The open dialogue approach to acute psychosis: its poetics and micropolitics.
In Finland, a network-based, language approach to psychiatric care has emerged, called "Open Dialogue." It draws on Bakhtin's dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: "tolerance of uncertainty," "dialogism," and "polyphony in social networks." A treatment meeting shows how these poetics operate to generate a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment. Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment-as-usual settings. In a nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild, psychotic symptoms remaining; and only 23% were on disability allowance.
Seikkula
Jaakko
J
Department of Psychology, University of Jyväskylä, P.O. Box 35, FIN 40351, Jyväskylä. seikkula@psyka.jyu.fi
Olson
Mary E
ME
D000208:Acute Disease; D005387:Finland; D006801:Humans; D007802:Language; D008605:Mental Health Services / Q000458:organization & administration; D010348:Patient Care Team; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy*