Open Dialogue in Dutch Psychiatry: Will Revolution help or is it just a Fata Morgana?

van oenen @ cornelis 2013

Goal of the workshop:discuss desirability and possibility of a dialogical approach in the setting of the Outreaching Psychiatric Emergency Service (OPES) in Amsterdam

van oenen @ cornelis 2013

Emergency psychiatry and (subsequent) brief therapy

Multidisciplinary team

Reasons for referral: psychiatric disorders, suicidality, psycho-social problems, behavioral problems, public nuisance

Systemic and psychiatric approach

Setting Outreaching Psychiatric Emergency Service (OPES) Amsterdam:

van oenen @ cornelis 2013

1) Medical, linear, approach . Therapist asks system for information, diagnoses patient, gives family psycho-education.

Three different systemic approaches

van oenen @ cornelis 2013

1) Medical, linear, approach . Therapist asks system for information, diagnoses patient, gives family psycho-education.

2) Consensus oriented Systemic Interviewing and Intervention. Therapist facilitates structure and content of meeting with identified patient and relatives. Part of plan can be psychiatric examination. Result will be discussed.

Three different systemic approaches

van oenen @ cornelis 2013

1) Medical, linear, approach . Therapist asks system for information, diagnoses patient, gives family psycho-education.

2) Consensus oriented Systemic Interviewing and Intervention. Therapist facilitates structure and content of meeting with identified patient and relatives. Part of plan can be psychiatric examination. Result will be discussed.

3) Open dialogue approach.Different voices can be heard without psychiatric labelling in open and equal encounter, without preconceived intentions or stategies. Aim is creating open space for new perspectives

Three different systemic approaches

van oenen @ cornelis 2013

Position of therapist in different approaches

van oenen @ cornelis 2013

Medical approach: expert.Directs conversation from a controlling position, operates in monologue.

Position of therapist in different approaches

van oenen @ cornelis 2013

Medical approach: expert.Directs conversation from a controlling position, operates in monologue.

CSII: consultant.Directs and facilitates dialogue (‘expert in consultancy’) and participates from a ‘semi-equal’ position.

Position of therapist in different approaches

van oenen @ cornelis 2013

Medical approach: expert.Directs conversation from a controlling position, operates in monologue.

CSII: consultant.Directs and facilitates dialogue (‘expert in consultancy’) and participates from a ‘semi-equal’ position.

Open dialogue: participant.Facilitates and participates in an equal postion. Subjective experience counts, no framing is offered.

Position of therapist in different approaches

van oenen @ cornelis 2013

Starting as an expert in cybernetic, structural and strategic school.

Shifting towards consultant position in circulair questioning and solution focused school

‘Ending’ in equal participant in narrative and open dialogue approach.

(and back…?)

Historical development systemic positions

van oenen @ cornelis 2013

Therapist has to switch between positions, fitting to the client, relatives and specific situation

Thesis 1

van oenen @ cornelis 2013

Open dialogue is often not applicable in Outreaching Psychiatric Emergences Service Amsterdam

Thesis 2

van oenen @ cornelis 2013

1) It does not fit into the Dutch culture of the patient and his relatives: “One is in crisis and wants help from an expert who solves the problem!”

2) The assurance asks for a psychiatric diagnosis.

3) Patients are sometimes too ill or too aggressive to have a dialogue. (I.e.: manic patients.)

4) Feedback (CDOI) worked counterproductive

Often not applicable because:

van oenen @ cornelis 2013

Woman, 34 years. Referral: anxiety, panic, suicidal thoughts.

History: has suffered from severe depession 5 years ago.

Actual situation: partner has to move abroad for job. Client anxious for renewed depression. ‘If I get depressed again, I’d rather die’.

Case

van oenen @ cornelis 2013

Which position would you take?

Which goal would you define for yourself?

How would you explain your approach to the client and relatives?

Questions

van oenen @ cornelis 2013

Client: wants to talk about events in the past, stressing need for help; concentration diminishes, level of anxiety rises.

Partner: asks urgently for advice

No solution comes up.

What would you do?

Case continued

van oenen @ cornelis 2013

Which position would you take?

Which goal would you define for yourself?

How would you explain your approach to the client and relatives?

Question

van oenen @ cornelis 2013

for the attention!van oenen @ cornelis 2013

Thank you…