogical Proposal for Analyzing Interactions and Positions in Couples Therapy. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2021. [DOI: 10.1080/10720537.2020.1717149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Carla Cunha
- University Institute of Maia, ISMAI & Center for Psychology at University of Porto – CPUP, Maia, Portugal
| | | | - João Salgado
- University Institute of Maia, ISMAI & Center for Psychology at University of Porto – CPUP, Maia, Portugal
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Jacobsen RK, Grov EK, Østefjells T, Karlsson B. Open Dialogue Approach: Exploring and Describing Participants' Experiences in an Open Dialogue Training Program. J Psychosoc Nurs Ment Health Serv 2021; 59:38-47. [PMID: 33440012 DOI: 10.3928/02793695-20210107-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Open dialogue (OD) is a family-oriented approach that has demonstrated good outcomes in treatment of first-episode psychosis. OD focuses on communication as a joint process of constructing meaning among patients, their social networks, and professionals. The current study investigates how 42 participants experienced a training program in OD. The study comprises a cohort with a longitudinal design. Data were collected by means of semi-structured questionnaires and contained quantitative and qualitative data. Descriptive analysis was performed to analyze quantitative data and thematic analysis for qualitative data. Findings show that participants' learning outcomes and confidence with using OD with patients, social networks, and professionals increased significantly throughout the training program. Reflection and role play were essential learning methods. Participants defined themselves as in-progress and considered the training program educational, engaging, and varied. Three main themes arose from the data: Developing an OD Training Program, Competence Development "From Novice to Expert," and Participation and Commitments. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 38-47.].
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20
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Larsen-Barr M, Seymour F. Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication. Ther Adv Psychopharmacol 2021; 11:2045125321989133. [PMID: 33796264 PMCID: PMC7970681 DOI: 10.1177/2045125321989133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is well-known that attempting antipsychotic withdrawal can be a fraught process, with a high risk of relapse that often leads people to resume the medication. Nonetheless, there is a group of people who appear to be able to discontinue successfully. Relatively little is known about how people do this. METHODS A convenience sample of adults who had stopped taking antipsychotic medication for more than a year were recruited to participate in semi-structured interviews through an anonymous online survey that investigated antipsychotic medication experiences in New Zealand. Thematic analysis explored participant descriptions of their efforts to maintain their wellbeing during and after the withdrawal process. RESULTS Of the seven women who volunteered to participate, six reported bipolar disorder diagnoses and one reported diagnoses of obsessive compulsive disorder and depression. The women reported successfully discontinuing antipsychotics for 1.25-25 years; six followed a gradual withdrawal method and had support to prepare for and manage this. Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely, and saw this as something that evolved over time. They described managing the process and maintaining their wellbeing afterwards by 'understanding myself and my needs', 'finding what works for me' and 'connecting with support'. Sub-themes expand on the way in which they did this. For example, 'finding what works for me' included using a tool-box of strategies to flexibly meet their needs, practicing acceptance, drawing on persistence and curiosity and creating positive life experiences. CONCLUSION This is a small, qualitative study and results should be interpreted with caution. This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterwards. Findings suggest internal resources and systemic factors play a role in the outcomes observed among people who attempt to stop taking antipsychotics and a preoccupation with avoiding relapse may be counterproductive to these efforts. Professionals can play a valuable role in facilitating change.
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Affiliation(s)
| | - Fred Seymour
- School of Psychology, The University of Auckland, Auckland, New Zealand
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21
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Wusinich C, Lindy DC, Russell D, Pessin N, Friesen P. Experiences of Parachute NYC: An Integration of Open Dialogue and Intentional Peer Support. Community Ment Health J 2020; 56:1033-1043. [PMID: 32036517 DOI: 10.1007/s10597-020-00556-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
Guided by the principles of Open Dialogue and Intentional Peer Support (IPS), Parachute NYC was designed to provide a "soft landing" for people experiencing psychiatric crisis. From 2012 to 2018, Parachute's teams of clinicians and peer specialists provided home-based mental health care to enrollees and their networks (family, friends), seeking to engage and improve their natural support networks. This qualitative study examined the experiences of enrollees and network members who participated in Parachute. Participants reported that they valued the accessibility and flexibility of Parachute as well as their relationships with, and the lack of hierarchy within, the Parachute team. Responses to the structure of network meetings and Parachute's approach to medication were mixed, with a few participants struggling with what they felt was a lack of urgency and others experiencing the approach as holistic. Many enrollees and network members reported that Parachute improved their self-understanding and relationships with each other.
