Open dialogue

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Open Dialogue (OD) is an alternative treatment approach in acute psychotic crises for the treatment of psychoses . The therapists that a psychosis by emotional or mental go with this approach assumes stress is caused in particular load situations and immediate assistance during or shortly after such crisis prevents the occurrence of psychotic symptoms or greatly weakens. In -patient treatment should be largely dispensed with and neuroleptic drugs are used only rarely and in small doses.

history

In 1968, Yriö Alanen and his team at the Turku University Hospital in Finland developed an intensive milieu therapeutic treatment. The team integrated systemic family therapy into their treatments with individual psychodynamic psychotherapy in the late 1970s, calling it needs-based therapy . This was tested as a model in the Finnish National Schizophrenia Project to improve the treatment of severely mentally ill patients in the 1980s and adapted in a results-oriented manner.

Due to needs-based therapy , psychologists and psychiatrists working with Jaakko Seikkula in community psychiatry in western Lapland developed the so-called "open dialogue" as a further model of intervention in acutely psychotic patients, which has proven to be successful in various studies. The studies provided the basis for how psychiatric treatment can be organized even in the most severe crises by using the resources of the patient's families and other social networks. The open dialogue was implemented in several steps: in 1984, instead of systemic family therapy, open meetings for family treatment were introduced. In 1987 a crisis department was established in the clinic to put together case-specific teams. From 1990 onwards, all psychiatric outpatient clinics organized mobile crisis intervention teams.

In an open dialogue , mobile teams quickly take over the treatment in acute situations and accompany the patient through to recovery. If possible, the meeting takes place at the patient's home, with his family members and his social network. The focus of the open dialogue sessions is on empowering the adult part of the patient and calming the situation, rather than encouraging regressive behavior. In the open dialogue, the problems are seen as socially conditioned and are recorded anew in every conversation.

At the start of the open treatment sessions, the team asks family members and other participants about the issues that matter most to them. The starting point for the treatment session is the way, the language, in which the family describes the patient's problem. The 'correct' diagnosis is only made in joint sessions. This dialogical process of understanding, which is promoted by everyone involved, leading to a deep and concrete understanding of the case, can be a therapeutic process. The team's interventions are adapted to how the family assesses and experiences the current crisis. Psychotropic drugs are not used at all or used in low doses if possible. Seikkula sees dialogue or dialogism as a way of life that we learn right after birth:

“ First we learn to breathe - breathe in and breathe out - and immediately afterwards we learn to become active participants in dialogical relationships in which we respond to the utterances of people around us and actively initiate responses to our utterances from them. "

- Roast, 2007; Trevarthen, 2007

In the follow-up examination after five years (Seikkula et al. 2006), the effectiveness of the open dialogue in first-time psychosis patients was evaluated: only 29 percent of the OD patients had one or more relapses, 82 percent no longer had any psychotic symptoms and the employment status (study, Work, active job search) was 86 percent. Since around 2008, the open dialogue approach has become a model in many countries around the world.

literature

  • Jaakko Seikkula, Birgitta Alakare: "Open Dialogues", in: Peter Lehmann , Peter Stastny (Eds.): "Instead of Psychiatry 2". Antipsychiatrieverlag, Berlin / Shrewsbury / Eugene (Oregon) 2007, pp. 234–249. ISBN 978-3-925931-38-3 (E-Book 2018)
  • Jaakko Seikkula, Birgitta Alakare: "Open Dialogues", in: Peter Stastny, Peter Lehmann (Eds.): "Alternatives beyond psychiatry". Peter Lehmann Publishing, Berlin / Shrewsbury / Eugene (Oregon) 2007, pp. 223-239. ISBN 978-0-9545428-1-8 (UK), ISBN 978-0-9788399-1-8 (USA). E-book 2018
  • Jaakko Seikkula, Birgitta Alakare, Jukka Aaltonen: "Open dialogue in psychosis treatment - principles and research results of the West Lapland project", in: Volkmar Aderhold, Yrjö Alanen, Gernot Hess, Petra Hohn (eds.): "Psychotherapy of the psychoses - integrative treatment approaches from Scandinavia ". Psychosozial Verlag, Giessen 2003, pp. 89-102. ISBN 978-3-89806-232-9

Web links

Individual evidence

  1. ↑ Film by Daniel Mackler, 2011: "Offener Dialog" (with German subtitles)
  2. ↑ Jaakko Seikkula, University of Jyväskylä Finland: Becoming dialogic: Psychotherapy or a way of life? In: The Australian and New Zealand Journal of Family Therapy, Volume 32, Number 3, 2011, pp. 179-193.
  3. ↑ Antipsychiatrie Verlag, Berlin 2007: Jaakko Seikkula, Birgitta Alakare: "Open Dialogues" (reader sample)
  4. ↑ Social Psychiatric Colloquium on May 24, 2018 at Inselspital Bern
  5. ↑ Deutsches Ärzteblatt of October 21, 2015: Schizophrenia: Open dialogue «navigates» patients better through initial therapy