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

Abstract

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....

The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals

“…Therapists in the present study report that containment of uncertainty was experienced as an absence of pressure to respond immediately to both network and their own expectations of themselves as omnipotent therapists, both during each meeting and overall, during the service user’s course of recovery. Sometimes the use of monological responses around critical issues of medical care and risk to self or others (as in cases of domestic violence) was deemed as necessary, however therapist attunement, flexibility and capacity to adjust to the ongoing network needs allowed them to gradually restore a dialogical stance ( Borchers, 2014 ; Stockmann et al, 2017 ; Schubert et al, 2020 ). Although these challenges are most likely due to the lack of experience and formal, systematic training in OD, they are consistent with findings reported in the literature.…”

“…In that context, mental health professionals from different disciplines need to challenge their own assumptions around hierarchy and to work towards the cultivation of a democratic culture within the organization ( Seikkula and Olson, 2003 ; Holmesland et al, 2010 ). Therapist experience and specialization in a specific discipline may indeed be challenging for mental health professionals that are members of a multidisciplinary team as they may actively aim for targeted interventions or solutions perhaps as a means of regulating their own anxiety and need to control therapeutic outcome ( Borchers, 2014 ; Buus et al, 2017 ; Stockmann et al, 2017 ; Schubert et al, 2020 ). Mental health professionals may face challenges in integrating practices that are not taught but rather experientially acquired and require the adoption of a new modus operandi where transparency and acting from a non-expert stance are elementary; further research seems to confirm that Open Dialogue principles may often cause insecurity in mental health professionals that may lead to reduced participation and questioning of the model ( Buus et al, 2017 ; Dawson et al, 2019 , 2020 ; Florence et al, 2020 ; von Peter et al, 2023 ).…”

Explorations on the use of lived experiences by psychiatrists: facilitators and barriers

“…Limited research exists focusing on the professional identity and “self” of psychiatrists and these studies have pointed out that the fluid nature of professional identity over time tends to shift from a reliance on technical expertise to one’s own experience, values and knowledge that integrates professional and personal identities (Borchers et al , 2014). Peer supervision settings are not only a mandatory part offering space for discussion with colleagues to review difficult or challenging decisions with others, they also allow room for reflection (van den Goor, 2020).…”