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Anestis E, Weaver T, Melia C, Clarke K, Pilling S. Becoming an Open Dialogue practitioner: a qualitative study of practitioners' training experiences and transitioning to practice. Front Psychol 2024; 15:1432327. [PMID: 39188867 PMCID: PMC11345226 DOI: 10.3389/fpsyg.2024.1432327] [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: 05/13/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction In the context of transforming mental healthcare towards more personalised and recovery-oriented models, Open Dialogue has attracted significant international interest. Open Dialogue proposes a way of organising services and delivering care that supports an immediate response to crisis, relational continuity of care, a social network approach and the empowerment of networks through shared decision-making and a flattened hierarchy. The ODDESSI trial currently being conducted in the UK is assessing the model's clinical and cost-effectiveness. Practitioners who delivered the approach within the trial undertook a one-year Open Dialogue foundation training programme, however little is known about their training experiences. This study aimed to explore practitioners' experiences of receiving the training and transitioning to dialogic practice. Methods Individual, joint and focus group interviews with 32 Open Dialogue practitioners were conducted. Thematic analysis was used to analyse the transcripts and transformational learning theory informed the interpretation of the findings. Results Two themes further divided in subthemes were generated from the data: (1) experiences and impact of formal training and (2) becoming an Open Dialogue practitioner as an ongoing learning process beyond formal training: barriers and facilitators. Discussion The one-year Open Dialogue foundation training was a transformative experience for participants due to its emphasis on self-work and its impact on a personal level. Practitioners felt adequately prepared by their training for dialogic practice, yet becoming an OD practitioner was seen as a continual process extending beyond formal training, necessitating ongoing engagement with the approach and organisational support. However, the commitment of participants to deliver optimal dialogic care was occasionally impeded by organisational constraints, resource limitations, and often having to concurrently deliver conventional care alongside Open Dialogue.
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Affiliation(s)
- Eleftherios Anestis
- Department of Mental Health and Social Work, Faculty of Health, Social Care & Education, Middlesex University London, London, United Kingdom
| | - Timothy Weaver
- Department of Mental Health and Social Work, Faculty of Health, Social Care & Education, Middlesex University London, London, United Kingdom
| | - Claire Melia
- Government Social Research, UK Civil Service, London, United Kingdom
| | - Katherine Clarke
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Steve Pilling
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
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Düring SW, Austin SF, Mårtensson S, Johansen KS. Perceived advantages and disadvantages of substance use in a dual diagnosis population with severe mental disorders and severe substance use disorder. Considering the self-medication hypothesis. Nord J Psychiatry 2024; 78:281-289. [PMID: 38380582 DOI: 10.1080/08039488.2024.2318649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
AIM Based on a large cohort of dual diagnosis patients, the aim of this study was to quantify the patient-perceived problems and advantages of their substance use and relate the quantity of problems to the substance type and psychiatric diagnosis. MATERIAL Data comes from a naturalistic cohort admitted to an in-patient facility in Denmark specialized in integrated dual diagnosis treatment. We included 1076 patients at their first admission to the facility from 2010 to 2017. Participants completed 607 DrugCheck and 130 DUDIT-E questionnaires. METHOD we analyzed the questionnaires and included admission diagnosis by use of t-test and ANOVA to depict the patterns in substance use in relation to psychiatric diagnosis. RESULTS The three most common substance related problems according to the DrugCheck questionnaire were: feeling depressed, financial problems, and losing interest in daily activities. From DUDIT-E, the highest-ranking negative substance related effects were financial ruin, deterioration of health, and problems at work. Effects on social life relationships were also evident with more than 40% of participants. The top three positive substance related effects reported were relaxation, improved sleep, and control over negative emotions. The number of problems listed varied significantly with the type of preferred substance. Patients using pain medication, sedatives, central stimulants, and alcohol reported most problems. Diagnosis did not differentiate the problems experienced. Results partially support the broad self-medication hypothesis for patients with severe mental illness, but also points out that patients are well aware of negative effects.
