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Open Forum

P~cho~sSenrln~: .

An Unconventional Approach .
t
Thomas Bock, Dipl.-Psych., Dr.phll.habil. F
Stefan Prlebe, Dipl.-fsych., Dr.med.habil.

I
I

I
C ommunication between con-
sumers, family members, and
Against this background, we report
about psychosis seminars, an uncon-
groups. The psychosis seminars are
usually attended by between 20 and I
mental health professionals can be ventional form of dialogue between 60 people (ideally with equal repre-
difficult in everyday practice. Psy- the three groups. "Ve briefly describe sentation from each group, which is
chosis seminars provide an innova- the characteristics and history of the frequently achieved in practice).
tive opportunity for all groups to psychosis seminars and the experi- Unlike conventional forms of I
meet in a neutral forum and share ences of persons attending them. teaching or psychoeducation, in psy- I
their perspectives without formal re- chosis seminars all participants meet
sponsibilities. They do not provide Characteristics with equal entitlements and \vithout
any form of conventional treatment, Psychosis seminars are not usual any formal responsibilities. The semi-
and they follow defined rules-for teaching seminars. They are forums nars offer no form of medical treat-
example, the meeting is held in a to allow a dialogue between con- ment. Participants from all three
neutral place after office hours, and sumers, family members, and health groups attend out of personal interest
the program topics are jointly agreed care professionals (2,3). Although de- and in their spare time. The aim of
upon. The seminars have been estab- tails of the seminars may vmy, there the meetings is a mutually respectful
lished mainly in German-speaking are some defined rules for the meet- dialogue, which allows participants to
countries and are regularly attended ings. The psychosis seminars are held learn from each other's perspective
by approximately 5,000 people. Some on neutral grounds-that is, in prem- and experiences. In this encounter,
evidence suggests that consumers, ises outside of where services are everyone is regarded as an expert
family members, and professionals provided and outside of consumer or with respect to their own role and ex-
benefit from the seminars in differ- family member organizations. They perience. Individual experiences are
ent ways. However, the feasibility are held after office hours and are emphasized. Also, participants aim to
. and effectsofthe seminarsshouldbe open to all interested consumers, overcome tenninological barriers and
tested more widely and subjected to family members, and professionals. rehearse open communication for
more systematic research. They usually last for about two hours everyday practice.
Communication and collaboration and include a break. The seminars
behveen consumers, family members, are held regularly and are arranged History
and mental health professionals is of- over a longer period. Most often, the The first psychosis seminar was or-
ten difficult because of different per- seminars are held once every two ganized in Hamburg, Germany, in
spectives, interests, and tenninologies weeks and continue for four to 12 1990. Similar to the voice-hearer net-
(1). These difficulties can make all months. At the end of a cycle there is work in the Netherlands, psychosis
three groups feel equally misunder- a break, after which a new seminar seminars originated from a dialogue
stood, disappointed, and isolated may be started with old and new par- between a clinician and a consumer.
ticipants. The seminar has topics that In a conventional teaching seminar
are jointly agreed upon. An example with medical students at the local
Dr. Bock is affiliated with the department
for an agreed program of topics is university, both the consumer and
of psychiatry at the University of Ham-
shown in Table 1. However, the ex- the professional realized that talking
burg in Gennany. Dr. Priebe is with the
unit for social and community psychiatnj ample is only for illustration. In prac- with each other provided more in-
at Qlleen Mary (University of London) in tice, the content of programs can sight than talking about each other.
London, England. Send correspondence vary substantially. The meetings are Subsequently, the consumer and pro-
to Dr. Priebe at the Newham Centre for chaired by one or more of the partic- fessional issued an open invitation to
Mental Health, London E13 BSp, England ipants. Often the chair rotates be- patients, their family members, and
(e-mail.s.priebe@qmlll.ac.llk). tween participants of the three professionals. The first meeting was
PSYCHIATRICSERVICES. hnp://ps.psychiattyonline.org . November2005 vo!. 5t1 :'\0. 11 1441
Table 1
Examples of programs for psychosis seminars

