Ihmis- ja perusoikeudet ja mielenterveysstrategia : mahdoton yhtälö?

The lost mother tongue : An interview study with Finnish war children

This article presents the third study of an interview investigation concerning 10 Finnish war children who were evacuated during the World War II to Sweden and who did not return to live in Finland after the war. The focus is on how they remembered or did not remember their early experiences of displacement and on how they expressed thoughts about their childhood and their adult life. We found that all of them as adults still bore signs of trauma. The younger the children were at the time of the evacuation, the more difficult or even impossible it was for them to think or fantasize about the past. It was consequently not possible for them to work through their experiences of loneliness, abs…

Depression : The differing Narratives of Couples in Couple Therapy

Introduction When a person becomes depressed, partnership can either be a source of strength, advancing recovery, or a source of further suffering, harming the health of both partners (Cordova & Gee, 2001). Also, depression in one spouse can create feelings of helplessness and hopelessness in both spouses (Cordova & Gee). These are some of the reasons why couple therapy has been used with persons diagnosed with depression and their spouses. Yet, according to Denton and Burwell's (2006) experience, which is similar to our own, the spouses of depressed patients often are not part of the treatment in psychiatric outpatient care, and hence feel unsupported, uninformed, isolated, confused, and f…

The long-term use of psychiatric services within the Open Dialogue treatment system after first-episode psychosis

AbstractOpen Dialogue is a family-oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. In the present study, the aim was to describe how psychiatric services were used in Western Lapland after decades of first-episode psychosis services, and to analyze how baseline characteristics were related to re-admission rates and the total duration of psychiatric treatment in geographical area where Open Dialogue approaches were developed and efforts made to systematically apply them to all psychiatric treatments. The data were obtained from the medical histories of patients who had first-episode psychosis in 1992–2005 and who lived…

Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed?

SummaryIn this multicentre study the two-year outcome of two groups of consecutive patients (total N = 106) with first-episode functional non-affective psychosis, both treated according to the ‘need-specific Finnish model’, which stresses teamwork, patient and family participation and basic psychotherapeutic attitudes, was compared. No alternative treatment facilities were available in the study sites. The two study groups differed in the use of neuroleptics: three of the sites (the experimental group) used a minimal neuroleptic regime whilst the other three (the control group) used neuroleptics according to the usual practice. Total time spent in hospital, occurrence of psychotic symptoms …

Agency displays in stories of drunk driving: Subjectivity, authorship, and reflectivity

This study examined 30 stories of drunk driving (DD) recounted by repeat offenders in the early phase of a court-mandated counseling program. The focus of analysis was on displays of agency in the narrators’ portrayal of themselves as protagonists in the stories. The expressions of subjectivity, authorship, and reflectivity were considered as constructors of agency positions. In the analysis of the videotaped and transcribed stories, five story types of agency were found. They displayed the narrator-protagonists’ agency positions as either unconcerned, weak, egotistical, akratic, or disowned. The quality of telling is viewed as expressing the narrators’ problematic agency positions, readine…

Sodanikäiset eivät vanhene

Dealing with negative connotations in family therapeutic treatment of an enmeshed family: A case study

In psychotherapy the moments when negative connotations of diagnostic remarks become apparent are also the moments for change. To be able to use those moments for positive outcome calls for, according to this case study: 1) An inquiring approach and attitude to therapeutic work which translates to the challenging of basic hypotheses and the unambiguous meaning of diagnostic signs starting from the referral and continuing through the treatment process. 2) The integration of the nonverbal experiential technique with the verbal reflective approach, which can be conceptualized as a double description of the problem situation, and which allows reframing, or recontextualization. 3) A diagnostic c…

The comprehensive Open-Dialogue approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care

An open dialogue need-adapted approach was applied in Finnish Western Lapland by organizing three-year family therapy training for the entire staff, and by following the outcomes. Three inclusion periods of first-episode psychotic patients were compared. In a two-year follow-up of two consecutive periods during the 1990s (1992–3 and 1994–7) it was found that 81% of patients did not have any residual psychotic symptoms, and that 84% had returned to full-time employment or studies. Only 33% had used neuroleptic medication. A third inclusion period, covering 2003–2005, was organized to determine whether the outcomes were consistent 10 years after the preliminary period. Fewer schizophrenia psy…