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Affiliation(s)
- Signe Wegmann Düring
- Competence Centre of Dual Diagnosis, Mental Health Services of the Capital Region, Mental Health Centre Sct. Hans, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services of the Capital Region, Mental Health Centre Sct. Hans, Roskilde, Denmark
- Mental Health Services of the Capital Region, Mental Health Centre Amager, Copenhagen, Denmark
| | | | - Solvej Mårtensson
- Competence Centre of Dual Diagnosis, Mental Health Services of the Capital Region, Mental Health Centre Sct. Hans, Roskilde, Denmark
| | - Katrine Schepelern Johansen
- Competence Centre of Dual Diagnosis, Mental Health Services of the Capital Region, Mental Health Centre Sct. Hans, Roskilde, Denmark
- National Institute of Public Health, University of Southern, Odense, Denmark
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Einboden R, Dawson L, McCloughen A, Buus N. Power, position and social relations: Is the espoused absence of hierarchy in Open Dialogue naïve? Health (London) 2024:13634593241249101. [PMID: 38676316 DOI: 10.1177/13634593241249101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Open Dialogue practitioners aim to reduce social hierarchies by not privileging any one voice in social network conversations, and thus creating space for a polyphony of voices. This sits in contrast to the traditional privileging of those voices credited with more knowledge or power because of social position or professional expertise. Using qualitative interviews, the aim of this current study was to explore Open Dialogue practitioners' descriptions of challenges in implementing Open Dialogue at a women's health clinic in Australia. Findings revealed how attempts to rhetorically flatten hierarchies among practitioners created challenges and a lack of clarity regarding roles and responsibilities. As the practitioners tried to adjust to new ways of working, they reverted to taking up engrained positions and power aligned with more conventional social and professional roles for leading therapy and decision-making. The findings raise questions about equity-oriented ways of working, such as Open Dialogue, where intentions of creating a flattened hierarchy may allow power structures and their effects to be minimised or ignored, rather than actively acknowledged and addressed. Further research is needed to consider the implications that shifting power relations might have on the roles and responsibilities of practitioners in the move to equity-oriented services.
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Affiliation(s)
- Rochelle Einboden
- University of Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Canada
- The University of Sydney, Australia
| | - Lisa Dawson
- Sydney Children's Hospital Network, Australia
| | | | - Niels Buus
- Aarhus University, Denmark
- Monash University, Australia
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Liu F, Qiao W, Yuan X, Hei G, Li X, Zhang Y, Song X, Zhang D. Psychosocial and psychological interventions for schizophrenia relapse prevention: A bibliometric analysis. Glob Ment Health (Camb) 2024; 11:e49. [PMID: 38690569 PMCID: PMC11058533 DOI: 10.1017/gmh.2024.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Various psychosocial and psychological interventions have been developed to reduce schizophrenia relapse prevention. A better understanding of these active interventions is important for clinical practice and for meaningful allocation of resources. However, no bibliometric analysis of this area has been conducted. Studies were retrieved from the Web of Science Core Collection database. The publication outputs and cooperation of institutions were visualized with Origin 2021. Global cooperation was visualized using ArcGIS Pro3.0. VOSviewer was used to generate visualizations of network of authors and keywords. The number of annual publications generally showed a fluctuating upward trend over the past 20 years. Germany published the most relevant articles (361, 26.76%). The Technical University of Munich was the most productive institution (70, 9.86%). Leucht Stefan published the most articles (46, 6.48%) and had the highest number of citations (4,375 citations). Schizophrenia Research published the most studies (39, 5.49%). Keywords were roughly classified into three clusters: cognitive behavioral therapy (CBT), family interventions and family psychoeducation and other factors related to interventions. The findings provided the current status of research on psychosocial and psychological interventions for schizophrenia relapse prevention from a bibliometric perspective. Recent research has mainly focused on CBT, family interventions and family psychoeducation.
