Diálogo Abierto: Una aproximación narrativa a un caso de terapia de pareja con malestar conyugal

Investigaciones previas han encontrado patrones comunicativos específicos en pare-jas que lidian con la depresión, específicamente cuando la depresión está asociada con problemas conyugales. Este hecho puede conllevar a que las parejas presenten dificultades para desarrollar una comunicación colaborativa en las sesiones, lo que supone un verdadero reto para los terapeutas. Este estudio exploratorio examina desde un enfoque dialógico la dominancia y el tipo de diálogo establecido en una pareja que lidia con la depresión y que presenta un bajo ajuste diádico. Las respuestas de los terapeutas fueron exploradas para identificar cuáles fueron las más efectivas al propiciar una actitud colaborati…

MONOLOGUE IS THE CRISIS-DIALOGUE BECOMES THE AIM OF THERAPY

The Open Dialogue Approach to Acute Psychosis: Its Poetics and Micropolitics

In Finland, a network-based, language approach to psychiatric care has emerged, called "Open Dialogue." It draws on Bakhtin's dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: "tolerance of uncertainty," "dialogism," and "polyphony in social networks." A treatment meeting shows how these poetics operate to generate a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment. Recent research suggests that Open Dialogue has improved outcomes for young peo…

Open dialogues with good and poor outcomes for psychotic crises: examples from families with violence.

In Open Dialogue the first treatment meeting occurs within 24 hr afer 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 offirst-episode psychotic patients. In good outcomes, the clients had both interactional and semantic dominance, and the dialogue tookplace 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 …

Soft Prosody and Embodied Attunement in Therapeutic Interaction: A Multimethod Case Study of a Moment of Change

This study focused on a moment of weeping in one psychotherapy case. The overall aim was toexplore the role of “soft prosody” in psychotherapy interaction—that is, the participants’ use ofpauses, a lower volume, slower rhythms, and softer intonation than in the surrounding speech. Amixed-method, micro-analytic perspective was applied to investigate (a) social interaction, includ-ing its verbal and nonverbal elements; (2) the participants’ bodily responses, including autonomicnervous system (ANS) measurements; and (3) the participants’ thoughts and feelings during thetherapy session, as reported in subsequent individual interviews. Soft prosody was observed to be animportant conversational t…

Significant Moments in a Couple Therapy Session: Towards the Integration of Different Modalities of Analysis

This chapter presents a couple therapy session from four different research perspectives: The verbal dialogue was analysed with the Dialogical Investigations of Happenings of Change method, the embodied reactions of each participant were analysed by examining the electrodermal activity of each participant, and nonverbal synchrony was observed between the participants. Stimulated Recall Interviews, conducted individually after the session, were used to gain insights on the participants’ thoughts and feelings concerning particular moments in the session. We wished to determine what could be learned from the embodied reactions of the participants in couple therapy, including whether the data o…

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…

“Open Dialogue behind locked doors” – exploring the experiences of patients, family members, and professionals with network meetings in a locked psychiatric hospital unit : A qualitative study

This paper explores and describes the experiences of patients, family members, and professionals with the Open Dialogue approach to network meetings at a locked psychiatric hospital unit in Norway. Previous research on Open Dialogue has mostly focused on acute crises in community care contexts. In this article, we discuss the participants’ experiences with Open Dialogue in a new context; that is in an inpatient locked unit. The inpatients are suffering from severe mental illness and might have been admitted to the unit against their will. The study has a qualitative design. Data were collected through a focus group interview with professionals and from written evaluations by patients and th…

A moment within the psychoanalytic psychotherapy of an adult female patient – The meanings of nonverbal and bodily expressions

This case study adresses the multiple meanings of a moment of strong non-verbal and bodily expression within a course of psychoanalytic psychotherapy. One therapy session was video-recorded in the ...