Transsubstantiaatio : ajan ulottuvuudet Aleksis Kiven ja Marcel Proustin romaaneissa ja elämässä

Cognitive Deficits in Patients with First-Episode Psychosis as Identified by Exner’s Schizophrenia Index in Finland and Spain

Traces of the past: an interview study with Finnish war children who did not return to Finland after the Second World War

ABSTRACTThis paper is an in-depth qualitative study based on interviews with 10 Finnish children who were evacuated to Sweden during Second World War and who did not return to Finland after the war. The interviewees were asked to tell about their lives. Nine of them were between 2 and 5 years and one was 7 years old at the time of evacuation. The aim was to study how their childhood experiences were reflected in adult memories, how they remembered or did not remember. This paper focuses on the consequences of not knowing about one’s early life and also on whether it is possible to observe signs of the Finnish mother. She did not appear explicitly but could be sensed in the tendency of the i…

The shared image guiding the treatment process. A precondition for integration of the treatment of schizophrenia.

The aim of the study reported here was to develop psychotherapeutic in-patient treatment for acute schizophrenia, following the principles of a need-adapted approach. To improve the integration of experiences which hospital staff have with acutely psychotic patients and their families, systematic supervision sessions were organised. In these sessions, it was possible to achieve shared psychological images through which the whole staff could integrate patients' behaviour and symptoms, both symbolic and non-symbolic. Such an image was called ‘the shared image guiding the treatment process’ (SIGTP). The process of achieving the SIGTP was interpreted through Peircean semiotics, especially the c…

The family-oriented Open Dialogue approach in the treatment of first-episode psychosis : nineteen–year outcomes

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 h…

Rorschach Characteristics and Comparison of First-Episode Psychotic Patients in Finland and Spain

Identifier avec précision les troubles schizophréniques a toujours été un problème complexe et controversé. Les caractéristiques psychologiques de la schizophrénie ont donné lieu à un volume considérable de travaux et de débats. Ces dernières années sont apparus un nombre croissant d'articles portant sur les différences et similitudes des manifestations de la psychose selon les cultures, partant de l'idée que les caractéristiques de personnalité nationales pourraient contribuer aux tableaux psychopathologiques. Le but premier de cette étude est de mieux comprendre les troubles psychotiques par l'investigation de la structure de personnalité et du fonctionnement de patients faisant un premi…

Predicting response to interpersonal counselling (IPC) from case formulation : a systematic comparison between recovered and unchanged depressive cases

We sought to explore how the process between the counsellor and patient for arriving at a case formulation may predict the outcome of manualized interpersonal counselling (IPC) for depression in primary care. Qualitative content analysis and applied conversation analysis (CA) were used to achieve depth in the understanding of case formulation process among five patients who recovered and five who were unchanged according to quantitative post-treatment change rates derived from Clinical Outcomes in Routine Evaluation– Outcome Measure (CORE-OM). Interaction in the case formulations for the recovered group was generally characterized by a joint construction effort between the counsellor and th…

Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies

The open dialogue (OD) family and network approach aims at treating psychotic patients in their homes. The treatment involves the patient’s social network and starts within 24 hr after contact. Responsibility for the entire treatment process rests with the same team in both inpatient and outpatient settings. The general aim is to generate dialogue with the family to construct words for the experiences that occur when psychotic symptoms exist. In the Finnish Western Lapland a historical comparison of 5-year follow-ups of two groups of first-episode nonaffective psychotic patients were compared, one before (API group; n! /33) and the other during (ODAP group; n! /42) the fully developed phase…

Integrated Treatment Model for First-Contact Patients with a Schizophrenia-Type Psychosis: The Finnish API Project

