Soteria

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Soteria Bern

Soteria (from the Greek σωτηρία “rescue”, also: well-being, preservation, salvation) is an alternative inpatient treatment for people in psychotic crises . In a normalizing context close to everyday life (homely, family-like, relaxed), patients are accompanied through their psychosis with the least possible neuroleptic medication. An important theoretical basis of this treatment is the emotional logic of Luc Ciompi .

This alternative treatment model was developed in the course of the anti- psychiatry movement since the 1960s. The first facility of this kind was founded in 1971 in California (USA) by the psychiatrist Loren Mosher (* 1933; † 2004), but had to be closed after twelve years due to the suspension of state aid. In 1984 the schizophrenia researcher Luc Ciompi founded the first Soteria in Europe in Bern (Switzerland) .

Since then, the Soteria concept has been particularly popular in Germany. Over 15 Soteria projects have been founded there since the 1990s. Today there are Soteria facilities in Germany in Zwiefalten (since 1999), Munich (since 2003), Reichenau (since 2012), Gangelt and Berlin (both since 2013). In addition, there has been a station with Soteria elements in Bonn since 2012 . The institutions mentioned are members of the International Soteria Working Group (IAS), which was founded in Berne in 1997 and converted into an association in 2015, whose focus, in addition to networking and professional exchange, is ensuring the Soteria treatment quality using the “Soteria Fidelity Scale”. There are also Soteria houses in Tokyo and Jerusalem as well as Soteria projects in Great Britain and the Netherlands.

Criteria of the Soteria

Soteria Berlin

Soteria is ideally located in a residential building with a large garden in the middle of the community and offers no space for more than 10 young patients, mostly suffering from acute psychosis from the schizophrenic group. This family-like environment, which is as normal as possible and hardly reminiscent of a psychiatric clinic, creates a relaxed atmosphere that contributes significantly to reducing anxiety without the use of high doses of neuroleptics . In the Soteria one tries to create a cognitive-affective calming and balance. The patients are called “residents” and are given holistic support in coping with their psychosis , if necessary at the beginning with 1: 1 support by the same caregiver around the clock. Luc Ciompi developed the “Soft Room” for this. The 1: 1 accompaniment in this sparsely furnished and pastel-colored room protects against too many outside stimuli, relieves tension and fears, helps build trust in the care team and supports the subsidence of psychotic symptoms.

After the acute phase has subsided, the patients / residents increasingly take on personal responsibility for the group and participate in the active community to cope with everyday life in the sense of milieu therapy (shopping together, cooking, cleaning, washing clothes or working in the garden). The employees support or encourage the residents depending on their current state of mind. For people in psychotic crises, a “normal everyday life” with practical action means a reference to reality, strengthens healthy parts and gives support and orientation. Towards the end of the stay, the focus is increasingly on the reality outside of the soteria and the preparation for a life that is as independent as possible while avoiding the too great risks of developing another psychosis. The Soteria is not only about combating symptoms, but also about dealing with the residents' personal living conditions.

A multi-professional team works in the Soteria. People with different professional and experience backgrounds are consciously employed. This also includes recovery companions who have had experiences similar to those of the patients. Employees and patients shape their relationship on an equal footing, there is little role differentiation and little hierarchy. The goals are to build a trusting relationship and to create a therapeutic atmosphere in which the patient can feel safe and secure. Personnel and conceptual continuity is helpful for the patients and their relatives, as this contributes more to calming a mostly fear-ridden psychosis than, for example, a stay in an acute ward with frequently changing caregivers and treatment ideas. What is important are the joint development of specific treatment goals and everyday life and learning in the therapeutic community . Close cooperation with relatives, other caregivers and carers is an important aspect of the approach. A careful use of psychotropic drugs has proven to be advantageous for the processing to allow the psychosis, but not to prevent. A sufficient individual stay time to come to terms with a psychosis and for constructive integration for the further course of life has proven to be beneficial in the past, but is now often only possible with the increasingly shorter inpatient stays in a subsequent stay in the day clinic, which ideally also by the Soteria is operated or is integrated into it.