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…

Inter-agency work in Open Dialogue: the significance of listening and authenticity

The article explores what professionals regard as important skills and attitudes for generating inter-agency network meetings involving intra- and interprofessonal work. More specifically, we will examine what they understand as promoting or impeding dialogue and how this is related to their professional backgrounds. The professionals participated in a project using an open dialogue approach in order to increase the use of inter-agency network meetings with young people suffering from mental health problems. In this explorative case study, empirical data was collected through interviews conducted with two focus groups, the first comprising healthcare professionals and the second professiona…

Increasing responsibility, safety, and trust through a dialogical approach: A case study in couple therapy for psychological abusive behavior

This article reports an analysis of conjoint therapy for psychological intimate partner violence, treated via a dialogical approach. The article reviews current controversies surrounding this treatment modality and its outcome. The dialogical approach is presented as an appropriate method for analyzing and understanding the issue of violence, but it is emphasized that the focus on communication does not involve a return to a systemic perspective on intimate partner violence. Four important dimensions are identified as emerging in conjoint treatment for psychological intimate partner violence, namely responsibility, safety, trust, and the role of the therapists. The Dialogical Investigations…

Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study.

AbstractOpen Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20–F29) were asked about their treatment of FEP, initiated under OD 10–23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enab…

Aikuisten turvapaikanhakija- ja pakolaisasiakkaiden terapeuttisissa keskusteluissa kuvaamat hyödylliset muutokset

Tutkimuksessa tarkastellaan sitä, kuinka kuusi aikuista turvapaikanhakija- ja pakolaisasiakasta kuvaavat kokemiaan hyödyllisiä muutoksia luonnollisissa terapeuttisissa keskusteluissa. Asiakkaiden keskustelukäynnit kriisikeskuksen työntekijöiden luona videotallennettiin. Tutkimuksen kohteena olivat asiakkaiden esittämät ja tulkkien suomeksi välittämät ilmaukset. Tutkimusmenetelmänä käytettiin aineistolähtöistä laadullista sisällönanalyysia. Analyysissä syntyi neljä hyödyllisen muutoksen kategoriaa. Hyödyllisen muutoksen kategorioita ovat helpottuneempi olotila, uusien ongelmiin ja elämään liittyvien hallintakeinojen omaksuminen, itseymmärryksen ja voimaantumisen tunteen lisääntyminen ja rake…

The Relational Mind in Couple Therapy : A Bateson-Inspired View of Human Life as an Embodied Stream

Research on human intersubjectivity has found that humans participate in a dialogue throughout their life, and that this is manifested not only via language, but also nonverbally, with the entire body. Such an understanding of human life has brought into focus some basic systemic ideas concerning the human relational mind. For Gregory Bateson, the mind works as a system, formed from components that are in continuous interaction with each other. In our Relational Mind research project, we followed twelve couple therapy processes involving two therapists per session, looking at the ways in which the four participants attuned to each other with their bodies, including their autonomic nervous s…

Nonverbal synchrony in couple therapy linked to clients’ well-being and the therapeutic alliance

Nonverbal synchrony between individuals has a robust relation to the positive aspects of relationships. In psychotherapy, where talking is the cure, nonverbal synchrony has been related to a positive outcome of therapy and to a stronger therapeutic alliance between therapist and client in dyadic settings. Only a few studies have focused on nonverbal synchrony in multi-actor therapy conversations. Here, we studied the synchrony of head and body movements in couple therapy, with four participants present (spouses and two therapists). We analyzed more than 2000min of couple therapy videos from 11 couple therapy cases using Motion Energy Analysis and a Surrogate Synchrony (SUSY), a procedure us…

Alliance Formations in Couple Therapy: A Multimodal and Multimethod Study

AbstractThe authors sought to study underlying processes of alliance formation, a multimethod and multimodal research procedure was developed and applied to a 6-minute episode from one couple thera...

Dialogue and Dominance in Couple Therapy for Depression: Exploring Therapists' Responses in Creating Collaborative Moments.

Previous investigations have found specific communication patterns in couples dealing with depression, specifically when depression concurs with conjugal conflicts. The presence of these patterns can reflect couples' difficulties in engaging in collaborative communication during their sessions, posing a real challenge for therapists. This exploratory study uses a dialogical approach to examine issues of dominance and type of dialogue in two couples who differed in terms of their levels of dyadic adjustment. The therapists' reactions were explored in order to detect the kinds of responses that were most effective at engendering a collaborative attitude in therapy sessions. The method used to…

Shared Sequences from Network Therapy with Adolescents Only the therapist Finds Meaningful

