The open dialogue approach to acute psychosis: Its poetics and micropolitics
The open dialogue approach to acute psychosis: Its poetics and micropolitics
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DOI：
10.1111/j.1545-5300.2003.00403.x
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发表时间：
2003-09-01
期刊：
影响因子：
3.9
通讯作者：
Olson, ME
中科院分区：
文献类型：
--
作者：
Seikkula, J;Olson, ME
在芬兰，一种基于网络的、以语言为基础的精神病治疗方法已经出现，被称为“开放对话”。它借鉴了巴赫金的对话原则(巴赫金，1984)，并植根于巴特森传统。提出了两个层面的分析，即诗学和微观政治。诗学包括三个原则：“容忍不确定性”、“对话性”和“社交网络中的复调”。一次治疗会议展示了这些诗学如何运作，以产生治疗对话。微观政治是支持这种工作方式的更大的制度实践，也是芬兰适应需要的治疗的一部分。最近的研究表明，与常规治疗相比，开放式对话改善了年轻人在各种急性、严重精神危机中的结果，例如精神病。在对首发精神分裂症进行的一项为期两年的非随机随访中，住院天数减少到了大约19天；35%的患者需要服用抗精神病药物；82%的患者没有或只剩下轻微的精神病症状，只有23%的患者在领取残疾津贴。
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.