Treatment principles

Soteria Munich

Since its inception in California, Soteria has claimed to be a pacemaker in psychosis treatment and is based on the following therapeutic principles:

  • Small, relaxing, stimulus-protected and as normal as possible, family-like environment
  • Careful and continuous personal support
  • Conceptual and personal continuity of support during the acute phase and beyond that for further treatment offers in terms of integrated care
  • Close cooperation with relatives and other important people from the social environment
  • Clear and similar information for residents, relatives and carers about vulnerability, psychotic crisis, clinical picture, treatment and prognosis
  • Joint development of specific goals and priorities in the living and working or employment or training area based on realistic, carefully positive future expectations, combined with appropriate risk awareness, especially with regard to future burdens
  • Restrained and individually tailored use of medication
  • Relapse prophylaxis based on the analysis of the individual signs of crisis and stressful situations as well as the development of coping options
  • Individually designed further treatment as part of the integrated care offer
  • The recovery approach is an integral part of the basic attitude of Soteria

research results

Soft room

Both Mosher in California and Ciompi in Bern carried out several studies on Soteria, on the one hand to empirically check the effectiveness of the Soteria concept and on the other hand to differentiate the concept on the basis of empirical results. This should also make the discussion about soteria more objective. These studies were able to show that Soteria differs significantly from conventional inpatient clinical treatment and still works just as well. In particular, it has been proven that the milieu therapeutic approach of Soteria helps to get by with fewer neuroleptics with a comparable improvement in psychological symptoms and a comparable risk of relapse. Mosher was also able to show that the psychosocial functional level of those treated in the Soteria is significantly better than that of control patients [1] . Treatment with fewer neuroleptics may increase the length of stay in the Soteria. This could be shortened in Bern by creating a Soteria day clinic.

There are no studies on how Soteria works. Possibly the psychotic therapeutic effect of the Soteria approach is based more on the combination of the therapy elements and the milieu to a lasting tension-relieving whole than on certain individual of these active factors: "Soteria has a neuroleptic-like effect - of course without the corresponding side effects". Whether the treatment of first-time patients in the Soteria influences the further course of the disease has not yet been scientifically verified. However, clinical observations and the evaluation of individual courses over around 25 years do not support such a hypothesis.