As part of a larger research project, this qualitative study explores sequences from six network therapy sessions. We focused on these sequences because only the therapists found them to be meaningful; the other participants did not think they were significant. The aim of this study was to explore the therapists’ inner dialogues, the degree to which these inner dialogues consist of professional and personal voices, and what this means for the dialogical process. We used a multi-perspective methodology that combines video recordings of network therapy sessions, participants’ interviews, and text analysis. We found that the outer dialogue and the therapists’ inner dialogues are strongly relat…

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…

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach

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 ps…

Protocol for a participatory survey to investigate the long-term effectiveness of adult psychiatric services (PSILEAPS) : a prospective exploratory cohort study

Mental health research and practice is currently moving beyond a focus on group-level symptom reduction models. Hence, research and treatment increasingly emphasize the real-life individual needs of service users and their social networks. One example is the Open Dialogue approach (OD), which has demonstrated promising outcomes in the Finnish Western Lapland (WL) catchment area. Nevertheless, it is unclear how OD-based services have so far been maintained in WL. It is also unclear how the experiences of multi-disciplinary care teams, service users and their social network members differ, with regard to differing approaches to mental health treatment. More generally, there is a global need f…

Long-Term Use of Medication is Based on Myths and Lack of other Skills to Help People in Most Severe Crises: Commentary to the Article of Peter Goetzsche

Change is an ongoing ethical event: Levinas, Bakhtin and the dialogical dynamics of becoming

In this article, we use the intersubjective ethics of Bakhtin and Levinas and a case illustration to explore change in therapy as an ethical phenomenon. We follow Lakoff and Johnson in their emphasis on the way our conceptions of change seem permeated by metaphors. Bakhtin and Levinas both suggest through a language in which metaphors play a crucial role, that human existence—the consciousness and the subject—emerge within the dialogue of the encounter. They both describe the dynamics of human existence as ethical in their origin. Following this, we argue that change may be seen as an ongoing ethical event and that the dynamics of change are found in the ways we constantly become in this ev…

Ruumiillisuus psykoterapiassa : dialogista toisiinsa virittäytymistä ja synkroniaa

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…

Open dialogue as a human rights-aligned approach

Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council…

The shift from monologue to dialogue in a couple therapy session: dialogical investigation of change from the therapists' point of view.

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners' "listening in" to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, …

Generating dialogical practices in mental health: experiences from southern norway, 1998-2008.

Published version of an article in the journal: Administration and Policy in Mental Health and Mental Health Services Research. Also available from the publisher at: http://dx.doi.org/10.1007/s10488-013-0479-3 In Norway and many other countries, political guidelines prescribe the development of mental health strategies with both a service user's perspective and a treatment system established by the local authority. The development of new strategies frequently involves challenges regarding procedures and treatment as well as a view of knowledge and humanity. Dialogical practices might provide a solution for these challenges not only because of its procedures but also due to its attitudes tow…

Becoming Dialogical: Psychotherapy or a Way of Life?

After birth the first thing we learn is becoming a participant in dialogue. We are born in relations and those relations become our structure. Intersubjectivity is the basis of human experience and dialogue the way we live it. In this paper the dilemma of looking at dialogue as either a way of life or a therapeutic method is described. The background is the open dialogue psychiatric system that was initiated in Finnish Western Lapland. The author was part of the team re-organizing psychiatry and afterwards became involved in many different types of projects in dialogical practices. Lately the focus has shifted from looking at speech to seeing the entire embodied human being in the present m…

Psychosis Is Not Illness but a Survival Strategy in Severe Stress: A Proposal for an Addition to a Phenomenological Point of View

Phenomenology often looks at psychosis as a defined pathological state. In this paper, psychosis is not seen as a (pathological) state but as a way to respond in extreme stress. It is psychological functioning of the embodied and relational mind, and psychotic experience can be seen as one form of affective arousal among any other affects. Taken the point of views of Emmanuel Levinas and Mikhail Bakhtin about the primacy of living in responsive relationships, psychotic behavior is seen as emerging in relationships that do not guarantee adequate responses and thus the subject is imposed to isolate from social relationships and developing odd behavior. If dialogical responses are guaranteed, …

The Need-Adapted Approach in Psychosis: The Impact of Psychosis on the Treatment and the Professionals