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Affiliation(s)
- Christina Wusinich
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA.
| | - David C Lindy
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA.,College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY, 10001, USA.,Department of Sociology, Appalachian State University, 209 Chapell Wilson Hall, 480 Howard Street, Boone, NC, 28608, USA
| | - Neil Pessin
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA
| | - Phoebe Friesen
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA.,Biomedical Ethics Unit, Social Studies of Medicine, McGill University, 3647 Peel St., Montreal, QC, H3A 1X1, Canada
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22
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Abstract
Studies of antipsychotic medication, which are increasingly prescribed for a broad range of problems and circumstances, rarely ask the people who take them to describe their experiences with the drugs. In this study, 650 people, from 29 countries, responded, in an online survey, to "Overall in my life antipsychotic medications have been _____?" and "Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?" Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones. Negative experiences were positively correlated with age. Thematic analysis identified 749 negative, 180 positive, and 53 mixed statements. The 2 positive themes were "symptom reduction" (14) and "sleep" (14), with the majority (153) unspecified. The 4 negative themes (besides "unspecified"-191) were: "adverse effects" (316), "interactions with prescriber" (169), "withdrawal/difficult to get off them" (62), and "ineffective" (11). The adverse effects included: weight gain, emotional numbing, cognitive dysfunction, sedation, akathisia, effects on relationships, and suicidality. "Interactions with prescriber" included lack of information about withdrawal effects, support, or discussion of alternatives. The only mixed theme was "short-term good, long-term bad" (28). Open questions can add to findings from methodologies focused on symptom reduction. Clinicians should pay more attention to the need for respectful and collaborative patient-prescriber relationships. At the point of prescription, this must include providing the full range of information about antipsychotics, including potential benefits and harms, difficulties withdrawing, and information on alternatives treatments such as psychological therapies.
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Affiliation(s)
- John Read
- Department of Psychology, University of East London – Stratford Campus, London, UK,To whom correspondence should be addressed; University of East London – Stratford Campus, Water Lane, London E15 4LZ; tel: +44 (0)208 223 4943, e-mail:
| | - Ann Sacia
- Department of Psychology, University of East London – Stratford Campus, London, UK
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Marlowe NI, Nicholson Perry K, Lee J. Ontological insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic-like experiences. J Clin Psychol 2019; 76:440-460. [PMID: 31800105 DOI: 10.1002/jclp.22905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine ontological insecurity as a predictor of positive psychotic-like experiences (PLEs) relative to concepts of childhood trauma, parental bonding, and adult attachment style. METHODS A nonclinical sample (N = 298) completed the Ontological Insecurity Scale (OIS-34), a new measure of ontological insecurity, along with measures of the above concepts. RESULTS The OIS-34 accounted for a significantly greater proportion of unique variance in positive PLEs than any other theoretical variable. Anxious and avoidant adult attachment were also strongly associated with positive PLEs, but these relationships were mediated by the OIS-34, ceasing to be significant once this latter variable entered the hierarchical regression equation. CONCLUSIONS The results are consistent with R. D. Laing's theory that ontological insecurity plays a significant role in psychosis. Moreover, the results suggest that this concept may mediate the established relationship between anxious/avoidant adult attachment and positive PLEs. Implications for psychological approaches to clinical psychosis are discussed.
