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spiritual_emergency · Mar 18, 2011, 04:03 AM

More information on ODT...

Quote:

In the Open Dialogue approach, when a person or family in distress seeks help from the mental health system, a team of colleagues are mobilized to meet with the family and concerned members of the family’s network as promptly as possible within 24 hours, usually at the family’s chosen familiar location. The team remains assigned to the case throughout the treatment process, whether it lasts for months or for years.

No conversations or decisions about the case are conducted outside the presence of the network. Evaluation of the current problem, treatment planning, and decisions are all made in open meetings that include the patient, his or her social relations, and all relevant authorities. Specific services (e.g., individual psychotherapy, vocational rehabilitation, psychopharmacology, and so on) may be integrated into treatment over the course of time, but the core of the treatment process is the ongoing conversation in treatment meetings among members of the team and network.

... The drama of the process lies not in some brilliant intervention by the professional, but in the emotional exchange among network members, including the professionals, who together construct or restore a caring personal community...

CASE ILLUSTRATION: FROM FLASHBACKS TO LOVE

This single meeting ... embodies much of what we seek to explore in the dialogical treatment process. The network meeting was organized for Ingrid, a resident in a sheltered psychiatric residence. Her difficulties had emerged 9 years ago in reaction to an assault that she and her boyfriend had suffered on the street when three men, friends of Ingrid’s brother, had tried to rob Ingrid’s boyfriend. Ingrid had been injured when she tried to defend her boyfriend. She began to experience flashbacks of the assault and sought psychiatric treatment.

Quite soon after the assault, she disconnected from both father and mother, who had earlier divorced. Nothing seemed to help. The flashbacks, in the form of painful nightly dreams, came to invalidate her entire life. Ingrid was a pleasant woman, and everyone eagerly wanted to help her. Two contact nurses were responsible for her treatment and rehabilitation, working in collaboration with other social and health-care professionals.

Early in her career as psychiatric patient, Ingrid’s treatment team had tried to organize family meetings, which turned out to be unsuccessful because of the strong emotions involved. After many years of treatment, the team arranged a network meeting to plan for Ingrid’s treatment and future. The meeting, included Ingrid, her current boyfriend (not the one assaulted), her mother and father, her social worker, the two contact nurses, and her doctor. Although invited to the meeting, her brother did not appear.

The consultant asked the team members about their ideas for the meeting. They said that they wanted to reconnect the family relationships and discuss the future. The consultant offered open-ended questions to Ingrid and her family, wondering how they wanted to use the meeting time. Ingrid said that she was very tense and wanted to hear from her parents. They in turn said that they wanted to hear about Ingrid’s current life. Her boyfriend accused Ingrid’s parents of failing to support her rehabilitation by not being in any contact with her. The meeting was tense; Ingrid and her parents avoided looking directly at each other.

Ingrid’s mother began to talk about the assault, coming to tears as she spoke of feeling guilt about the event. She said that when she spoke with Ingrid’s brother, he blamed Ingrid’s boyfriend for what had happened. The consultant moved carefully to ensure that everyone had opportunity to express his or her concerns, aiming to move neither toward conclusions nor toward treatment planning decisions. One of the contact nurses burst into tears as she described her difficulties trying to help Ingrid without any remarkable success. The mood of the meeting became progressively sadder. Ingrid’s mother spoke of pining for the daughter she had loved so much when she was a child.

After the reflective dialogue, the consultant asked the family members if they wanted to comment on what they had heard. Ingrid’s mother had been listening to the team’s conversation in tears. Her father spoke of being moved by the dialogue and was especially touched by their affirmation of the family despite his own feeling that he had not done enough to reconnect. Ingrid’s mother said that she loved her daughter very much.

From my perspective as the consultant, I had been tracking verbal and gestural signs of emotional expression throughout the meeting, my own feelings resonating to the feelings in the room. I was moved by Ingrid’s mother’s expression of love and by the signs that the others in the room were deeply touched by her words. Ingrid and her mother took each other’s hand.

In a follow-up 1 year later, Ingrid remembered the meeting well. She said that it was one of the most powerful experiences of her life. She did not have a single flashback for 4 months following the meeting. Although the dreams of the assault occasionally recurred thereafter, she had managed to start vocational school with team support. She was no longer in a relationship with her boyfriend but was in contact with her mother and had visited with her father and his new family. She had met with her brother on one of her visits with her mother. They had had a couple of family meetings with the team as well.

THE SHARED EXPERIENCE OF EMOTION
Committed to responding as fully embodied persons, team members are acutely aware of their own emotions resonating with expressions of emotion in the room. Responding to odd or frightening psychotic speech in the same manner as any other comment offers a ‘‘normalizing discourse,’’ making distressing psychotic utterances intelligible as understandable reactions to an extreme life situation in which the patient and her nearest are living. ... In the case illustration, it was important that the emotions of the family members connected to the ‘‘not-yet-spoken’’ experience of Ingrid’s assault were expressed openly in the meetings in the presence of the most important people in Ingrid’s life...

The most difficult and traumatic memories are stored in nonverbal bodily memory. Creating words for these emotions is a fundamentally important activity. For the words to be found, the feelings have to be endured.

Employing the power of human relationships to hold powerful emotions, network members are encouraged to sustain intense painful emotions of sadness, helplessness, and hopelessness. A dialogical process is a necessary condition for making this possible. To support dialogical process, team members attend to how feelings are expressed by the many voices of the body: tears in the eye, constriction in the throat, changes in posture, and facial expression. Team members are sensitive to how the body may be so emotionally strained while speaking of extremely difficult issues as to inhibit speaking further, and they respond compassionately to draw forth words at such moments. The experiences that had been stored in the body’s memory as symptoms are ‘‘vaporized’’ into words.

... Before the meeting, network members may have been struggling with unbearably painful situations and have had difficulty talking with each other about their problems. Thus, they have estranged themselves from each other when they most need each other’s support.

In the meeting, network members find it possible to live through the severity and hopelessness of the crisis even as they feel their solidarity as family and intimate personal community. These two powerful and distinct emotional currents run through the meeting, amplifying each other recursively. Painful emotions stimulate strong feelings of sharing and belonging together. These feelings of solidarity in turn make it possible to go more deeply into painful feelings, thus engendering stronger feelings of solidarity, and so on. Indeed, it appears that the shift out of rigid and constricted monological discourse into dialogue occurs as if by itself when painful emotions are not treated as dangerous, but instead allowed to flow freely in the room.

Observing and reflecting on his experience participating in scores of network meetings, the first author began to recognize an emotional process that, when it emerged in a treatment meeting, signaled a shift out of monologic into dialogic discourse and predicted that the meeting would be helpful and productive. Participants’ language and bodily gestures would begin to express strong emotions that, in the everyday language used in meetings, could best be described as an experience of love.

As in the meeting with Ingrid and her social network, this was not romantic, but rather another kind of loving feeling found in families absorbing mutual feelings of affection, empathy, concern, nurturance, safety, security, and deep emotional connection. Once the feelings became widely shared throughout the meeting, the experience of relational healing became palpable...

Read more: Healing Elements of Therapeutic Conversation: Dialogue as an Embodiment of Love[PDF File]

Music of the Hour:

James Taylor ~ Shower the People