Psychosis is a challenging phenomenon for professionals. In the need-adapted approach (NAA), therapy meetings constitute a deliberate effort to meet the challenges by bringing all the main parties together within a common discussion. The aims of this study are to analyze and evaluate psychiatrists' experiences of the treatment processes in psychosis. A qualitative multiple case study approach has been used. Between August 2007 and January 2009, co-research interviews (CR-Is) and stimulated-recall interviews (STR-Is) with 10 psychiatrists from 3 different parts of Finland were videoed and transcribed verbatim. The material was analyzed using qualitative content analysis. The difficult emotio…

Constructing Healing Dialogues in Group Treatment for Men Who Have Used Violence Against Their Intimate Partners

Although various “talking cure” treatments typically constitute an important part of practices in social work and mental health services, there are few studies on the actual “talk-within-the-cure.” This qualitative study examined talk in group treatment for men who had used violence against their intimate partners. Using the method termed Dialogical Investigations, the aim of the present study was to examine the construction of “healing dialogues,” that is, dialogues that promote change in clients, within treatment conversations. The results of the micro-analysis suggest that mutually responsive and constructive dialogical interaction and talk with symbolic language may support the emergenc…

From Research on Dialogical Practice to Dialogical Research: Open Dialogue Is Based on a Continuous Scientific Analysis

Open dialogue is based on systematic research since the very beginning of the development. In every new phase of the development and reorganization of the psychiatric organization, research was needed for both understanding the phenomenon of the therapeutic processes and detecting the outcome of the new approach. The research is “naturalistic” in the way that it takes place within the everyday – natural – clinical practice following what happens there. This means that the research designs do not change the clinical practice for the research, as so often done in empiristic clinical trials. The research employs “mixed method research” to identify all the possible elements of the object of the…

Sympathetic Nervous System Synchrony in Couple Therapy

The aim of this study was to test whether there is statistically significant sympathetic nervous system (SNS) synchrony between participants in couple therapy. To our knowledge, this is the first study to measure psychophysiological synchrony during therapy in a multiactor setting. The study focuses on electrodermal activity (EDA) in the second couple therapy session from 10 different cases (20 clients, 10 therapists working in pairs). The EDA concordance index was used as a measure of SNS synchrony between dyads, and synchrony was found in 85% of all the dyads. Surprisingly, co-therapists exhibited the highest levels of synchrony, whereas couples exhibited the lowest synchrony. The client-…

Associations Between Sympathetic Nervous System Synchrony, Movement Synchrony, and Speech in Couple Therapy

Background: Research on interpersonal synchrony has mostly focused on a single modality, and hence little is known about the connections between different types of social attunement. In this study, the relationship between sympathetic nervous system synchrony, movement synchrony, and the amount of speech were studied in couple therapy. Methods: Data comprised 12 couple therapy cases (24 clients and 10 therapists working in pairs as co-therapists). Synchrony in electrodermal activity, head and body movement, and the amount of speech and simultaneous speech during the sessions were analyzed in 12 sessions at the start of couple therapy (all 72 dyads) and eight sessions at the end of therapy (…

Developing Dialogicity in Relational Practices: Reflecting on Experiences from Open Dialogues

The paper analyses open dialogicity in psychotherapy and juxtaposes it with education in order to find common dialogical elements in all relational practices. The core is found in unconditional respect for otherness and generating dialogical space for voices to be heard. In traditional practice, professionals are tempted to plan interventions according to the goals of change informed by their methods and in team work and multi-professional practices they may even do this between themselves, away from the clients. Pre-set categories, plans and goals, however well founded they may seem, hinder listening. Following what others present here-and-now calls for tolerating uncertainty. Insight into…

Aikuisten turvapaikanhakijoiden ja pakolaisten mielenterveyden ja psyykkisten ongelmien erityispiirteet

The Embodied Attunement of Therapists and a Couple within Dialogical Psychotherapy: An Introduction to the Relational Mind Research Project

In dialogical practice, therapists seek to respond to the utterances of clients by including in their own response what the client said. No research so far exists on how, in dialogs, therapists and clients attune themselves to each other with their entire bodies. The research program The Relational Mind is the first to look at dialog in terms of both the outer and the inner dialogs of participants (clients and therapists), observed in parallel with autonomic nervous system (ANS) measurements. In the ANS, the response occurs immediately, even before conscious thought, making it possible to follow how participants in a multiactor dialog synchronize their reactions and attune themselves to eac…

Making sense of multi-actor dialogues in family therapy and network meetings.

