6533b7d0fe1ef96bd125aecf

RESEARCH PRODUCT

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

subject

description

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 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, R&ol%nen, & 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