Academic journal article Journal of Marital and Family Therapy

Open Dialogues with Good and Poor Outcomes for Psychotic Crises: Examples from Families with Violence

Academic journal article Journal of Marital and Family Therapy

Open Dialogues with Good and Poor Outcomes for Psychotic Crises: Examples from Families with Violence

Article excerpt

In Open Dialogue the first treatment meeting occurs within 24 hr after contact and includes the social network of the patient. The aim is to generate dialogue to construct words for the experiences embodied in the patient's psychotic symptoms. All issues are analyzed and planned with everyone present. A dialogical sequence analysis was conducted comparing good and poor outcomes of first-episode psychotic patients. In good outcomes, the clients had both interactional and semantic dominance, and the dialogue took place in a symbolic language and in a dialogical form. Already at the first meeting, in the good outcome cases, the team responded to the client's words in a dialogical way, but in the case with the poor outcome, the patient's reflections on his own acts were not heard.

In Finnish Western Lapland, an interesting approach has emerged that has improved the care of all psychotic crises. The entire state public psychiatric system-including both inpatient units and outpatient clinics-is organized around the idea of bringing patients together with the people in their social networks in open treatment meetings, starting with the first contact and continuing throughout the entire process. In the 1980s, in the context of the Finnish National Schizophrenia Project, Alanen and his colleagues (Alanen, 1997; Alanen, Lehtinen, Rakkolainen, & Aaltonen, 1991), in Turku, first pioneered the Need-Adapted approach. This model introduced rapid early intervention, flexible planning in response to the changing, case-specific needs of each situation, and attention to therapeutic attitude in both examination and ongoing therapy. It conceives of treatment as a continuous process, involving the integration of different therapeutic methods and constant monitoring of progress and outcomes. Operating within the Need-Adapted approach and beginning in the early 1980s, there has been a further innovation in the form of the Open Dialogue (OD). It also is based in treatment meetings that draw on the patient's existing support system. The focus of OD approach, however, is to attend to the form of communication that occurs within the treatment system composed of the mobile crisis intervention teams, the patients, and their social networks. Here, the concept of communication derives from the tradition that sees it as a forum for constituting and negotiating a positive sense of identity. It is a joint process in which new meanings are constructed "in between" people, in contrast to the view of communication as a way of transmitting something ready made from one person to another (Linell, 1998).

Current research shows that the OD approach with its emphasis on facilitating dialogue within the treatment system can be effective. Since the establishment of this new approach, the incidence of new cases of schizophrenia in this small and homogeneous region has declined (Aaltonen et al., 1997). Further, the appearance of new chronic schizophrenia patients at the psychiatric hospital has ceased (Tuori, 1994). In an on-going study of first episode psychotic patients, the need for hospitalization decreased, and it proved possible in many cases to compensate the use of neuroleptic medication with anxiolytics at the outset, with the results that 27% received neuroleptic medication during the 2-year follow-up period (Seikkula, Alakare, & Aaltonen, 2000, 2001b). This did not lead to poorer outcomes, given that 83% of the patients had returned to their jobs or studies or were job seeking, and 77% did not have residual psychotic symptoms. A possible reason for these relatively good prognoses was the fact that the duration of untreated psychosis declined to 3.6 months in Western Lapland, where the network-centered system has enabled easy access to psychiatric care and an immediate start of treatment (Seikkula et al., 2001b). This article describes the dialogues generated in actual treatment meetings and gives contrasting examples of "dialogical" and "monological" dialogues on the topic of family violence in the cases of two first-episode psychotic patients. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.