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Affiliation(s)
| | - Kathryn Nicholson Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Jacob Lee
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
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Dawson L, River J, McCloughen A, Buus N. ‘Should it fit? Yes. Does it fit? No’: Exploring the organisational processes of introducing a recovery-oriented approach to mental health in Australian private health care. Health (London) 2019; 25:376-394. [DOI: 10.1177/1363459319889107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the implementation of an innovative approach to mental health care in a private health setting. Open Dialogue is a recovery-oriented approach to mental health that emerged in Finland, which emphasises family involvement, interdisciplinary collaboration and a flexible, needs-adapted approach. Early research is promising; however, little research has explored Open Dialogue outside Finland. This study aimed to explore the introduction of this approach at a private, inpatient young-adult mental health unit in Australia. Drawing on data from a long-term ethnographic field study that included 190 hours of observation and qualitative interviews, the findings show that despite staff members being inspired by and supportive of Open Dialogue, the existing ideology and organisational structures of the unit conflicted with the integration of Open Dialogue principles. Dialogical ways of working were challenged by medical dominance and emphasis on economic efficiencies. This study emphasises the importance of a ‘good’ fit between organisational cultures and innovations. It also highlights the challenges of moving towards recovery-oriented and family-focused models of care in the Australian neoliberal health care context. There is a need for organisational and ideological change in health services that is receptive to, and meaningfully supports, efforts to implement recovery-oriented care.
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Affiliation(s)
- Lisa Dawson
- The Centre for Family-Based Mental Health Care, St. Vincent’s Private Hospital Sydney, Australia
| | | | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Niels Buus
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; The Centre for Family-Based Mental Health Care, St. Vincent’s Private Hospital Sydney, Australia; St. Vincent’s Hospital Sydney, Australia; and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Marlowe NI, Nicholson Perry K, Lee J. Ontological insecurity I: Psychometric development of a new measure and relationship to subclinical psychotic-like experiences. J Clin Psychol 2019; 76:423-439. [PMID: 31476249 DOI: 10.1002/jclp.22849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The present study sought to develop a new psychometrically sound measure of ontological insecurity, the OIS-34 and, determine its relationship with subclinical psychotic-like experiences (PLEs). METHODS A nonclinical sample (N = 600) completed an initial 60-item version of the new scale along with measures of PLEs, psychosis proneness, and mental health history. RESULTS Exploratory factor analysis indicated a single factor, ontological insecurity, with 34 items loading positively and above a criterion of 0.4. Internal consistency and test-retest reliability were excellent. The OIS-34 correlated positively and significantly with psychosis proneness and subclinical positive and negative symptom PLEs. The OIS-34 also differentiated significantly between participants with and without a history of mental health problems, including psychosis. CONCLUSIONS The OIS-34 appears to represent a psychometrically sound measure of ontological insecurity. The results suggest that the concept is associated with PLEs. Directions for further research are discussed.
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Affiliation(s)
| | - Kathryn Nicholson Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, NSW, Australia
| | - Jacob Lee
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, NSW, Australia
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26
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The association between Open Dialogue to young Danes in acute psychiatric crisis and their use of health care and social services: A retrospective register-based cohort study. Int J Nurs Stud 2019; 91:119-127. [DOI: 10.1016/j.ijnurstu.2018.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/19/2018] [Accepted: 12/16/2018] [Indexed: 01/11/2023]
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27
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Kantorski LP, Cardano M. [Open Dialogue and the Challenges for its Implementation - an analysis based on a review of the literature]. CIENCIA & SAUDE COLETIVA 2019; 24:229-246. [PMID: 30698256 DOI: 10.1590/1413-81232018241.32232016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/04/2017] [Indexed: 11/21/2022] Open
Abstract
METHOD The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the literature on the Open Dialogue Method, this article sought to identify the principles and contributions for deinstitutionalization.The PubMed (365), PsycInfo (134), Lilacs (no articles found) databases and 2 books were consulted. Thirty-four publications that fulfilled the requirements of this review were selected. The search was conducted in October 2015. The key words used were: open dialogue, crisis, first psychotic episode, schizophrenia, family therapy, need-adapted approach. RESULTS There were 3 reviews, 5 theoretical studies, 21 qualitative studies and 5 quantitative studies. Two of them were written in Italian, one in French and thirty-one in English. The authors were from Norway, the United States, Finland, Australia, the United Kingdom, Belgium, Canada and Poland. The publications were grouped for purposes of analysis into the following categories: Open Dialogue concepts and principles; Open Dialogue contributions; Challenges for Open Dialogue implementation in other countries, realities and contexts.
