Exploring a dialogic approach in tackling psychotic diseases: A systematic review

Abstract

Psychosis is a severe mental disorder traditionally treated from a purely biological approach, which often has led to a dehumanisation in psychiatric hospitals. To counteract this trend and aiming at tackling the disease with a more human approach, psychosocial interventions have increased. In this vein, interventions based on a dialogic approach, with specific features such as egalitarian dialogue, foster psychological and social transformations in different contexts. This review aims to analyse the clinical and social effects of psychological interventions based on these principles when treating patients with psychosis. A systematic review has been carried out, following PRISMA recommendations, in the Web of Science, Scopus and PsycInfo databases. After applying the inclusion criteria, thirteen empirical studies were selected and analysed, including a quality assessment. These studies show that when introducing a dialogic approach in treating psychosis, positive clinical and relational outcomes are obtained. Likewise, patients value positively these collaborative environments, where they feel listened and understood. Whereas dialogism emerges as a tool with potential benefits to tackle psychosis, more studies are needed to clearer determine the influence of specific dialogic features on improving psychotic patients’ mental health. La psicosis es un trastorno mental grave que tradicionalmente se ha tratado desde un enfoque puramente biológico, lo que a menudo ha conllevado una deshumanización en los hospitales psiquiátricos. Con el fin de contrarrestar esta tendencia y con el objetivo de abordar la enfermedad desde enfoque más humano, las intervenciones psicosociales han aumentado. En esta línea, las intervenciones basadas en un enfoque dialógico, con características específicas como el diálogo igualitario, fomentan transformaciones psicológicas y sociales en diferentes contextos. Esta revisión pretende analizar el impacto clínico y social de las intervenciones psicológicas basadas en principios dialógicos en pacientes con psicosis. Se ha realizado una revisión sistemática, siguiendo las recomendaciones PRISMA, en las bases de datos Web of Science, Scopus y PsycInfo. Tras aplicar los criterios de inclusión, se seleccionaron y analizaron trece estudios empíricos, además, se ha incluido una evaluación de la calidad de dichos estudios. Estos estudios muestran que, al incorporar un enfoque dialógico en el tratamiento de la psicosis, se obtienen resultados clínicos y relacionales positivos. De la misma manera, los pacientes valoran positivamente estos entornos de colaboración, donde se sienten escuchados y comprendidos. Aunque el dialogismo emerge como una herramienta eficaz para abordar la psicosis, se necesitan más estudios para determinar con mayor claridad la influencia de características dialógicas específicas en la salud mental de los pacientes.

The politicizing clinic: insights on ‘the social’ for mental health policy and practice

“…Because social and political activity often increased emotional struggle [ 46 , 47 ], distress often became constitutive of the therapeutic process itself [ 48 ]. Also key were young people’s repudiation of behavioral language and their ongoing reframing of mental distress as inextricably social, relational, and political [ 49 ].…”

Open Dialogue in Spain: an initial survey of knowledge and perspectives

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