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Affiliation(s)
- Fang Liu
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wei Qiao
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiuxia Yuan
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Gangrui Hei
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xin Li
- Department of Logistics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yu Zhang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Dongqing Zhang
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Scognamiglio D, Boarini M, la Forgia MC, Grippa E, Forni S, Sergi A, Romeo A, Massa G, Sangiorgi L. Defining priorities in the transition from paediatric to adult healthcare for rare bone disease patients: a dialogic approach. Eur J Med Genet 2024; 67:104891. [PMID: 38040052 DOI: 10.1016/j.ejmg.2023.104891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
The Italian patient association for Multiple Osteochondromas, Ollier Disease, and Maffucci Syndrome, Associazione Conto Alla Rovescia-ACAR Aps, conducted a mixed-methods study at its 2023 annual conference. The study included the Open Dialogue Approach and a feedback survey to identify the main priorities in the transitioning process from paediatric to adult healthcare for patients with Multiple Osteochondromas, Ollier Disease, and Maffucci Syndrome. The common needs identified by patients, families, caregivers, and healthcare professionals were coordination and continuity of care, patient empowerment and communication, social and practical support, and transition planning and support. This experience fostered a sense of collaboration and cooperation among stakeholders, helping to build trust and create a shared vision for improving the quality of care for these patients. Furthermore, it could be considered a starting point for other patient associations interested in using different approaches to identify the needs of their members and actively involve all stakeholders.
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Affiliation(s)
- D Scognamiglio
- A.C.A.R. Aps - Associazione Conto Alla Rovescia, Rome, Italy
| | - M Boarini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - M C la Forgia
- A.C.A.R. Aps - Associazione Conto Alla Rovescia, Rome, Italy
| | - E Grippa
- A.C.A.R. Aps - Associazione Conto Alla Rovescia, Rome, Italy
| | - S Forni
- A.C.A.R. Aps - Associazione Conto Alla Rovescia, Rome, Italy
| | - A Sergi
- SOC Monitoraggio e Programmazione Performance Clinico-assistenziale, Azienda USL Toscana Centro, Italy
| | - A Romeo
- A.C.A.R. Aps - Associazione Conto Alla Rovescia, Rome, Italy
| | - G Massa
- A.C.A.R. Aps - Associazione Conto Alla Rovescia, Rome, Italy
| | - L Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ong B, Tseliou E, Strong T, Buus N. Power and dialogue: A review of discursive research. FAMILY PROCESS 2023; 62:1391-1407. [PMID: 37038958 DOI: 10.1111/famp.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
Collaborative-dialogic approaches to family therapy advise therapists to take a position of client-as-expert and promote an equality of multiple perspectives. This has led to debates about how to conceptualize power in dialogical therapies with scholars theorizing and researching power as social and negotiated through interaction. We aimed to understand power in dialogical therapy through reviewing discursive research on therapeutic conversations. We performed a systematic search of bibliographical databases PsycINFO, PubMed, and CINAHL. We reviewed the findings from 18 studies utilizing discursive analyses of collaborative-dialogical therapy sessions and examined their findings in relation to power within interactions. We found a strong focus on the practices of the therapist rather than on those of the client. The therapist was presented as a catalyst of dialogue using minimal and active responses to promote dialogical conversations. Therapists also utilized power in response to broader institutional and social demands that may not be consistent with some interpretations of dialogical therapy. We consider practice implications where the exercise of power to direct a session facilitates dialogical interactions.
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Affiliation(s)
- Ben Ong
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Eleftheria Tseliou
- Laboratory of Psychology, Department of Early Childhood Education, University of Thessaly, Volos, Greece
| | - Tom Strong
- Educational Studies in Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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7
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Pocobello R, Camilli F, Alvarez-Monjaras M, Bergström T, von Peter S, Hopfenbeck M, Aderhold V, Pilling S, Seikkula J, el Sehity TJ. Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services. Front Psychol 2023; 14:1241936. [PMID: 38023059 PMCID: PMC10668593 DOI: 10.3389/fpsyg.2023.1241936] [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: 06/17/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. Methods A structured questionnaire including a self-assessment scale to measure teams' adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation. Results The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision. Conclusion The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts.