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Affiliation(s)
- Luciane Prado Kantorski
- Faculdade de Enfermagem, Universidade Federal de Pelotas. R. Gomes Carneiro 1, Centro. 96010-610 Pelotas RS Brasil.
| | - Mario Cardano
- Dipartimento di Culture, Politica e Società, Università degli Studi di Torino. Torino Piemonte Itália
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Bergström T, Seikkula J, Alakare B, Mäki P, Köngäs-Saviaro P, Taskila JJ, Tolvanen A, Aaltonen J. The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen-year outcomes. Psychiatry Res 2018; 270:168-175. [PMID: 30253321 DOI: 10.1016/j.psychres.2018.09.039] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/03/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19-20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach.
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Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | | | - Jyri J Taskila
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Asko Tolvanen
- The Methodology Center for Human Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jukka Aaltonen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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Boardman J. Mental Health and Social Care and Social Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112328. [PMID: 30360463 PMCID: PMC6267323 DOI: 10.3390/ijerph15112328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 06/08/2023]
Abstract
In common parlance, the term 'social' is used in many senses ranging from the way society is organised to the rank or status someone has in society; to activities that involve meeting with other people; to the experience, behaviour and interaction of persons forming groups; and to promoting companionship and communal activities. [...].
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Affiliation(s)
- Jed Boardman
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London SE5 8AF, UK.
- Centre for Mental Health, Unit 2D21, Technopark, South Bank University, 90 London Road, London SE1 6LN, UK.
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Jacobsen RK, Sørgård J, Karlsson BE, Seikkula J, Kim HS. “Open Dialogue behind locked doors” – exploring patients’, family members’, and professionals’ experiences with network meetings in a locked psychiatric hospital unit: A qualitative study. ACTA ACUST UNITED AC 2018. [DOI: 10.15714/scandpsychol.5.e5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Ramon S. The Place of Social Recovery in Mental Health and Related Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061052. [PMID: 29789511 PMCID: PMC6025044 DOI: 10.3390/ijerph15061052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/23/2022]
Abstract
This article looks at the place of social recovery in mental health and social care services, alongside personal recovery. Despite its conceptual and practice centrality to the new meaning of recovery, social recovery has remained a relatively neglected dimension. This article attempts to provide an updated critical commentary based on findings from fifty nine studies, including a variety of research methodologies and methods. Definitions of social recovery within the new meaning of recovery are looked at. This is followed by outlining the development and significance of this dimension as reflected in the key areas of shared decision making, co-production and active citizenship, re-entering employment after experiencing mental ill health, being in employment, poverty and coping with poverty, the economic and the scientific cases for social recovery. The article highlights the connections between service users’ experiencing mental health and social care systems, and the implications of ideologies and policies reflecting positions on social recovery. The complexity of social recovery is indicated in each of these areas; the related conceptual and methodological frameworks developed to research this dimension, and key achievements and barriers concerning everyday practice application of social recovery. The summary indicates potential future development perspectives of this dimension.
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Affiliation(s)
- Shulamit Ramon
- Department of Nursing (Children, Learning Disability and Mental Health) and Social Work, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
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Stringfellow A, Evans N, Evans AM. Understanding the impact of eating disorders: using the reflecting team as a learning strategy for students. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:117-121. [PMID: 29412036 DOI: 10.12968/bjon.2018.27.3.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article outlines how the application of a reflecting team from systemic family therapy practice was used as a learning strategy for a postgraduate programme for healthcare students. The programme was designed to increase the students' skills, knowledge and awareness of the needs of people with eating disorders, and their families. There were some benefits to this learning strategy. Students reported that the use of a reflecting team enabled them to gain a deep understanding of the emotional impact of eating disorders on individuals and their carers. However, as this method of learning was new to the students, they needed some initial instruction on the approach. During the programme of study, it became evident that the health professionals were deeply affected by the experiences of people with eating disorders. This would suggest that possibly it was the presence of the sufferers themselves as part of the reflecting team that provided the pivotal learning opportunity, rather than the reflecting team per se.