In recent years, a number of family therapists have conceptualized psychotherapy as a dialogical activity. This view presents family therapy researchers with specific challenges, the most important of which is to find ways of dealing with the dialogical qualities of the multi-actor dialogues that occur, for example, in family therapeutic conversations. In this article, we propose some preliminary ideas concerning qualitative investigations of multi-actor dialogues. Our aim is to work toward an integration of Bakhtin’s theoretical concepts with good practices in qualitative research (e.g., dialogical tools and concepts of a narrative processes coding system) in order to make sense of family …

The added value of studying embodied responses in couple therapy research : A case study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly…

‘Through speaking, he finds himself … a bit’: Dialogues Open for Moving and Living through Inviting Attentiveness, Expressive Vitality and New Meaning

Studies exploring the experiences of recovering from mental health difficulties show the significance of social and relational aspects. Dialogical practices operate within the realm of social relations; individual perspectives are not the primary focus of attention. The present study is part of a series of qualitative studies from southern Norway, exploring dialogical practices and change from the perspective of lived experience and in relationship with network meetings. Two co-researchers, who themselves had experienced mental health difficulties, were part of the research team. Material from qualitative interviews was analysed through a dialogical hermeneutical process where ideas from Em…

Dialogues in partner abusive clients' group treatment: conversational tools used by counselors with differently motivated clients.

This qualitative study investigated talk and interaction as process factors potentially influencing outcomes in abuser group intervention. The findings showed that (a) abusers participate in group programs with considerably different degrees of motivation; (b) the interaction in abusers’ various stages of change is characterized by different qualities; and (c) group counselors face a challenge in adapting their ways of working to abusers’ various needs and backgrounds. The findings demonstrate the importance of attending to the interactional elements in abuser treatment programs and show the value of matching an abuser’s needs and degree of motivation with the timing of interventions. It is…

A 5-Year Suicide Rate of Adolescents Who Enrolled to an Open Dialogue-Based Services: A Nationwide Longitudinal Register-Based Comparison

AbstractIn the Open Dialogue (OD) based psychiatric services adolescent patients receive less medication and are more often treated within an outpatient setting as compared to standard services. An evaluation of the possible risks of implementing OD are required. The aim of this longitudinal register-based study was to evaluate how treatment under OD is associated with the probability of suicide as compared standard psychiatric care. Study included all 13- to 20-year-old adolescents who enrolled to a psychiatric service in Finland in 2003–2013. The OD-group included adolescents whose treatment commenced in the Western Lapland area (n = 2107), this being the only region where OD covered all …

The Significance of Silent Moments in Creating Words for the Not-Yet-Spoken Experiences in Threat of Divorce

In the context of couple therapy involving the threat of divorce, the study examined the significance of silent moments for arriving at words for the not-yet-spoken experiences. It also examined whether interactional and embodied synchrony occurred during such silent moments. A mixed method analysis was conducted, focusing on the therapeutic dialogue, psychophysiological data (the Autonomic Nervous System, ANS), and the participants’ thoughts and feelings during individual Stimulated Recall interviews. Two episodes containing several silent moments were analyzed. The analysis indicated that during the silent moments the participants continued the therapeutic conversations through their enti…

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 …

Inner and outer voices in the present moment of family and network therapy

Dialogue in the polyphony of inner and outer voices in the present moment of family therapy is analysed. In Western Lapland a focus on social networks and dialogues in the meeting with families has proved to be effective in psychotic crises.

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 …

Open Dialogues in social networks: professional identity and transdisciplinary collaboration

Aim: The aim of this article is to explore the challenges connected to the transformation and emergence of professional identity in transdisciplinary multi-agency network meetings and the use of Open Dialogue.Introduction: The empirical findings have been taken from a clinical project in southern Norway concerning multi-agency network meetings with persons between 14 and 25 years of age. The project explores how these meetings are perceived by professionals working in various sectors.Methodology: Data was collected through three interviews conducted with two focus groups, the first comprising health care professionals and the second professionals from the social and educational sectors. Con…

Entrevistas de Recuerdo Estimulado: ¿Cómo la entrevista de investigación puede contribuir a nuevas prácticas terapéuticas? [Stimulated Recall Interviews: How can the research interview contribute to new therapeutic practices?]

