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Clinical studies carry with them a paradox: The more obviously efficient an intervention is, the more ethical problems its trials pose. This article discusses the ethical problem of breached equipoise principle because of the perceived effectiveness of a nonblindable verbal technique, crisis dialogue (CD). CD is designed to help establish a therapeutic relationship with persons in a suspected psychotic state. In a pilot randomized controlled study in Yverdon, Switzerland (usual treatment vs. usual treatment + CD), after inclusion of 30 patients, clinicians expressed a consensual opinion that CD was effective in most cases. Following their opinion, the joint clinical and research team decided that the study had to be discontinued and that CD should be tried with all patients for ethical reasons. This poses an ethical problem with potential far-reaching consequences: In this interrupted study, differences between groups in terms of clinical outcome (Brief Psychiatric Rating Scale, Clinical Global Impression), therapeutic alliance (Working Alliance Inventory, Difficult Doctor–Patient Relationship Questionnaire), and patient satisfaction were consistent in favoring CD, but these differences did not reach statistical significance in most measurements. The early interruption of the study because of perceived effectiveness of the intervention can be seen as unethical as well because chances were high that a larger sample would have shown more conclusive results, allowing for faster introduction of CD in various clinical settings with corresponding improvement of patient care.

Although presented as a care measure, the use of seclusion rooms (SR) is controversial for both ethical and therapeutic reasons. Given that music seems to have a positive impact on psychiatric patients, offering them the possibility of listening to music in SRs might help to improve their care dimension. This study aimed to develop, implement and test a musical listening device that would be completely at patients' disposal, easy to use and beneficial to the quality of care provided in SRs. Over a twelve-week period, interviews were conducted with nurses (N=6) caring for patients placed in an equipped SR. The music player was user friendly, encouraged patients to make choices and decisions, helping them to regain control over themselves and their behavior, and elicited various patient-nurse interactions, thus contributing to the establishment of a caring relation. Further research is warranted to examine whether the systematic use of the music player has an impact on the subjective experience of both patients and caregivers, and on daily ward routine.

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Depuis 2012, une équipe alliant sciences infirmières, psychologie, sociologie et ingénierie réalise une recherche-action sur le développement et l’impact d’un dispositif d’écoute musicale dans les chambres de soins intensifs d’hôpitaux psychiatriques suisses et français. Conçu comme un exercice autoréflexif, cet article retrace la genèse de cette recherche-action afin d’en révéler la fabrique et les coulisses. Il rapporte comment le projet s’est concrètement déroulé, avec ses réussites, ses défis et ses difficultés. À terme, il s’agit de soulever les principaux enjeux au coeur de la recherche et ainsi d’interroger les conditions de possibilité des recherches-actions, notamment lorsqu’elles se déroulent en milieu hospitalier et en psychiatrie.