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Affiliation(s)
| | - Nicola Evans
- Senior Lecturer, Mental Health Nursing, Cardiff University, Cardiff
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Summers A, Martindale B. Using psychodynamic principles in formulation in everyday practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.112.010181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryWe try to demonstrate that using psychodynamic principles as part of case formulation is both possible and useful in everyday practice. We consider steps to developing a psychodynamically informed formulation, frameworks that can be used to structure this, and processes and resources needed to support good-quality formulation. We discuss the potential value of incorporating psychodynamic thinking and emphasise that this is complementary to other frameworks for understanding psychosis. Detailed case studies are provided.
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Rosenbaum B, Martindale B, Summers A. Supportive psychodynamic psychotherapy for psychosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.111.009142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThe UK National Institute for Health and Care Excellence guidance suggests that psychodynamic principles may be used to understand the experiences of people with psychosis. In this article we consider the application of psychodynamic principles in psychotherapy for psychosis, focusing on one particular model: supportive psychodynamic psychotherapy (SPP). We describe this approach with a detailed fictitious case example and discuss how SPP has developed through significant modifications of classical psychoanalytic therapy and the evidence base for it. We consider its overlap with cognitive–behavioural therapy, its advantages and disadvantages, and the arguments for making SPP available as a treatment option in services for psychosis.
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Galbusera L, Kyselo M. The difference that makes the difference: a conceptual analysis of the open dialogue approach. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1397734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Laura Galbusera
- Berlin Center for Knowledge Research, Technical University of Berlin, Berlin, Germany
| | - Miriam Kyselo
- Berlin Center for Knowledge Research, Technical University of Berlin, Berlin, Germany
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Bergström T, Alakare B, Aaltonen J, Mäki P, Köngäs-Saviaro P, Taskila JJ, Seikkula J. The long-term use of psychiatric services within the Open Dialogue treatment system after first-episode psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1344295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tomi Bergström
- Department of Psychiatry, Western Lapland Health District, Tornio, Finland
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Birgitta Alakare
- Department of Psychiatry, Western Lapland Health District, Tornio, Finland
| | - Jukka Aaltonen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | | | - Jyri J. Taskila
- Department of Psychiatry, Western Lapland Health District, Tornio, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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Martindale B. A Psychoanalytic Contribution to Understanding the Lack of Professional Involvement in Psychotherapeutic Work with Families where there is Psychosis. BRITISH JOURNAL OF PSYCHOTHERAPY 2017. [DOI: 10.1111/bjp.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Buus N, Bikic A, Jacobsen EK, Müller-Nielsen K, Aagaard J, Rossen CB. Adapting and Implementing Open Dialogue in the Scandinavian Countries: A Scoping Review. Issues Ment Health Nurs 2017; 38:391-401. [PMID: 28165840 DOI: 10.1080/01612840.2016.1269377] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Open Dialogue is a resource-oriented mental health approach, which mobilises a crisis-struck person's psychosocial network resources. This scoping review 1) identifies the range and nature of literature on the adoption of Open Dialogue in Scandinavia in places other than the original sites in Finland, and 2) summarises this literature. We included 33 publications. Most studies in this scoping review were published as "grey" literature and most grappled with how to implement Open Dialogue faithfully. In the Scandinavian research context, Open Dialogue was mainly described as a promising and favourable approach to mental health care.
