The book narrates about introduction of a new method into the psychotherapeutic practice — Open dialogue, which Archangel psychiatrists - the first in Russia — begin to master The essence of the method — open, easy, confidential dialogue of a reflexing team, patient and his or her nearest environment, more often — members of the family The authors of the articles included in this book — experts from Russia, Sweden, Finland and Norway give not only theoretical substantiation of the new system, but also open its practical importance using concrete examples
The book is addressed to psychiatrists and psychotherapists, psychologists and social workers, teachers and students of medical high schools, and also readers interested in the problems of mental health.
P. I. Sidorov
The process of democratisation in Russia arise/proceeds on the background significant socialpolitical economic changes and shocks. Psychiatric environment, as any other part of the social space, certainly, should
reflect democratic changes and to promote their development in the society. As in the whole country, the changes in this environment pass hardly and spontaneously, in conditions of social instability and financial collapse. But the
main difficulties on the way of evolution of the psychiatric service carry, nevertheless, more specific character.
I am speaking, first of all, about such traditional features of domestic psychiatry, as significant prevalence of medical therapy over other methods of treatment, priority of nosological diagnostics over syndromic in the consciousness of psychiatrists, traditional treatment of the patients in large centralised hospitals with a long separation from habitual community, authoritarian style of attitude to the patient, and much other. Not casually many modern tendencies, which were accepted in most of European countries, are permitted in official Russian psychiatry with very hard labour. The out-ofdate traditions are supported not only by deep roots going to the past of our country, but also by many social and professional circumstances of the present. For example, if a doctor is compelled to treat simultaneously some tens of patients in psychiatric hospital, he has neither time, nor physical opportunities to develop and widely use new psychotherapeutic techniques in the department. And the building of a democratic society requires a construction of appropriate psychiatric environment. It is especially important to emphasize this, taking into consideration that the highest level of an emotional tension in the society results in growth of number of psychological diseases and their chronification.
In this respect it is useful to acquaint with work of foreign psychiatrists and experience of development of the psychiatric service in western countries, where the stage of democratic transformations in psychiatric communicative environment is already passed. Especially if this acquaintance is carried out thoughtfully, taking into consideration domestic peculiarities, bears structured and concrete character allowing achieving some concrete results in the purpose of expansion of therapeutic opportunities as a result.
In spring of 1998 at Archangel Medical Academy was held a scientific-practical conference with participation of a group of psychiatrists, psychologists and social workers from three countries - Norway, Sweden and Finland. Professor Tom Andersen from Troms0 University, Norway headed the delegation. That visit was planned as a successive stage in the development of international co-operation of professionals in the field of psychiatry within the framework of the large- scale programme called “Utviklingspros- jekt pa Nordkalotten”. The basic purpose of the programme is the widening of the international network of co-operation of the professionals in the field of the psychiatry supposing development of new forms of practical work on the basis of the structured programme of training and exchange of experience. Within the framework of the programme visits of the foreign psychiatrists to Russia was planned, aiming at training of their Russian colleagues concerning the modem psychotherapeutic approach named Open Dialogue, with participation of so-called reflecting team in it.
The training programme in Archangel was planned to carry out under the standard scheme during three years. Four groups of the participants were created. Two of them were organised from doctors-psychiatrists and psychologists working in psychiatric hospitals. The third group was established on the basis of children’s psychiatric department. The fourth group included doctors-psychiatrists and psychotherapists, working in polyclinic institutions: the municipal centre of mental health, the psychotherapeutic centre and in the department of teenage psychiatric service. These four groups included 24 participants. The basic components of the programme:
- The groups of the participants carry out practical exercises, work with patients and their families, organise discussion of theoretical materials once within 1-2 weeks, duration of the studies - 2-3 hours;
- Once per 6 months within one week - joint studies with colleagues from the countries of Barents-region are carried out which allow to solve the collected questions and to proceed to the next level of mastering of the technique.
The programme is introduced and works. The most important result of it has become the contiguity of the positions of «Therapists» and «Patient», significant increase of a degree of trust and removal of intensity, which presents in the relations quite often. The opportunity of active participation of the close relatives in the therapeutic process raises their understanding of the patient’s problems and induces them to the acceptance of crucial decisions. The ability to empathy, creative search of own resources in problem situations, positive attitude to difficulties develop as well. It is necessary to note that Open Dialogue is a good opportunity to receive important «feedback» to psychiatrists from the side of supervisors, which can be both colleagues and patients.
A result of the work on Open Dialogue is this book, which has reflected concrete practical experience of partnership of doctors and patients.
The main feature of the present book is its wide readers’ addressing. This edition in an equal measure can be demanded by the psychiatrists and psychotherapists, clinical psychologists and social workers, patients and their families. All of us in an equal measure are interested to overcome the press of stigmatisation with a psychiatric problematic. The book convinces that the modern Russian psychiatry is open and humane. Partnership relations between patients and their families with multiprofessional therapeutic team create new quality of therapeutic environment and essentially raise efficiency of medical-rehabilitation programmes in all sections of psychiatry and narcology.