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Affiliation(s)
| | | | - Mauricio Alvarez-Monjaras
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
| | - Sebastian von Peter
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mark Hopfenbeck
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Stephen Pilling
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Department of Psychology, University of Agder: Kristiansand, Kristiansand, Norway
| | - Tarek Josef el Sehity
- Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
- Faculty of Psychology, Sigmund Freud Private University, Vienna, Austria
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Cotes RO, Palanci JM, Broussard B, Johnson S, Grullón MA, Norquist GS, Mehta CC, Wood K, Cubellis L, Gholami M, Ziedonis D. Feasibility of an Open Dialogue-Inspired Approach for Young Adults with Psychosis in a Public Hospital System. Community Ment Health J 2023; 59:1428-1435. [PMID: 36939990 DOI: 10.1007/s10597-023-01120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/12/2023] [Indexed: 03/21/2023]
Abstract
The objective was to determine the feasibility of an Open Dialogue-inspired approach in a metropolitan, public hospital setting with predominately African American participants. Participants were ages 18-35, experienced psychosis within the past month, and involved at least one support person in their care. We evaluated domains of feasibility including implementation, adaptation, practicality, acceptability, and limited-efficacy. An organizational change model (Addressing Problems Through Organizational Change) facilitated implementation. Clinicians received three trainings and ongoing supervision. Network meetings were successfully implemented with good self-reported fidelity to principles of dialogic practice. Some adaptations (less frequent meetings and no home visits) were necessary. A subset of individuals completed research assessments over 12 months. Qualitative interviews with participants suggested the intervention was acceptable. Symptom and functional outcomes were preliminary but trended toward improvement. Implementation was feasible with relatively brief training, organizational change processes, and context-specific adaptations. Lessons learned can assist in planning a larger research study.
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Affiliation(s)
- Robert O Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA.
| | - Justin M Palanci
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA
| | | | - M Alejandra Grullón
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA
| | - Grayson S Norquist
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Keith Wood
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA
| | - Lauren Cubellis
- Department of Anthropology, Humboldt University of Berlin, Berlin, Germany
| | - Maryam Gholami
- Altman Clinical and Translational Research Institute, UC San Diego Health, San Diego, CA, USA
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Buus N, Ong B, McCloughen A. Open dialogue trainees' perspectives on learning processes and psychotherapeutic practice: A prospective focus group study. FAMILY PROCESS 2023; 62:993-1005. [PMID: 36303470 DOI: 10.1111/famp.12832] [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: 03/11/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Open Dialogue is a collaborative approach to mental health care emphasizing integrated services and a dialogical psychotherapy approach. Open Dialogue training programs eschew traditional didactic teaching of technical therapeutic skills in favor of more experiential learning processes. It is unclear how these training programs affect trainees and shape their perspectives on Open Dialogue. Our aim was to follow up a group of Australian Open Dialogue trainees and explore their perspectives on learning processes and psychotherapeutic practice. We utilized a prospective focus group design with data from audio-recorded focus groups convened before (n = 2) and after (n = 3) participants completing an advanced Open Dialogue training program. Data were subjected to reflective thematic analysis. We identified the theme "Extending possibilities by holding ideas lightly," which represented a universal principle that participants applied to multiple aspects of their practice, for example, favoring multiple perspectives and approaches to therapy, including those other than Open Dialogue. This theme had two sub-themes: (1) "Allowing intimacy by being aware of personal biographies" and (2) "Learning by joining others," which reflected an increased willingness by participants to reflect on and share their inner experiences and an emphasis on joint experiential exercises in the training program. "Extending possibilities by holding ideas lightly" facilitated a means of incorporating a dialogical perspective into existing practices thus avoiding the potential barriers to a wholesale implementation of Open Dialogue. Findings indicated that the participants were not learning how to practice a therapeutic technique or propositional knowledge, but were socialized into a dialogical way of being.
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Affiliation(s)
- Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ben Ong
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Parrabera-García S, Oujo-Fernández C, Lirola MJ, Cangas AJ, Marfá-Vallverdú J, Correa-Urquiza M, Garcia-Torrents E. Open Dialogue in Spain: an initial survey of knowledge and perspectives. Front Psychol 2023; 14:1166919. [PMID: 37637916 PMCID: PMC10448387 DOI: 10.3389/fpsyg.2023.1166919] [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: 02/15/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
In Spain, the introduction of the Open Dialogue framework is relatively recent. This study takes a closer look at Open Dialogue training, interest and research in this region. To this end, a survey has been conducted through a convenience sample of professionals, people with their own experiences in mental health, family members, relatives, university professors and students. The results showed that a significant number of participants had no training in OD, and their exposure to relevant literature and congress attendance was limited. Amongst the different profiles, professionals reported the highest level of training. These findings highlight the urgent need for further research and training initiatives to improve the understanding and application of the OD framework in Spain. Efforts should be directed towards broadening the knowledge base, increasing access to training programmes and fostering interest amongst different stakeholders. By addressing these gaps, the implementation and use of OD can be expanded to meet the growing demand and interest in this approach in the Spanish context.