The subjective experiences of participants in couple therapy have been explored through Stimulated Recall Interviews (SRIs), in which both clients and therapists come individually to watch video clips of their therapy sessions. We believe SRIs offer a good resource for Practice Oriented Research (POR) by promoting meaningful, flexible interplay between scientific research and clinical practice. Team members have different roles, either as “insiders” or “outsiders” of the therapeutic setting. The potential benefits of these interviews are illustrated by a case study conducted within the Relational Mind research project, in which SRIs helped to promote the emergence of reflections. SRIs, hith…

Affective Arousal During Blaming in Couple Therapy: Combining Analyses of Verbal Discourse and Physiological Responses in Two Case Studies

Blaming one’s partner is common in couple therapy and such moral comment often evokes affective arousal. How people attune to each other as whole embodied beings is a current focus of interest in psychotherapy research. This study contributes to the literature by looking at attunement during critical moments in therapy interaction. Responses to blaming in verbal dialogue and at the level of the autonomic nervous system (ANS) were investigated in two couple therapy cases with a client couple and two therapists. Video-recorded couple therapy sessions were analyzed using discursive psychology and a narrative approach. The use of positioning, a discourse analytic tool, was also studied. ANS res…

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study.

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single-case study comprise couple therapy process videotapes recorded in a multi-camera setting, and measurements of participants' SNS activity. The voluntary participants were a marital couple in their late thirties and two middle-aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly…

“She Offered Me a Place and a Future”: Change is an Event of Becoming Through Movement in Ethical Time and Space

Published version of an article in the journal: Contemporary Family Therapy. Also available from the publisher at: http://dx.doi.org/10.1007/s10591-014-9317-3 Within mental health research, the promise of exploring the lived experience of those affected is increasingly acknowledged. This research points to the significance of social aspects. The present study is part of a series of qualitative studies exploring network-oriented practices in southern Norway. The aim of this study was to explore the social dynamics of change related to adolescents in psychosocial crises. From the perspective of lived experience the study focused changes related to the adolescents’ ways of existing in various …

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…

CAN I TELL JUST BY MYSELF? DISCUSSING A PARENTAL MENTAL DISORDER WITH A CHILD IN A RESEARCH INTERVIEW

In this single-case study, we focus on how to have a dialogue in a research interview with a child whose parent has been diagnosed with a mental disorder. The interactional context and the interviewer’s role in co-constructing the child’s accounts have been largely neglected in the qualitative psychological research on this subject. Stigma related to mental disorders is increasingly being recognized as a central issue for the entire mental health field. It is considered to have far-reaching effects on the social interaction of the stigmatized person and also to contaminate the interactions of those around that person. We examine how the stigma of a parental mental disorder arises and is neg…

Electrodermal activity in couple therapy for intimate partner violence

The aim of this study was to examine the extent to which intimate partner violence (IPV) is discussed in couple therapy, what the participants say about it and how, and how the participants’ electrodermal activity (EDA) is activated during these discussions. We studied four couples for whom IPV was an issue in dialog with their therapists. We used thematic analysis and examined the differences in EDA (measured as skin conductance responses, SCRs) between the participants. We found that although IPV was discussed relatively little in therapy, when the topic arose the victims took an active part in the discussion. We also found that the main themes were descriptions of IPV, explanations for I…

A Study of a Network Meeting: Exploring the Interplay between Inner and Outer Dialogues in Significant and Meaningful Moments

The present study is part of a series of qualitative studies focusing on dialogic practice in southern Norway. In this article, we present a qualitative study of a network meeting focusing on the interplay between the participants' inner and outer dialogues. The network meeting is between an adolescent boy, his mother and two network therapists, the same adolescent case discussed previously in this journal by Boe et al. (2013). The aim of this study is to explore how the interplay between inner and outer dialogues contributes to significant and meaningful moments for the interlocutors. A multiperspective methodology is used that combines video recordings of a network meeting and participant…

How do people talk decades later about their crisis that we call psychosis? : A qualitative study of the personal meaning-making process

Psychosis refers to a severe mental state that often significantly affects the individual’s life course. However, it remains unclear how people with the lived experiences themselves view these phenomena, as part of their life story. In order to evaluate this personal meaning-making process, we conducted in-depth life-story interviews with 20 people who had been diagnosed with non-affective psychosis 10 to 23 years previously in one catchment area. 35% of them were still receiving mental health treatment, and 55% of them were diagnosed with schizophrenia. Only a minority named their experiences as psychosis. On the basis of narrative analysis, two types of stories appeared to encompass how m…

Sympathetic nervous system synchrony: An exploratory study of its relationship with the therapeutic alliance and outcome in couple therapy.