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Affiliation(s)
- Niels Buus
- a Faculty of Nursing and Midwifery , University of Sydney , Camperdown , New South Wales , Australia , and Centre for Family-Based Mental Health Care, St. Vincent's Private Hosptial Sydney , Darlinghurst , New South Wales , Australia and St. Vincent's Hospital Sydney , Darlinghurst , New South Wales , Australia
| | - Aida Bikic
- b Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark , and Child and Child and Adolescents Psychiatry Unit , Aabenraa , Denmark
| | | | - Klaus Müller-Nielsen
- d Child and Child and Adolescents Psychiatry Unit , Aabenraa and Kolding Hospital , Aabenraa , Denmark
| | - Jørgen Aagaard
- e Clinical Institute , Aalborg University Hospital , Psychiatry , Aalborg , Denmark and Aarhus University Hospital , Risskov , Aarhus , Denmark
| | - Camilla Blach Rossen
- f Interdiciplinary Research Unit , Regional Hospital Silkeborg , Silkeborg , Denmark and Psychiatric Unit , Svendborg , Svendborg, Denmark
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Abstract
RESUMO O Diálogo Aberto é um método desenvolvido na década de 1980, na Finlândia, para o enfrentamento da crise psicótica. Este artigo é um ensaio teórico que tem como objetivo apresentar o Diálogo Aberto em seus princípios e enquanto prática de saúde mental desinstitucionalizante, enfatizando seu potencial terapêutico, seus resultados e suas contribuições para outros países. Conclui-se que, para a implementação do Diálogo Aberto em outros contextos, é necessária uma mudança organizativa na estruturação dos serviços e uma substantiva mudança cultural no interior da equipe e da comunidade.
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Diagnoses in and out of time: historical and medical perspectives on the diagnoses of distress. Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2016-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractFocusing on the medical approach to the subjective forms of distress, this article has a three-fold argument. First, the historical starting point of diagnosing distress was neurasthenia during the last two decades of the 19th century. Second, the diagnosis of neurasthenia that initially contained more somatic than mental symptoms was gradually replaced by the more psychologically conceptualized neuroses. Such a psychiatrization of neurosis gradually separated mental and somatic syndromes into two distinct diagnostic categories, those of mental and somatic. Third, when modern “neuroses” are seen in the framework of distress rather than disease, it provides tools for new kinds of interventions, in which the principal aim is to alleviate the subjective distress with all possible and reasonable means and methods. As the social context constitutes a crucial “etiology” to medicalized forms of distress, we need new, context-based approaches to both analyze and alleviate such distress. In our historical and medical approach to these “diagnoses of distress”, we are guided by the belief that analyzing diagnostic categories can provide important insight into the mechanisms behind our changing conceptions of health and wellbeing.
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Affiliation(s)
- Ruth Y Pavlovic
- Nottinghamshire Healthcare NHS Trust; Nottingham Psychotherapy Unit; St Ann's House 114 Thorneywood Mount Nottingham Nottinghamshire UK NG3 2PZ
| | - Aleksandar Pavlovic
- Derbyshire Healthcare Foundation NHS Trust; General Adult Psychiatry; Chesterfield Royal Hospital, Hartington Unit Calow Chesterfield UK S44 5BL
| | - Stephen Donaldson
- Tees, Esk and Wear Valley NHS Trust; Ayckbourn Unit; Cross Lane Hospital Cross Lane Scarborough UK YO12 6DN
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Adame AL. “Present Through It All”: A Qualitative Exploration of Psychotherapy and Psychosis. JOURNAL OF HUMANISTIC PSYCHOLOGY 2016. [DOI: 10.1177/0022167816665524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article provides an overview of a qualitative study that focused on psychotherapists’ experiences of working with people struggling with psychosis. I interviewed four therapists in private practice about their experiences working with this population and describe many aspects of their work including how they understood the nature of psychosis, how they envision process of psychotherapy, and challenges they have faced. I used interpretive phenomenological analysis to analyze the therapists’ interviews. The findings of this project highlight the necessity of a supportive therapy relationship and the therapists’ genuine interest and respect for their clients.
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Olson M. An Auto-Ethnographic Study of "Open Dialogue": The Illumination of Snow. FAMILY PROCESS 2015; 54:716-729. [PMID: 26133053 DOI: 10.1111/famp.12160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This auto-ethnographic study describes the changes in the author's thinking and clinical work connected to her first-hand experience of Open Dialogue, which is an innovative, psychosocial approach to severe psychiatric crises developed in Tornio, Finland. In charting this trajectory, there is an emphasis on three interrelated themes: the micropolitics of U.S. managed mental health care; the practice of "dialogicality" in Open Dialogue; and the historical, cultural, and scientific shifts that are encouraging the adaptation of Open Dialogue in the United States. The work of Gregory Bateson provides a conceptual framework that makes sense of the author's experience and the larger trends. The study portrays and underscores how family and network practices are essential to responding to psychiatric crises and should not be abandoned in favor of a reductionist, biomedical model.
