0000000000175188
AUTHOR
Klaus Lehtinen
Psychosis, Need Adapted treatment, and psychiatrists' agency
Background: In the Need-Adapted approach (NAA) therapy meetings are a deliberate effort to bring all meaningful parties and views to a common discussion prior to decisions; this constitutes a challenge for psychiatrists’ agency. Aims: To describe how psychiatrists see their agency in NAA. Methods: Using videos of co-research interviews, stimulated-recall interviews of 10 interviewees were conducted and transcribed verbatim. The material was analyzed via an adapted dialogical-narrative analytical method. Results: Institutional forces were experienced as having an enormous impact on psychiatrists’ agency, especially in the inpatient setting, reducing professional creativity. In the outpatient…
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…
Psychiatrists’ inner dialogues concerning workmates during need adapted treatment of psychosis
Background: In the Need-Adapted approach decisions are made in therapy meetings with all relevant parties; this poses a professional challenge to psychiatrists. Aims: To describe psychiatrists’ inner dialogues concerning their workmates in treatment meetings. Methods: Using videos of co-research interviews, stimulated-recall interviews with eight psychiatrists were conducted and transcribed verbatim. The material was analyzed using an adapted form of dialogical analysis, focusing on voices and positioning. Results: The psychiatrists took actions in the treatment situation not only as professionals, but also as individuals who had their own characteristics, and individual relationships with …
Psychiatrists’ inner dialogues concerning workmates during need
Background: In the Need-Adapted approach decisions are made in therapy meetings with all relevant parties; this poses a professional challenge to psychiatrists. Aims: To describe psychiatrists’ inner dialogues concerning their workmates in treatment meetings. Methods: Using videos of co-research interviews, stimulated-recall interviews with eight psychiatrists were conducted and transcribed verbatim. The material was analyzed using an adapted form of dialogical analysis, focusing on voices and positioning. Results: The psychiatrists took actions in the treatment situation not only as professionals, but also as individuals who had their own characteristics, and individual relationships with …
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…