In previous research, we found that sympathetic nervous system synchrony, measured via electrodermal activity (EDA), occurs between participants at the start of couple therapy. The aim now was to test whether this synchrony changes during the therapy process, and how any changes may be related to clients' and therapists' evaluations of the working alliance, and the outcome of therapy. Twelve different couple therapy processes were analyzed (24 clients, plus 10 therapists, working in pairs; hence, 4 persons per session) using EDA concordance indices and questionnaires (Outcome Rating Scale, Session Rating Scale, and Clinical Outcomes in Routine Evaluation-Outcome Measure). EDA synchrony betw…

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…

Therapists’ Responses for Enhancing Change Through Dialogue: Dialogical Investigations of Change

The point of view on research represented here is based on a dialogical framework. Our emphasis is on understanding the contribution of the therapists to the process of change. We conceptualize therapeutic conversation as a dialogical activity. In using the research method The Dialogical Investigation of Happenings of Change (DIHC) the focus is on how therapists participate and answer from a specific position of “responsive responsibility.” In this chapter our aim is twofold: (1) to present a method for conducting a dialogical analysis of couple sessions and (2) to track detailed sequences of events of change. To make sense of the details of this process, we use Bakhtinian concepts includin…

Five-year cumulative exposure to antipsychotic medication after first-episode psychosis and its association with 19-year outcomes

Abstract Background: The long-term effectiveness of antipsychotic maintenance treatment after first-episode psychosis (FEP) is contested. In this real-world observational study, we examined how cumulative exposure to antipsychotics within the first 5 years from FEP was associated with the 19-year outcome. Methods: Finnish national registers were used to detect all patients who were hospitalized due to non-affective psychosis in the mid-1990s, and who were treatment naïve prior to the inclusion period (N = 1318). Generalized linear models with logit link function were used to estimate how cumulative exposure to antipsychotics within the first 5 years from onset was associated with mortality,…

“Open Dialogue behind locked doors” – exploring patients’, family members’, and professionals’ experiences with network meetings in a locked psychiatric hospital unit: A qualitative study

This paper explores and describes the experiences of patients, family members, and professionals with the Open Dialogue approach to network meetings at a locked psychiatric hospital unit in Norway. Previous research on Open Dialogue has mostly focused on acute crises in community care contexts. In this article, we discuss the participants’ experiences with Open Dialogue in a new context; that is in an inpatient locked unit. The inpatients are suffering from severe mental illness and might have been admitted to the unit against their will. The study has a qualitative design. Data were collected through a focus group interview with professionals and from written evaluations by patients and th…

Open Dialogues in social networks: Professional identity

Aim: The aim of this article is to explore the challenges connected to the transformation and emergence of professional identity in transdisciplinary multi-agency network meetings and the use of Open Dialogue. Introduction: The empirical findings have been taken from a clinical project in southern Norway concerning multi-agency network meetings with persons between 14 and 25 years of age. The project explores how these meetings are perceived by professionals working in various sectors. Methodology: Data was collected through three interviews conducted with two focus groups, the first comprising health care professionals and the second professionals from the social and educational sectors. C…

The 10‐year treatment outcome of open dialogue‐based psychiatric services for adolescents: A nationwide longitudinal register‐based study

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 Finl…

Studying Nonverbal Synchrony in Couple Therapy : Observing Implicit Posture and Movement Synchrony

AbstractResearch on nonverbal synchrony (movement coordination) in psychotherapy has recently attracted increased attention. Nonverbal synchrony has been shown to relate to the therapeutic alliance and outcome. However, research on nonverbal synchrony in couple therapy remains scarce. In this study, we examined the therapy process of one couple in detail and created a coding scheme to depict posture and movement synchrony. In this case study, we found that the relationship between nonverbal synchrony and the therapeutic alliance was complex. During the therapy process, the amount of nonverbal synchrony varied, as did the participants’ evaluations of the alliance. In couple therapy nonverbal…

Open Dialogue as a Human Rights Aligned Approach

Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council…

Introduction : Open Dialogue around the world – implementation, outcomes, experiences and perspectives