When the boundary opens: family and hospital in co‐evolution

Abstract

This paper reports how, at the outset of a crisis, a psychiatric hospital admission team in Finland has experimented with openly discussing treatment decisions in the presence of and with patients and members of their families and social network. The paper aims to clarify the coevolving process between the family and hospital and reports some results using this approach.This paper describes the change in a psychiatric hospital in Finland from a traditional individually orientated treatment approach to a family-and network-centred one. The development of family-centred treatment began at Keropudas Hospital in 1981 and by 1984 joint treatment meetings for the patient, the family, the staff and other professionals were part of our standard practice (Seikkula and Sutela, 1990). In these meetings a systemic view of the family and our understanding of the psyche of the psychotic patient were integrated. Treatment meetings also provided an opportunity to organize the treatment resources of the staff working as a team. At the same time, we realized that the healing capacities within a patient's social network could become a valuable part of the whole process. The boundary of the hospitalThis paper proposes the opening of the traditional boundary in psychiatric treatment between the treatment team and the patients and their families. Traditionally, the boundary of the hospital team has been a closed one and the patient's family has not had any place in treatment plans and decisions.After opening the boundary, patients and their families can participate in the discussions and planning of treatment.* Senior Psychologist, Keropudas Hospital, 95410 Kiviranta, Finland.

Postmodern Society and Social Networks: Open and Anticipation Dialogues in Network Meetings

“…This led to a rapid decrease in the need to hospitalize (Kerä nen, 1992;Seikkula, 1991Seikkula, , 1994. This led to a rapid decrease in the need to hospitalize (Kerä nen, 1992;Seikkula, 1991Seikkula, , 1994.…”

“…Several studies have provided information on the course and results of treatment (Kerä nen, 1992;Seikkula, 1991Seikkula, , 1994. There are also qualitative analyses of dialogues in treatment meetings (Haarakangas, 1997;Holma, 1999).…”

Communication problems in Swedish Mental Health reform

“…This exchange of agents in the field of care, treatment, support and service has brought forward questions about different types of knowledge needed for rehabilitation activities. Psychiatric rehabilitation methodology has to a greater extent incorporated knowledge from psychology and education than from the traditional sphere of clinical psychiatry (1,2). This has been particularly noticeable during the 1990s and has been experienced in different parts of the world.…”

‘Strangers in a Familiar Place’: The Evolution of a Family Therapy Clinic Within an In‐Patient Adolescent Unit

“…Finally, our team wished to retain the support of the unit staff rather than appear to be separate from the unit, which could result in jealousy and a loss of legitimacy. Our conceptualization of our position vis à vis the unit differed from other teams' ideas (Seikkula, 1994) but also began with an understanding about boundaries and the role of family therapy within in-patient units.…”

“…Some choose to concentrate on consultation to the staff group as a whole (Street, 1984;Dare, 1986). Others have constructed a systemic admission procedure and in-patient regime in the expectation that this will prevent parts of the staff group taking sides and ensure family/professional co-operation in the treatment plan (Harbin, 1979;O'Brian, 1984, 1987;Procter and Stephens, 1984;John and Bradford, 1991;Seikkula, 1994;Sourander and Piha, 1996). In some rare cases whole residential units have been adapted in order to treat families (Kennedy et al, 1986).…”