Juha Holma

THE SENSE OF AGENCY AND THE SEARCH FOR A NARRATIVE IN ACUTE PSYCHOSIS

The search for a narrative in acute psychosis exists but the result of this search can be insufficient because the stories available do not sufficiently capture the pre-narrative quality of personal experience, and hence the sense of agency may be diminished. The context of reflexivity is lost when a subjugating story blocks an individual off from making a choice from among a multiplicity of stories. Psychosis can also be an escape in order to maintain a sense of agency. When the patient has trouble in creating meaning through narrative action, the aim of therapy and treatment is to open a channel through which the pre-narrative quality of life can become narrated, to create a multiplicity of stories, and so offer the possibility of choice in the construction of a narrative identity.

Narrative understanding in acute psychosis

Hermeneutical premises are adequate in understanding the psychotic patient. It is more important to hear and try to understand the patients story told by the latter as an equal partner in conversation than understand events through stories in which the meanings are already determined. Understanding is dependent on the unique way in which the feelings, thoughts, and actions of the patient are connected with those of the ward staff, i.e., mutual knowledge. In this way understanding conforms to the preunderstanding of the interpreter as well as adequately captures the intentions of its originator. These are the preconditions for the integration of the need-adapted approach to the treatment of schizophrenia.

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.

The experience of time in acute psychosis and schizophrenia

From the narrative point of view the plot of a story configures time. In psychosis, when experiences remain unnarrated, experience being-in-time is also missing. Once experiences are given narrative form, they can be left behind as a part of individuals personal history, thus enabling present experiences to be narrated. Unnarrated experiences do not accumulate. Narrative history contains, however, enough redundancy to invite you to restory your past in a new way if you need to. Hence, from the narrative point of view, early, family- and network-centered intervention is of special value in cases of acute psychosis.

Increasing Responsibility, Safety, and Trust Through a Dialogical Approach: A Case Study in Couple Therapy for Psychological Abusive Behavior

This article reports an analysis of conjoint therapy for psychological intimate partner violence, treated via a dialogical approach. The article reviews current controversies surrounding this treatment modality and its outcome. The dialogical approach is presented as an appropriate method for analyzing and understanding the issue of violence, but it is emphasized that the focus on communication does not involve a return to a systemic perspective on intimate partner violence. Four important dimensions are identified as emerging in conjoint treatment for psychological intimate partner violence, namely responsibility, safety, trust, and the role of the therapists. The Dialogical Investigations of Happenings of Change method was used to analyze the transcripts of the therapy sessions. The results on these four dimensions, as identified via a dialogical method, are illustrated with transcript vignettes. Finally, there is discussion of the contribution that the dialogical approach can make in conjoint therapy for psychological intimate partner violence, with mention also of the implications for research and for clinical practice.

Discussions of Fatherhood in Male Batterer Treatment Group

The aim of this study was to examine how men who have perpetrated violence toward their partners and participated in batterer group talked about being a father and how they perceived their own fatherhood. The discussion in the group was analyzed qualitatively by using the methods of content analysis. In traditional fatherhood, they talked about avoidant, passiveness, distant, indifference, and authoritative controlling ways of acting. These men also created an image of themselves as active and caring fathers, thus including empathy and nurture in the concept of fatherhood. This new fatherhood was considered an achieved goal and an objective for the men as being a father. Talking about fatherhood in these groups is important as fatherhood and relations to children are both an important motivator toward nonviolence.

Possibilities for Intervention in Domestic Violence: Frame Analysis of Health Care Professionals’ Attitudes

ABSTRACT. Violence is a serious problem, and social and health care providers are in a key position for implementing successful interventions. This qualitative study of 6 focus groups with professionals (n = 30) examines the health care professionals’ ways of framing a domestic violence intervention. Of special interest here is how professionals see their own roles in the process of recognizing and helping victims of domestic violence. By using Erving Goffmans frame analysis, this study identifies several frames that either: a) emphasize the obstacles to intervention and justify nonintervention, or on the contrary, b) question these obstacles and find justifications for intervention. The possibilities for intervention are further explored by analyzing the ways in which the dynamics between the different frames allow redefinition of domestic violence interventions. Despite the challenges involved in a domestic violence intervention, there seems to be potential for change in personal attitudes and reform of professional practices. The research findings underline the role of social and health care professionals as members of a larger chain of service providers working collaboratively against domestic violence. Implications for practice and directions in policy and future research are suggested.

Dialogical Views on Partner Abuser Treatment: Balancing Confrontation and Support

Treatment programs for intimately abusive men seek to stop and prevent partner and family violence by applying a variety of methods based on different disciplinary premises. For professionals working with this particular group of clients, the challenge is to combine therapeutic understanding and support with adequate efforts to make clients stop and reconsider their behavior. This qualitative study investigated conversations within a Finnish abuser treatment program in which an integrative treatment approach was applied. A detailed study of videotaped conversations within a 15-week therapy program was conducted through Dialogical Investigations, a method specifically designed for studying interactions in multiple-actor settings. The findings demonstrate how dialogical investigations can assist in evaluations of the efficacy of abuser treatment programs. Consideration is also given to facilitators’ working style, and some examples of how the two dominant approaches in abuser treatment can be successfully combined are provided.

Constructing Healing Dialogues in Group Treatment for Men Who Have Used Violence Against Their Intimate Partners

Although various “talking cure” treatments typically constitute an important part of practices in social work and mental health services, there are few studies on the actual “talk-within-the-cure.” This qualitative study examined talk in group treatment for men who had used violence against their intimate partners. Using the method termed Dialogical Investigations, the aim of the present study was to examine the construction of “healing dialogues,” that is, dialogues that promote change in clients, within treatment conversations. The results of the micro-analysis suggest that mutually responsive and constructive dialogical interaction and talk with symbolic language may support the emergence of new meanings, with alternative ways of thinking and behaving. These can be seen as important triggers of the goal of the treatment (i.e., a change in behavior and an end to violence in the relationship).

Finnish Health Care Professionals’ Views of Patients Who Experience Family Violence

The aim of this study was to examine the beliefs health care personnel have about patients who experience family violence. This was done by analyzing the positions constructed for such patients using content analysis. The data comprise six focus groups conducted with physicians, nurses, social workers, and psychologists working in a maternity unit, a psychiatric ward, and an emergency department. The research team collected the data in 2006 in Finland. Three main positions were constructed for these patients: as a “victim,” with the classic characteristics of such; as a person damaged or disturbed in such a way that his or her victimization has become hidden behind secondary symptoms; and, as responsible for ending the violence and thus as an active contributor to and supporter of the violence. The results support the notion that health care personnel often have stereotypical beliefs about people experiencing family violence. It would be important to educate personnel about the dynamics of family violence.