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Affiliation(s)
| | | | | | | | | | - Martín Correa-Urquiza
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Enric Garcia-Torrents
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
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Skourteli MC, Issari P, Dimou L, Antonopoulou AOA, Bairami G, Stefanidou A, Kouroglou V, Stylianidis S. The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals. Front Psychol 2023; 14:1074203. [PMID: 37303906 PMCID: PMC10249676 DOI: 10.3389/fpsyg.2023.1074203] [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: 10/19/2022] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The present study is part of a large-scale original action-research project aiming to assess the introduction and implementation of the Open Dialogue approach within the clinical practice of an established multidisciplinary team in a Day Centre in Athens, Greece. More specifically, it aimed to explore the experiences of professionals within the process of implementation both in relation to their clinical practice and their professional identity. Methods Data collection employed a focus group, which was set up to explore professional reflections of the implementation and research processes since the introduction of the model. Thematic Analysis of transcripts revealed two main themes that correspond to the impact of Open Dialogue on professionals' clinical practice and on team dynamics, respectively. Results Professionals identify several challenges in implementing OD, such as difficulties in linking theory to practice, containing uncertainty, and addressing cultural barriers to dialogical ways of working. Professionals further reflect on their own internal journey stemming from the implementation of Open Dialogue that has led them to greater openness and growth, personally and as a team. Discussion The role of mental health professionals is being acknowledged as being at the frontline of any meaningful psychiatric reform through the assimilation and promotion of humanistic paradigms aiming towards a change of culture in psychiatric care across different contexts. Despite variations in implementation across different contexts, the importance of consolidating and embracing Open Dialogue as a philosophical framework underpinning mental health care is being discussed.
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Affiliation(s)
| | - Philia Issari
- Laboratory for Qualitative Research in Psychology and Psychosocial Well-being, National and Kapodistrian University of Athens, Athens, Greece
| | - Lito Dimou
- E.P.A.P.S.Y.—Association for Regional Development and Mental Health, Athens, Greece
| | - Ariadni O. A. Antonopoulou
- Laboratory of Psychopathology, Social Psychiatry and Developmental Psychology, Panteion University, Athens, Greece
| | - Georgia Bairami
- Laboratory of Psychopathology, Social Psychiatry and Developmental Psychology, Panteion University, Athens, Greece
| | - Artemis Stefanidou
- Laboratory of Psychopathology, Social Psychiatry and Developmental Psychology, Panteion University, Athens, Greece
| | - V. Kouroglou
- E.P.A.P.S.Y.—Association for Regional Development and Mental Health, Athens, Greece
| | - Stelios Stylianidis
- E.P.A.P.S.Y.—Association for Regional Development and Mental Health, Athens, Greece
- Laboratory of Psychopathology, Social Psychiatry and Developmental Psychology, Panteion University, Athens, Greece
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Mosse D, Baker D, Carroll M, Chase L, Kloocke R, Wickremasinghe K, Cramer B, Pratt-Boyden K, Wuerth M. The contribution of anthropology to the study of Open Dialogue: ethnographic research methods and opportunities. Front Psychol 2023; 14:1111588. [PMID: 37275712 PMCID: PMC10237270 DOI: 10.3389/fpsyg.2023.1111588] [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: 11/29/2022] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
When Open Dialogue diversifies internationally as an approach to mental healthcare, so too do the research methodologies used to describe, explain and evaluate this alternative to existing psychiatric services. This article considers the contribution of anthropology and its core method of ethnography among these approaches. It reviews the methodological opportunities in mental health research opened up by anthropology, and specifically the detailed knowledge about clinical processes and institutional contexts. Such knowledge is important in order to generalize innovations in practice by identifying contextual factors necessary to implementation that are unknowable in advance. The article explains the ethnographic mode of investigation, exploring this in more detail with an account of the method of one anthropological study under way in the UK focused on Peer-Supported Open Dialogue (POD) in the National Health Service (NHS). It sets out the objectives, design and scope of this research study, the varied roles of researchers, the sites of field research and the specific interaction between ethnography and Open Dialogue. This study is original in its design, context, conduct and the kind of data produced, and presents both opportunities and challenges. These are explained in order to raise issues of method that are of wider relevance to Open Dialogue research and anthropology.
