Soteria represents an alternative approach to the treatment of acute psychosis providing a community-based social milieu, personal relationships (“being-with”), and meaningful shared activities (“doing-with”) along with minimal neuroleptic medication. In this review article, we analyze Soteria’s potential to adapt to and restore self-disturbances, a central element of phenomenological conceptions of the schizophrenia syndrome. Based on typical difficulties of psychotic patients in responding adequately to situational demands, in relating to others, and in utilizing skills, we analyze how the architectural and social context, being-with, and doing-with take account of self-disturbances. The central elements of the Soteria approach all appear to carry the potential to adjust to self-disturbances and even offer opportunities for their relief. We suggest that it is precisely this property of the Soteria paradigm that induces sustained relaxation in patients, allowing for symptom relief, thereby specifying a central claim of “affect-logic” to explain the antipsychotic effect of Soteria.
Background: Phenomenological conceptualizations of schizophrenia regard the fundamental transformation of self-experience as the central feature of the schizophrenic state of mind. Recently, self-disorders as subtle, trait-like, merely subjective alterations of self-experience have received vast empirical attention. However, the question of how to address self-disorders psychotherapeutically has remained neglected. Methods: From phenomenologically inspired analyses of self-disorders we derive a therapeutic intervention that focuses on the following: (1) verbalizing diffuse changes in self-experiences and (2) conceptualizing these self-experiences in terms of aggravating and relieving factors in order to stimulate coping and derive targeted therapeutic interventions. Results: The clinical implementation is illustrated by two case studies. The feasibility of our approach is preliminarily supported by an exploratory study. Conclusions: This intervention seems promising in assisting patients to develop an embodied and enacted understanding of self-disorders.
Zusammenfassung. Hintergrund: In der vorliegenden Studie wurde ein kurzes psychoedukatives Programm (PE) für akut psychotische Patienten evaluiert. Das PE-Programm nahm besonders Rücksicht auf die in der Akutphase vorherrschenden neuropsychologischen Defizite und fokussierte darüber hinaus auf den Austausch über gegenwärtige psychotische Symptome. Methode: 57 Probanden mit ICD-10-Diagnosen aus dem F2-Bereich wurden randomisiert einer Kontrollgruppe (KG: TAU) oder Experimentalgruppe (EG: TAU + PE) zugewiesen und vor der Intervention (t1), danach (t2) und vier Wochen später (t3) hinsichtlich Wissenszuwachs, Einsicht und Krankheitskonzept untersucht. Ergebnisse: Die EG wies im Vergleich zur KG einen signifikanten Wissenszuwachs und höhere globale Krankheitseinsicht zu t2 und t3 auf. Diskussion: Auch Patienten mit relativ akuten psychotischen Symptomen können von PE profitieren, wenn die Maßnahmen neuropsychologische Einschränkungen berücksichtigen.
Soteria is an alternative approach to the treatment of schizophrenia that focuses on human interaction ("being-with") within a residential community and the cautious use of neuroleptic medication. Despite forty years of promising clinical and empirical evidence, the need for facilities based on the Soteria paradigm is still largely grounded on humanitarian and "moral" reasons. In addition to this, we will try to demonstrate that Soteria might also prove to be a promising approach based on scientific reasons immanent to the disorder. From a phenomenological informed conception of schizophrenia we will explicate clinical implications, specifically the need for a holistic treatment in real life settings, and demonstrate how these conclusions can most adequately be implemented within Soteria.
ZusammenfassungEin zentraler Aspekt von Moshers Soteria ist die Bedeutung des individuellen Verständnis über die psychotische Erfahrung, die sich durch interpersonelle Phänomenologie u. a. im „Dabei-Sein” und „Mit-Tun” entwickeln soll. Als Ergänzung zu den zahlreichen Berichten über Dabei-Sein und Mit-Tun in der Fachliteratur stellen wir hier eine phänomenologisch orientierte Analyse von Sinn- und Bedeutungsstiftung am Beispiel der Soteria Reichenau vor. Aus dieser werden vier therapeutische Strategien abgeleitet, die den inneren Dialog der Betroffenen wieder in Gang bringen und die Entwicklung eines persönlichen Verständnis´ der Psychose und ihrer Bedeutung fördern können.
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