The search for a narrative : investigating acute psychosis and the need-adapted treatment model from the narrative viewpoint
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1999This study is a subproject of the Finnish multicenter project The Integrated Approach to the Treatment of Acute Psychosis (API project). The basis of this project is the need-adapted treatment model developed in Finland over the last three decades. The aim of the studies presented here was to investigate from a social constructionist narrative viewpoint psychosis and schizophrenia as well as the psychology of the recommendations of the need-adapted treatment model. In recent family therapy, social constructionism and the narrative viewpoint have been the main theoretical approaches. This study integrates the Finnish tradition of treating acute psychosis and schizophrenia with recent developments in the field of family therapy. The material was gathered during the treatment of 21 first-episode psychotic patients. The method used was participant-observer qualitative narrative analysis. The author participated altogether in 140 therapy meetings during the hospitalization stage and in 34 follow-up meetings. The results indicate that constructing a self-narrative is essential in acute psychosis, since it may be either collapsed or not coherent enough (Study I). The search for a narrative in acute psychosis exists but the result of this search can be insufficient because the stories available in the social context do not sufficiently capture the pre-narrative quality of personal experience (Study II). Psychosis can also be an escape in order to maintain a sense of agency. When experiences remain unnarrated, the experience of being-in-time is also missing (Study III). When the patient has trouble in creating narrative form for experiences, the aim of therapy and treatment is to open a channel through which the pre-narrative quality of life can become narrated. Once experiences are given narrative form, they can be left behind as a part of the individual's personal history, enabling present experiences to be narrated and preventing unnarrated experiences from accumulating (Study III). Hence, early, family- and network-centred intervention is of special value in cases of acute psychosis. It is important that the narratives conform to the preunderstanding of the interpreter as well as adequately capture the intentions of its originator, that is, the patient (Study IV). Thus team work utilizing therapeutic principles and involving patient, family and social network alike is specially indicated.
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978-951-39-8001-6Keywords
aika hermeneutiikka hoito hoitomenetelmät identiteetti kerronta kertomukset kokemukset konstruktivismi narratiivinen terapia narratiivisuus perheterapia potilaat psykiatria psykiatrinen hoito psykoosit psykoterapia psyykkisesti sairaat skitsofrenia sosiaalinen konstruktivismi ymmärtäminen experience identity narration psychiatry psychosis psychotherapy schizophrenia therapy treatment
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