Renegotiating "best treatment practice" and professional subject positions

Publikation: KonferencebidragPaperForskningpeer review


This paper will investigate the situated enactments of the psychiatric prevention and treatment approach Open Dialogue. Open Dialogue has theoretical roots in constructionist language theory (e.g. Gergen) and systemic therapy (e.g. the Milanoschool; Selvini-Palazzoli et al.). The ideal of prevention in this treatment approach is connected with the existential project of every single member of personnel, that is turned into a project of finding ones own integrity, in order to be able to meet the patient "where she is" and in order  to show "respect", rather than being an "expert". The goal the professionals strive for is being able to meet patients as humans rather than meeting them as diagnosed patients.

I will explore how situated and local enactments of these treatment ideals, for example dissolving the role of expert have complex constitutive effects and create alternative subject positions for the professionals involved. In other words I will discuss how situated ways of becoming psychiatric member of personnel is connected with the enactments of ideals in Open Dialogue.

The analysis draws on empirical material collected through observations, interviews and videos dealing with different aspects of the daily work of the psychiatric personnel that has introduced Open Dialogue treatment in the district psychiatry. The paper presents an in-depth analysis which focuses on the relational character of Open Dialogue in the respect that the treatment approach and the personnel constantly (re-) produce each other.

The analysis indicates that an argument of prevention may be a reinforcing motivation factor and possibility of subjectivation for the personnel. A possibility to construct a story about oneself, that facilitates the staff development as self-managing professional, in line with modern management strategies, where governing strategies are made invisible, and where management strategies are converted to individual existential projects. A central argument is that the individual ethical project of the introduction of a new treatment approach melts together with psychiatric treatment. There is no longer a primary focus on the crucial balance between care and coercion in psychiatric treatment and prevention, but what is at stake is rather sustaining a balance between professionalism and individual existential ethical considerations.

Antal sider13
StatusUdgivet - 2008
Udgivet eksterntJa

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