Topics Content Aims

What is a psychosis? Models, terminology, metaphors, and e},:planationsused by Individual description instead of general
the three groups (patients, caregivers, and professionals); abstraction; maintaining wealth of
comparison of different explanations for psychosis descriptive language rather than categories
of the International Classification of
Diseases; widening of perspectives

Prejudices toward patients, What prejudices hurt me? What prejudices appear To articulate own concerns and worries
caregivers, and most absurd? through the discussion of prejudices; more
professionals differentiated view of all three groups

Good and bad experiences In what services did I and did I not feel respected, and in More detailed view of mental health
with services what situations did I e:..-perienceservices as helpful or services; challenging of organizational
stressful? structures; accepting different perspectives

Life crises (before and after What crises did I a-perience and overcome? What were To accept crises as inevitable; biographic
psychosis, with and my positive resources? "Vhat was the role of psychosis interpretation of psychosis; emphasizing
\vithout psychosis) in the conte:..iof crises? resources and mutual understanding of
roles and crises

Early warning signs Different e}.-periencesand perceptions. What are early More confident dealing \vith own
warning signs in individual cases? How can I avoid being limitations and crises; critical view of
overly concerned with monitoring warning signs? overemphasizing warning signs
What is beneficial? What helps me to stabilize? What makes me stronger, To adopt a more open view that is not
\vith and \vithout psychosis? fixed on symptoms and illness; insight on
enjoyable and beneficial factors, in general
and after crises

Help and cure Exchange of e}.-periencewith professionals. What To discover new helpful aspects; to
relationships are helpful? What precisely is helpful challenge each other expectations; to
and why? What does "cure" mean? understand cure as individual recovery and
development, as a process to find the best
balance \vith and \vithout psychosis; and to
accept different dreams and ideas
including utopian ones
Medication Possibilities and limitations; different a-periences; Open controversial discussion,
typical and atypical neuroleptics, including their effects challenge generalizing judgments,
and side effects; alternatives to neuroleptics; support respect individual experience, and
with discontinuing medication pragmatically assess effects beyond
preformed expectations
Mood Mood changes in psychotic states; specific problems Appropriate self-assessment of mood;
\vith affective psychosis, understanding of depressive strategies to understand and deal \vith
and manic states; how to live with extreme mood S\vings mood S\vings

Religious experience and Parallels between psychosis and dream; e:..-perienceswith Understanding of cultural determination of
symbolic content of the unconscious; discussion of religious and other psychosis and putting diagnoses into
psychotic symptoms symbolic pictures with different e:..-planations perspective