See also

literature

  • V. Aderhold: A healing environment - from the Soteria idea to home treatment . In: Bock, Dörner, Naber (Ed.): Impetus - To an anthropological psychiatry . Psychiatrie-Verlag, Bonn 2008, ISBN 3-88414-368-9
  • V. Aderhold, P. Stastny, P. Lehmann: Soteria - An alternative psychosocial reform movement . In: P. Stastny, P. Lehmann (Ed.): Instead of Psychiatrie 2 . Berlin / Eugene / Shrewsbury: Antipsychiatrieverlag 2007, pp. 150–165. ISBN 978-3-925931-38-3 (E-Book 2018)
  • V. Aderhold, P. Stastny, P. Lehmann: Soteria: An alternative mental health reform movement . In: P. Stastny, P. Lehmann (Eds.): Alternatives beyond psychiatry . Berlin / Eugene / Shrewsbury: Peter Lehmann Publishing 2007, pp. 146-160. ISBN 978-0-9545428-1-8 (UK), ISBN 978-0-9788399-1-8 (USA). E-book 2018
  • E. Aebi, L. Ciompi, H. Hansen: Soteria in conversation . PARANUS-Verlag, 2013, ISBN 978-3-940636-26-3
  • JR Bola, LR Mosher: Treatment of acute psychosis without neuroleptics: Two-year outcomes from Soteria Project . In: J Nervous Mental Disease , 2003, 191, pp. 219-229
  • JR Bola, K. Lehtinen, J. Cullberg, L. Ciompi: Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first episode psychosis . In: Psychosocial Treatment and Psychosis , 2009, 1, pp. 4-18
  • T. Calton, M. Ferriter, N. Huband, H. Spandler: A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia . In: Schizophrenia Bulletin , 2008, 34, pp. 181-192
  • L. Ciompi: Soteria Berne: 32 years of experience. An alternative approach to acute schizophrenia . In: Swiss Arch. Neurol Psychiat. , 2017, 168, pp. 10-13
  • L. Ciompi: The key role of emotions in the schizophrenia puzzle . In: Schizophrenia Bulletin , 2015, 41, pp. 318–322
  • L. Ciompi: Affect Logic. About the structure of the psyche and its development. A contribution to schizophrenia research . Klett-Cotta, Stuttgart 1982
  • L. Ciompi, H. Hoffmann, M. Broccard (Eds.): How does Soteria work? An atypical psychosis treatment was critically examined . Huber, Bern a. a. 2001, ISBN 3-456-83570-1 (e-book: Carl Auer Systeme, 2011, ISBN 978-3-89670-802-1 )
  • L. Ciompi, H. Hoffmann: Soteria Berne: an innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic . In: World Psychiatry , 2004, 3 (3), pp. 140-146, PMID 16633478
  • L. Ciompi, H.-P. Dauwalder, Ch. Maier, E. Aebi: The pilot project “Soteria Bern” for the treatment of acute schizophrenics. Conceptual foundations, practical implementation, clinical experience . In: Der Nervenarzt , Vol. 62, No. 7, July 1991, pp. 428-435, PMID 192258 (English), ISSN  0028-2804
  • L. Ciompi, Z. Kupper, E. Aebi, H.-P. Dauwalder, T. Hubschmid, K. Trütsch, C. Rutishauer: The pilot project “Soteria Bern” for the treatment of acute schizophrenics . II. Results of a comparative prospective follow-up study over 2 years . In: neurologist , 1993, 64, pp 440-450
  • L. Ciompi, H. Hoffmann, S. Leisinger: “Soteria Station”? - On the question of the name of psychiatric hospital wards with so-called Soteria elements . In: Krankenhauspsychiatrie , Volume 16, 2005, pp. 120-124, doi: 10.1055 / s-2004-830274 , ISSN  0937-289X
  • C. Clare, R. Hurtz: 1: 1 psychosis support and soft room . In: Nervenheilkunde , 2017, 11, pp. 893–895
  • WS Fenton, LR Mosher, JM Herell, CR Blyler: Randomized trial of general hospital and residential alternative care for patients with severe and persistent mental illness . In: American Journal of Psychiatry , 1998, 155, pp. 516-522
  • G. Franz: Miracles don't happen in psychosis either - a former patient and his wife report on their experience . In: Nervenheilkunde , 2017, 11, pp. 914–917
  • C. Heldt: Mosher's Soteria in the context of its antipsychiatric time of origin . In: Nervenheilkunde , 2017, 11, pp. 874–879
  • RM Hirschfeld, SM Matthews, LR Mosher, AZ Menn: Being with madness: personality characteristics of three treatment staffs . In: Hosp Community Psychiatry , 1977, 28, pp. 267-273
  • H. Hoffmann, S. Leisinger: Soteria Bern: A Pacemaker in Schizophrenia Treatment . In: Schweizerische Ärztezeitung , Volume 87, No. 43, 2006, pp. 1859–1863, saez.ch (PDF; 928 kB), ISSN  0036-7486
  • H. Hoffmann: Soteria - atmosphere as a therapeutic agent in the treatment of schizophrenia . In: St. Debus, R. Posner (Hrsg.): Atmospheres in everyday life. About their creation and effect . Psychiatrie-Verlag, Bonn 2007, ISBN 978-3-88414-445-9 , pp. 15-41
  • H. Hoffmann: On the myth of the "lay workers" in the Soteria . In: The Notch. Die Fachzeitschrift der Sozialpsychiatrie , Volume 27, No. 1, 2009, pp. 21-23, kerbe.info (PDF; 1.2 MB), ISSN  0724-5165
  • H. Hoffmann: The importance of the atmosphere in the Soteria . In: Nervenheilkunde , 2017, 11, pp. 887–892
  • H. Hoffmann, M. Voss: What is Soteria? A position assessment . In: Nervenheilkunde , 2017, 11, pp. 881–886
  • R. Hurtz: From antipsychiatry to large hospitals - experiences with Soteria at the Munich-East Clinic . In: Psychodynamische Psychotherapie , 1/2013, pp. 34–44
  • R. Hurtz, D. Nischk, M. Showah, J. Rusch: Space for personal history - search for meaning in the soteria . In: Bock, Klapheck, Ruppelt (eds.): Search for meaning and recovery. Experiences and research on the subjective meaning of psychoses . Psychiatrie Verlag, Bonn 2014, pp. 202–216
  • R. Hurtz, P. Brieger: Soteria at the Munich-East Clinic. Results of the accompanying research . In: Nervenheilkunde , 2017, 11, pp. 907–913
  • B. Kroll: On the road to reform with Soteria. An alternative project is moving acute psychiatry . Jakob van Hoddis, Gütersloh 1998, ISBN 3-926278-38-2
  • P. Lehmann: Soteria and Empowerment. About the interests of those affected by psychiatry . Berlin: Antipsychiatrieverlag 2003, ISBN 3-925931-24-4
  • P. Lehmann: Soteria: As viewed by (ex-) users and survivors of psychiatry . In: Asylum - The Magazine for Democratic Psychiatry, Vol. 17 (2010), No. 4, pp. 11-13
  • SM Matthews, MT Roper, LR Mosher, AZ Menn: A non-neuroleptic treatment of schizophrenia: Analysis of the two-year postdischargerisk of relapse . In: Schizophrenia Bulletin , 1979, 5, pp. 322-333
  • LR Mosher, R. Vallone, A. Menn: The treatment of acute psychosis without neuroleptics: Six-week psychopathology outcome data from the soteria project . In: International Journal of Social Psychiatry , 1995, 41, pp. 157-173
  • LR Mosher, A. Menn, SM Matthews: Soteria: Evaluation of home-based treatment for schizophrenia . In: American Journal of Orthopsychiatry , 1975, 45, pp. 455-467
  • LR Mosher, AZ Menn: Community residential treatment for schizophrenia: Two year follow-up . In: Hospital and Community Psychiatry , 1978, 29, pp. 715-723
  • LR Mosher, L. Burti: Psychiatry in the community. Basics and practice . Psychiatrie-Verlag, Bonn 1992, ISBN 3-88414-127-9 . (New edition, reprint as: Mental Health. A Guide for Practice = Community Mental Health. I-books, St. Gallen 2004, ISBN 3-9522485-2-5 )
  • LR Mosher, V. Hendrix, DC Fort: Soteria. Through Madness to Deliverance . Xlibris Corporation, Philadelphia PA 2004, ISBN 1-4134-6523-4
  • D. Nischk, P. Merz, J Rusch .: News from the Soteria - The promotion of practical and social skills of people with schizophrenia from a phenomenological point of view . In: Psychiatrische Praxis , 2014, 41, pp. 45–49
  • D. Nischk, A. Temme, J. Rusch: Give the psychosis a meaning . In: Nervenheilkunde , 2017, 11, pp. 902–906
  • I. Runte: Very personal accompaniment. Innovative milieu-therapeutic projects for acutely psychotic people . Psychiatrie-Verlag, Bonn 2001, ISBN 3-88414-275-5
  • M. Voss, J. Danziger: Design of a therapeutic milieu - meaning of architecture using the example of the Soteria Berlin . In: Nervenheilkunde , 2017, 11, pp. 896–890