This paper presents the background, rationale, set-up and first results of the Finnish API study, whose aim was to investigate the use of a psychotherapeutically oriented and familycentred treatment model for acute psychosis in different treatment settings, and especially the role of neuroleptic drug treatment when working along the principles of the integrated treatment model. Six psychiatric catchment areas from different parts of the country participated by collecting a material of 136 first-contact patients with a schizophrenia-type psychosis. More than half of the patients received a formal diagnosis from the schizophrenia group at the initial examination, and more than one-third a dia…

Narrative process modes as a bridging concept for the theory, research and clinical practice of systemic therapy

This article is concerned with the relationships which hold between the clinical practice and the theory of family therapy; and between these and academic research. These relationships are seen as tenuous and thin because, in the first place, there is a lack of rigorous theoretical underpinning; and second, the research methods employed do not fit in with current family therapy practice, and with the theory that underlies this practice. The role of the concept of narrative process modes is proposed as a bridging and mediating one. The external, internal and reflective narrative process modes are seen as relevant from the point of view of family therapy process research, and the clinical pra…

12‐month follow‐up of first‐episode psychosis in Finland and Spain—differential significance of social adjustment‐related variables

Objective:  This study explored 12‐month outcome and its associations to social adjustment‐related variables in patients with first‐episode non‐affective psychosis in Finland and Spain.Methods:  Fo...

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.

Merkillinen vapaus ja psykoterapian huokoisuus

Need adapted use of medication in the open dialogue approach for psychosis : a descriptive longitudinal cohort study

Background The open dialogue (OD) approach includes the need-adapted use of psychiatric medication in treating first-episode psychosis (FEP), but there is limited information on how psychiatric medications are actually used in OD-based services. This study aims to analyse long-term medication dispensing patterns among FEP cohort treated according to the OD. Methods The OD cohort consisted of people who received treatment for FEP in the Finnish Western Lapland catchment area at a time of OD implementation (n=61). The comparison group included people whose FEP treatment commenced outside the catchment area during the mid-1990s (n=1378). Data were gathered from national registers from onset to…

Couple therapy for depression in a naturalistic setting in Finland: a 2-year randomized trial

The dialogical and narrative processes in couple therapy (CT) for depressions project was conducted to develop therapy for depression and to investigate the effectiveness of CT in everyday clinical practice; thus aiming at high external validity. Patients with moderate or major depression were randomized to a CT group (n = 29) and a control group (n = 22). The CT group needed significantly fewer therapy sessions. There were significant differences in favour of the CT group in terms of general mental health (symptom check list), Hamilton depression rating scale, global assessment of functioning and decreasing alcohol use. As regards depressive symptoms using the Beck depression inventory, 79…

The comprehensive Open-Dialogue approach in Western Lapland: I. The incidence of non-affective psychosis and prodromal states

Mental health services in a health district in Finland with a population of 72,000 were developed into a comprehensive family- and network-centered entity by giving all the psychiatric personnel training in family therapy or psychodynamic individual therapy, and by arranging a system in which all psychiatric crises were treated in a family- and network-centered manner by multidisciplinary crisis teams, mostly in the patient’s home. The system is a modification of the Need-Adapted Approach called the Open-Dialogue Approach (ODA). The changes in the incidence of first-contact non-affective psychoses and prodromal states were studied in two cities of the District, considering the five-year per…

Psykoterapioitten yksinäisyys ja salutogeneesi

Läheisyys, etäisyys ja covidin aika

Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain

Kalla O, Aaltonen J, Wahlstrom J, Lehtinen V, Garcia Cabeza I, Gonzalez de Chavez M. Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain. Acta Psychiatr Scand 2002: 106: 265–275. © Blackwell Munksgaard 2002. Objective: To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first-episode psychosis in Finland and Spain. Method: Eighty-six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics. Results: The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long …

Mental health care: trust and mistrust in different caring contexts.

Aims and objectives.  To identify the factors that make trust within the context of public mental health possible. We also consider the question of patients’ trust in the whole caring system. The study is based on individual interviews with 22 psychiatric patients, who were also users of social services. Background.  There are theoretical studies concerning trust between human beings in several disciplines within psychiatry and social services but few studies investigate how trust can be created and what makes it possible. The literature reveals that there is need for research concerning trust in psychiatry. In this study we examined two different caring contexts and investigated what makes…