Background: In the Need-Adapted approach (NAA) decisions are made in therapy meetings together 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 their coworkers.Conclusions: Professionals as individuals and the quality of clinician-clinician relationships have an impact on treatment, and these aspects should be taken into account in practice, in education, and in future research.

This research aimed to describe the inner dialogues of psychiatrists in the context of the Need-Adapted treatment of psychosis. It strived to show that the experiences of professionals can have an impact on the treatments offered. In addition, the research aimed to clarify how the phenomenon of professionals' inner dialogues may be studied.The data for the three studies of the research consisted of eight videotaped and transcribed stimulated recall interviews with psychiatrists, who recalled their inner dialogues, assisted by videos from co-research interviews. The dialogues took place in multi-agent discussions with patients, with the family members of patients, and with other professionals. The first study provided an overall picture of the research material, with a focus on psychiatrists' inner dialogues concerning their workmates. The second study focused on how the psychiatrists viewed their agency. The third study dealt with the impact of psychosis on the treatment, the psychiatrists, and other professionals. The first two studies used adaptations of dialogical-narrative analysis, while the third study used an adaptation of qualitative content analysis.From the perspective of real-world clinical practice the studies suggested the following: (i) since psychiatrists interact with the clients and with other professionals, they respond as embodied individual human beings with possibly strong emotions; this suggests that the experiences and inner dialogues of the participants may be interdependent; (ii) clinician-clinician relationships can be of crucial importance in the treatment; (iii) especially in the inpatient setting, institutional forces can have an enormous impact on psychiatrists' agency by reducing professional creativity, and occasionally, by leading to a kind of agentless situation; (iv) psychiatrists seem to be more or less aware of the many harmful effects of (in particular) inpatient treatment; (v) the interview methods used in the research increased professionals' reflective opportunities, indicating that such interviews could be helpful in the dilemmas professionals encounter in practice. Tämän tutkimuksen tavoite oli kuvata psykiatrien sisäistä keskustelua psykoosien tarpeenmukaisen hoitomallin kontekstissa. Se pyrki osoittamaan, että ammattilaisten kokemuksilla voi olla vaikutusta tarjottuun hoitoon, ja selvittä-mään, miten ammattilaisten sisäistä keskustelua voidaan tutkia. Kolmen osatutkimuksen aineisto koostui kahdeksasta videolle tallennetusta ja transkriptoidusta stimulated recall -haastattelusta, joissa psykiatrit yhteisen tutkimisen haastattelun kuvanauhan avulla palauttivat mieleensä sisäistä keskusteluaan. Yhteisen tutkimisen haastattelu oli ryhmäkeskustelu, jossa oli lääkärien ohella läsnä potilas, hänen perheenjäseniään sekä muita ammattilaisia. Ensimmäisessä osatutkimuksessa kuvattiin tutkimusaineistoa kokonaisuudessaan ja keskityttiin psykiatrien työtovereita koskevaan sisäiseen keskusteluun. Toisessa osatutkimuksessa paneuduttiin psykiatrien kokemukseen toimijuudestaan....

Final DraftBackground: 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 ten 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 setting, psychiatrists who attended also hospital care were the most able to follow the principles of NAA and those who took part only in outpatient treatment had a tendency to adopt the position of medical consultants. Conclusions:The ability of psychiatrists to have agency in the language used with the clients is an underrated issue. The interview methods used in the research could be utilized in practice.