attended by more than 100 people. discuss the e:..."perienceof psychosis public opinion. Other seminars or-
The title "seminar" was chosen, de- and treatment. Outside of German- ganize information events at schools
spite its academic connotation, to speaking countries, there have been as a form of an antisfigma campaign.
emphasize the learning experience only sporadic initiatives to establish
for all participants. psychosis seminars. Perceptions and experiences
The idea spread quickly across Several psychosis seminars have of participants
German-speaking countries. There widened their goals and aimed to in- Psychosis seminars have not been
are now approximately 130 regular fluence the public perception of peo- evaluated by using systematic docu-
psychosis seminars in urban and rural ple with psychotic disorders and of mentation or experimental trials,
areas (www.psychiatrie.de). Approxi- mental health services. Some semi- which would be incompatible \vith
mately 5,000 people are estimated to nars actively invite journalists and the philosophy of the seminars and
regularly meet in these seminars to other people who might influence the expectations of a significant pro-
1442 PSYCIllATRlC SERVICES . http://ps.psychiatryonline.org.November2oo;Vo!.;6No.11
portion of participants. However, on tice and role, and they gain new in- The described positive effects are
the basis of perceptions and a postal sights into the processes of psychosis plausible, but tl1ey do not stand the
survey of 43 facilitators and chairs and treatment. test of strict criteria that is required of
and 147 participants of 58 seminars Factual information appears to be evidence-based medicine. In fact, be-
(2,4), a few statements can be made most important for family members. cause the seminars do not offer treat-
about who attends and whether dif- Consumers seem to want to be re- ment, despite tl1eir potentially tl1era-
ferent groups perceive that they ben- spected with .their psychotic experi- peutic effects, they may fall out.side
efit from attending these seminars. ence and to understand their psy- the realm of evidence-based medi-
In all three groups, the age of par- chosis in th~ context of their biogra- cine. Yet, it is common sense that the
ticipants varied greatly, and women phy. and living situation: All three . openness and the atmosphereofhon.:
are slightly overrepresented. Among groups appear to benefit from the un- est dialogue in the seminars inay be
consumers, soon after the .seminars usual opportunity to listen to each beneficial in various ways. -
were created most participants were other without any dependence and The seminars are not expensive.
those with long-term contacts with responsibility and witl10ut a directly Funding is required only to hire a
mental health services. However, as shared history within the same family room. However, they require com-
time went on more consumers with or treatment processes. mitment, energy, and a willingness
recent onset of the disorder have Professionals are.responsible only if to respect the perspectives of and
participated, as well as an increasing an obvious acute disorder requires to learn from other groups. We
number of people with psychotic immediate medical intervention. think it is time to implement these
disorders, who otherwise avoid any However, not a single such case has seminars more widely and to sub-
contact with professional services. been reported, and there have not ject them to more research for fur-
Consumers who are explicitly criti- been any reports about physical vio- ther development. .
cal of services are particularly well lence, although verbal aggression can
represented. Many of the attending occur. The only responsibility that ex- References
family members feel insufficiently ists is shared by all three groups-tl1e 1. McCabe R, Heath C, Bums T, et aI: En-
supported by health services or live one for the seminar. to be conducted gagement of patients with psycbosis in the
medical consultation: a conversation analyt-
with patients with psychosis who do so that it is beneficial and helpful. ic study. British Medical Journal 325:1148-
not accept any form of psychiatric 1151,2002
treatment. Among professionals, Conclusions
2. Bock T, Nika E: For the understanding of
those with several years of profes- Psychosis seminars do not replace psychotherapy and social psychiatry from
sional experience are overrepresent- conventional services. Rather, they the perspective of the dialog in the "psy-
ed. However, there are also some complement them as an alternative chosis-seminar." Psychotherapie Forum 8:
117-122,2000
students and professionals.who re- forum to engage and learn. The sem-
cently began working in mental inars are unlikely to be an attractive 3. Amering M, Hofer H, Rath I: The "First Vi-
health services. and useful option for every consumer, enna Trialogue": experiences with a new
form of communication between users, rel-
With respect to the main motiva- family member, and professional. atives, and mental health professionals, in
tion for each group, patients expect However, a significant number of Family Interventions in Mental Illness: In-
to get actively involved and initiate people from each group organize the ternational Perspectives. Edited by Lefley
HP, Johnson DL. Westport, Conn, London,
change in the way mental health seminars, participate regularly, and Praeger, 2002
care is practiced. Family members appear to benefit in one way or an-
are more interested in increasing other. The seminars reach consumers 4. Johannisson A: Bundesweite Erfassung
aIler zur Zeit bestehenden Psychosesem-
their knowledge about the illness and family members who do not feel inare und Befragung von Personen, die an
and sharing their feelings and the well supported by services. For all einem Seminar teilnahmen [National Sur-
learning experience with others. three groups the seminars offer op- vey of All Existing Psychosis-Seminars in
Gennany and Interviews of Participants].
Professionals are interested mainly portunities and benefits that conven- Hamburg, .Germany, department of psy-
in reflecting about their own prac- tional services do not provide. chology, University of Hamburg, 1997

PSYCIDATRICSERVICES+ http://ps.psychiatryonline.org+November2005Vo!.56No.11 1443