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Affiliation(s)
- David Mosse
- Department of Anthropology and Sociology, SOAS University of London, London, United Kingdom
| | - Darren Baker
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
| | - Molly Carroll
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
| | - Liana Chase
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Ruth Kloocke
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
| | - Kiara Wickremasinghe
- Department of Anthropology and Sociology, SOAS University of London, London, United Kingdom
| | | | - Keira Pratt-Boyden
- Department of Anthropology and Sociology, SOAS University of London, London, United Kingdom
| | - Milena Wuerth
- Department of Anthropology and Sociology, SOAS University of London, London, United Kingdom
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13
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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
| | - 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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14
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Lorenz-Artz K, Bierbooms J, Bongers I. Introducing Peer-supported Open Dialogue in changing mental health care. Front Psychol 2023; 13:1056071. [PMID: 36743614 PMCID: PMC9891459 DOI: 10.3389/fpsyg.2022.1056071] [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: 09/28/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
The need to transform mental health care toward person-centered, recovery-based, and network-oriented care is recognized worldwide. Open Dialogue (OD) is seen as a hopeful approach in the context of this transformation and is introduced in countries around the globe. Five Dutch mental health care organizations spread over the Netherlands introduced the Peer-supported Open Dialogue (POD) approach, which adds an explicit role of peer-support workers to the OD approach. It appeared that (P)OD-trained professionals face issues in introducing the (P)OD approach in existing MHC settings. One of the reasons, which is the focus of this study, may be that they encounter difficulties in explaining to non-(P)OD-trained professionals what (P)OD entails. The main objective of this study is to provide guidance to and contribute to making (P)OD better understandable for non-(P)OD-trained professionals. In this study, we used a qualitative design and conducted 23 semi-structured interviews with POD-trained professionals with various backgrounds, to cultivate a rich understanding of which aspects could contribute to a better understanding of POD for non-POD-trained professionals. We used a hybrid approach to analyze the data, meaning that the technique of both inductive and deductive thematic analyses has been applied. From these analyses, six aspects emerged that could give guidance to and contribute to making (P)OD more understandable for non-(P)OD-trained professionals: (1) Experiencing (P)OD by attending treatment network sessions, (2) a coherent and profound narrative about (P)OD, (3) adjusting terminology to better fit the context, such as the two terms "principles" and "responsibility" in this study, (4) the order in which (P)OD elements are introduced in the narrative, (5) bringing the elements "presence," "reflecting," and "expertise by experience" more to the foreground, and (6) conceptualizing the main elements in a "talking paper." A better understanding of (P)OD might be one of the building blocks for improving (P)OD adoption in existing MHC practices, which are on their way toward person-centered, recovery-based, and network-oriented care.
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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,*Correspondence: Karin Lorenz-Artz, ✉
| | - Joyce Bierbooms
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands,Erasmus School of Health Policy and Management (ESHPM), Erasmus University, Rotterdam, 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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15
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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: 5] [Impact Index Per Article: 5.0] [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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16
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Organizational Change in Complex Systems: Organizational and Leadership Factors in the Introduction of Open Dialogue to Mental Health Care Services. Community Ment Health J 2023; 59:95-104. [PMID: 35585467 PMCID: PMC9813114 DOI: 10.1007/s10597-022-00984-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine individual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles.
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17
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Buus N, McCloughen A. Client and Family Responses to an Open Dialogue Approach in Early Intervention in Psychosis: A Prospective Qualitative Case Study. Issues Ment Health Nurs 2022; 43:308-316. [PMID: 34666592 DOI: 10.1080/01612840.2021.1986758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this prospective case study was to explore clients' and social network members' responses to participating in a newly implemented Open Dialogue approach in an Australian early intervention in psychosis treatment context. We followed four clients' trajectories through treatment by drawing on data from electronic medical record entries, observed or audio-recorded network meetings, and client and family interviews. Data were analysed thematically. Clients and families generally appreciated the Open Dialogue approach, even though it created hard practical and psychosocial work for them before, during and in between meetings. We discuss the increased workload as responsibilization of families.
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Affiliation(s)
- Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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