1 / 21

DIALOGUE

DIALOGUE “For the word (and, consequently, for a human being) there is nothing more terrible than a lack of response” ( Bakhtin , Speech genres, 127). OPEN DIALOGUE: Clients voices as resources. Jaakko Seikkula Val Jackson . Psychotic behavior is response.

aldis
Download Presentation

DIALOGUE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DIALOGUE “For the word (and, consequently, for a human being) there is nothing more terrible than a lack of response” (Bakhtin, Speech genres, 127)

  2. OPEN DIALOGUE: Clients voices as resources Jaakko Seikkula Val Jackson

  3. Psychotic behavior is response • A strategy to manage difficult experiences • Hallucinations include real events in one’s life • Experiences that do not yet have words

  4. Hypothesis • Longstanding psychotic behaviour is perhaps more an outcome of poor treatment in two respect - treatment starts all too late - non adequate understanding of the problem leads to a wrong response

  5. Tornio Jyväskylä

  6. Origins of open dialogue • Initiated in Finnish Western Lapland since early 1980’s • Integrating systemic family therapy and psychodynamic psychotherapy • Systematic family therapy training for the entire staff – since 1989 • Whole service approach

  7. MAIN PRINCIPLES FOR ORGANIZING OPEN DIALOGUES IN SOCIAL NETWORKS • IMMEDIATE HELP • SOCIAL NETWORK PERSPECTIVE • FLEXIBILITY AND MOBILITY • RESPONSIBILITY • PSYCHOLOGICAL CONTINUITY • TOLERANCE OF UNCERTAINTY • DIALOGISM

  8. IMMEDIATE HELP • First meeting in 24 hours • Crisis service for 24 hours • All participate from the outset

  9. SOCIAL NETWORK PERSPECTIVE • Those who define the problem should be included into the treatment process • Psychotic stories are discussed in open dialogue with everyone present

  10. FLEXIBILITY AND MOBILITY • The response is need-adapted to fit the special and changing needs of every patient and their social network • It does not exclude other therapies but integrates them into the process

  11. RESPONSIBILITY • The one who is first contacted is responsible for arranging the first meeting • All issues are openly discussed and all decisions are made in the meetings

  12. PSYCHOLOGICAL CONTINUITY • An integrated team, including both outpatient and inpatient staff, is formed • The meetings as often and as long as needed • The same team both in the hospital and in the outpatient setting • In the next crisis the core of the same team

  13. TOLERANCE OF UNCERTAINTY • To build up a scene for a safe enough process , team work essential

  14. DIALOGISM • Everyone has a voice, including the psychotic experiences • New words and joint language for the experiences, which do not yet have words or language • Impact of medication on dialogue at the point of crisis

  15. Outcomes (Aaltonen et al., 2011 and Seikkula et al, 2011): • DUP declined to three weeks • about 1/3 used antipsychotic drugs • 84 % returned to full employment • Few new schizophrenia patients: Annual incidence declined from 33 (1985) to 2-3 /100 000 (2005)

  16. OPEN DIALOGUE IN ACUTE PSYCHOSISFigure 1. Means of hospital days at 2 and 5 years follow-ups 2-5 years

  17. OPEN DIALOGUE IN ACUTE PSYCHOSIS Table 3. Psychotic symptoms at 5 year follow-up compared to neuroleptic medication during the first 2 years / % Rating of symptoms Neuroleptics 0 1 2 3 4 Total ------------------------------------- Not used 85 9 3 3 0 100 Used or cont. 58 17 8 17 0 100 ------------------------------------- Total 80 10 4 6 0 100 Chi-square 5.93; df=3; p=.145 (NS)

  18. UK • A lot of interest but challenging for the present structure of MH services. • Needs to be adapted to local services - projects in other countries, parachute project in New York city. • Leeds trial – replicated could produce a series of case studies.

  19. REFERENCES Seikkula, J. & Arnkil TE (2007). Sociale nettverk i dialog. Oslo: Universitetsforlaget. Seikkula, J. & Arnkil, TE (2006) Dialogical meetings in social networks. London: Karnac Books Bakhtin, M. (1984) Problems of Dostojevskij’s Poetics. Theory and History of Literature: Vol. 8. Manchester: Manchester University Press. Bakhtin, M. (1990) Art and Answerability: Early Philosophical Essays of M. M. Bakhtin, trans. Vadim Liapunov. Austin: University of Texas Press. Bakhtin, M. (1993) Toward a Philosophy of the Act, trans. Vadim Liapunov. Austin: University of Texas Press. Iacoboni, M (2008) Mirroring People: The new science of how we connect with others. Farrar, Straus and Giroux Carman, T. (2008). Merleau-Ponty. London:Routledge. Hermans, H. & Dimaggio, A. (2005).Dialogical self in psychotherapy. Stern, D.N. (2004). The present moment in psychotherapy and every day life. NY: Norton

More Related