Web links

Commons : Soteria (psychiatry)  - Collection of pictures, videos and audio files

Soteria websites

media

Individual evidence

  1. ↑ L. Ciompi, H. Hoffmann, M. Broccard (eds.): How does Soteria work? An atypical psychosis treatment was critically examined . Huber, Bern a. a. 2001, ISBN 3-456-83570-1 .
  2. ^ Soteria. igs - Social Psychiatry Association Bern, accessed on August 16, 2018 .
  3. ↑ stations. ZfP Südwürttemberg, accessed on August 16, 2018 .
  4. ^ Station 14 Soteria. kbo-Isar-Amper-Klinikum, Klinikum München-Ost, accessed on August 16, 2018 (English).
  5. ^ Soteria. ZfP Reichenau, accessed on August 16, 2018 .
  6. ↑ Soteria House. Retrieved August 16, 2018 .
  7. ^ Soteria. Alexianer Berlin St. Hedwig Hospital, accessed on August 16, 2018 (German).
  8. ↑ Psychiatry and Psychotherapy II. LVR Clinic Bonn, accessed on August 16, 2018 .
  9. ↑ Criteria for (acute psychiatric) wards with integrated Soteria elements. Soteria Network, accessed on August 16, 2018 (German).
  10. ^ Soteria Network - International Soteria Working Group. Retrieved on August 16, 2018 (German).
  11. ^ Holger Hoffmann: Soteria Fidelity Scale. (PDF) International Soteria Working Group, accessed on August 16, 2018 .
  12. ↑ 東京 ソ テ リ ア. Retrieved August 16, 2018 (Japanese).
  13. ↑ Soteria Israel - סוטריה . In: סוטריה . ( org.il [accessed August 16, 2018]).
  14. ↑ soteria network home. Retrieved on August 16, 2018 .
  15. ↑ Home. Soteria NL, herkenbaar different, accessed on August 16, 2018 (nl-NL).