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Affiliation(s)
- Mary Olson
- Department of Psychiatry, The University of Massachusetts Medical School, Worcester, MA
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McKeown M, White J. The future of mental health nursing: are we barking up the wrong tree? J Psychiatr Ment Health Nurs 2015; 22:724-30. [PMID: 26459922 DOI: 10.1111/jpm.12247] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M McKeown
- University of Central Lancashire, School of Health, Preston, United Kingdom
| | - J White
- University of Hull, Faculty of Health and Social Care, Hull, Yorkshire
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Summers A. Working Towards A UK Randomized Controlled Trial of Psychodynamic Therapy for Psychosis. BRITISH JOURNAL OF PSYCHOTHERAPY 2015. [DOI: 10.1111/bjp.12175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Purpose
– Open dialogue (OD) is an innovative approach to mental health crises based on close collaboration between services and an individual’s family and social network. The approach was originally designed by Jaakko Seikkula and his colleagues in Tornio, Finland and is now being developed in many countries around the world, in particular Denmark, Germany, Norway and the USA. OD describes both a way of being with families and also a way of organising services aimed at maximising communication and connection. The purpose of this paper is to describe the principles of OD, it’s development in Finland and here in the UK.
Design/methodology/approach
– This paper is a description of the principles and outcomes of OD as practised in Western Finland. It also describes the recent developments in the UK using the approach.
Findings
– This paper is descriptive of the model and is not of a research project.
Originality/value
– Whilst care must be taken in assuming that these remarkable results are transferable to the UK, other countries and several Mental Health trusts in England are actively engaged with developing an OD approach.
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47
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Open Dialogue as a contribution to a healthy society: possibilities and limitations. POSTEPY PSYCHIATRII I NEUROLOGII 2015. [DOI: 10.1016/j.pin.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Anorexia nervosa is currently presented as a pathologised, psycho-medical feminine phenomenon through aetiological rationalisations and theories. Research results indicate that there have been no improvements in treatment outcomes for anorexia for over 50 years, except, possibly, with forms of family therapy for adolescents. This situation can be seen as critical and calls for alternative ways of understanding anorexia, and consequent different approaches to psychotherapy for persons in relationship with anorexia. This article critically explores these issues, and suggests that such circumstances offer opportunities for alternative post-structuralist approaches for informing different understandings of and working with anorexia in collaborative relational arrangements where the voices of persons in relationship with anorexia are honoured and heard.
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Lakeman R. Unknowing: a potential common factor in successful engagement and psychotherapy with people who have complex psychosocial needs. Int J Ment Health Nurs 2014; 23:383-8. [PMID: 24597461 DOI: 10.1111/inm.12067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mental health nurses have a demonstrated capacity to work with people who have complex mental health and social problems in a respectful and non-coercive way for lengthy periods of time. Despite contributing to positive outcomes, nurses are rarely described as possessing psychotherapeutic skills or having advanced knowledge. More often, they are described as being instrumental to medicine, and nurses are socialized into not overstepping their subordinate position relative to medicine by claiming to know too much. Paradoxically, this position of unknowing, when employed mindfully, could be a critical ingredient in fostering therapeutic relationships with otherwise difficult-to-engage people. The concept of unknowing is explored with reference to different schools of psychotherapy. Adopting an unknowing stance, that is, not prematurely assuming to know what the person's problem is, nor the best way to help, might enable a deeper and more authentic understanding of the person's experience to emerge over time.
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Affiliation(s)
- Richard Lakeman
- School of Health & Human Sciences, Southern Cross University, Lismore, New South Wales, Australia; Acute Care Team, Emergency Department, Queensland Health, Cairns, Queensland, Australia
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50
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Borchers P, Seikkula J, Lehtinen K. Psychosis, Need Adapted treatment, and psychiatrists’ agency. PSYCHOSIS 2014. [DOI: 10.1080/17522439.2012.755218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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