Aikuisten turvapaikanhakija- ja pakolaisasiakkaiden terapeuttisissa keskusteluissa tekemät ongelmanmäärittelyt

Tässä tutkimuksessa tarkasteltiin sitä, kuinka kuusi aikuista turvapaikanhakija- ja pakolaisasiakasta kuvasivat ongelmiaan terapeuttisissa keskusteluissa. Tutkimuksen kohteena ja tiedon lähteenä olivat asiakkaiden tekemät ja tulkkien suomeksi välittämät ongelmia kuvaavat ilmaukset. Terapeuttisia keskusteluita analysoimalla pyrittiin tavoittamaan ensisijaisesti se, mitä ongelmia asiakkailla on ja lisäksi se, miten nämä ongelmat heihin vaikuttavat ja mikä ongelmat aiheuttaa. Tutkimusmenetelmänä käytettiin aineistolähtöistä laadullista sisällönanalyysia. Ongelmat koskivat kotimaassa koettua epäoikeudenmukaisuutta ja kotimaassa koettujen traumaattisen kokemusten aiheuttamaa ahdistusta, tulevaisuuteen liittyviä huolia ja pelkoja, huolta läheisten tilanteesta ja siihen liittyvää syyllisyyttä sekä toimijuutta, pystyvyyttä ja elämänhallintaa. Ongelmat aiheutuivat niin kotimaassa koetusta kuin maahantulon jälkeisistä asioista. Ongelma oli yleensä monen tekijän summa. Tämän tutkimuksen löydökset eivät puolla terapeuttiseen keskusteluun mallia, jossa keskityttäisiin kategorisesti vain joko aiemmin kotimaassa tai maahantulon jälkeen koettuihin asioihin. Ongelmien koostumus vaihteli eri asiakkailla. Huoli kotimaahan palautetuksi joutumisesta tuotti yleisesti pelkoa. Kotimaassa koettu epäoikeudenmukaisuus ja petetyksi tuleminen oli kaikille asiakkaille erityisen raskas asia. Sitä oli vaikeaa tai mahdotonta unohtaa ja antaa anteeksi. AbstractAdult asylum seeker and refugee clients’ problem definitions in therapeutic conversations This study examined how six adult asylum seeker and refugee clients express their problems in therapeutic conversations. This study aimed to find out primarily what kind of problems the clients present, and also how these problems affect them and what caused the problems. The research method was inductive qualitative content analysis. Therapeutic sessions of the six clients were videotaped and the problem formulations given by the clients and as expressed by an interpreter were extracted as units of analysis. Five problem categories emerged from the analysis: experiences of injustice in home country; anxious ideations originating from past traumatic experiences; fear for the future; worries and feelings of guilt concerning relatives; and problems of self-agency, self-efficacy and life management. Both pre-migration and post-migration factors caused problems. Most often problems were caused by several interacting factors. This study do not support therapeutic conversation formats that focus solely to the issues either related to pre-migration or to post-migration stage. Different clients had different sets and compositions of problems. Fear of deportation was a common cause for fear to clients. Experiences of injustice and betrayal in the home country caused extreme distress to all clients. Such experiences were hard to forget and hard to forgive. Key words: asylum seeker, refugee, therapeutic conversation, problems, explanatory models Authors:Olli Snellman, MA, Psychotherapist, Head of Section, Finnish Immigration Service,Reception UnitJaakko Seikkula, PhD, Professor, University of Jyväskylä, Department of Psychology, Psychotherapy Training and Research CentreJarl Wahlström, PhD, Professor, emeritus, University of Jyväskylä, Department of Psychology, Psychotherapy Training and Research CentreKatja Kurri, PhD, Researcher, Psychotherapist, University of Jyväskylä, Department of Psychology, Psychotherapy Training and Research Centr

Associations Between Sympathetic Nervous System Synchrony, Movement Synchrony, and Speech in Couple Therapy

Background: Research on interpersonal synchrony has mostly focused on a single modality, and hence little is known about the connections between different types of social attunement. In this study, the relationship between sympathetic nervous system synchrony, movement synchrony, and the amount of speech were studied in couple therapy. Methods: Data comprised 12 couple therapy cases (24 clients and 10 therapists working in pairs as co-therapists). Synchrony in electrodermal activity, head and body movement, and the amount of speech and simultaneous speech during the sessions were analyzed in 12 sessions at the start of couple therapy (all 72 dyads) and eight sessions at the end of therapy (48 dyads). Synchrony was calculated from cross-correlations using time lags and compared to segment-shuffled pseudo synchrony. The associations between the synchrony modalities and speech were analyzed using complex modeling (Mplus). Findings: Couple therapy participants’ synchrony mostly occurred in-phase (positive synchrony). Anti-phase (negative) synchrony was more common in movement than in sympathetic nervous system activity. Synchrony in sympathetic nervous system activity only correlated with movement synchrony between the client-therapist dyads (r = 0.66 body synchrony, r = 0.59 head synchrony). Movement synchrony and the amount of speech correlated negatively between spouses (r = −0.62 body synchrony, r = −0.47 head synchrony) and co-therapists (r = −0.39 body synchrony, r = −0.28 head synchrony), meaning that the more time the dyad members talked during the session, the less bodily synchrony they exhibited. Conclusion: The different roles and relationships in couple therapy were associated with the extent to which synchrony modalities were linked with each other. In the relationship between clients and therapists, synchrony in arousal levels and movement “walked hand in hand”, whereas in the other relationships (spouse or colleague) they were not linked. Generally, more talk time by the therapy participants was associated with anti-phase movement synchrony. If, as suggested, emotions prepare us for motor action, an important finding of this study is that sympathetic nervous system activity can also synchronize with that of others independently of motor action.publishedVersio

Aikuisten turvapaikanhakija- ja pakolaisasiakkaiden terapeuttisissa keskusteluissa kuvaamat hyödylliset muutokset

Tutkimuksessa tarkastellaan sitä, kuinka kuusi aikuista turvapaikanhakija- ja pakolaisasiakasta kuvaavat kokemiaan hyödyllisiä muutoksia luonnollisissa terapeuttisissa keskusteluissa. Asiakkaiden keskustelukäynnit kriisikeskuksen työntekijöiden luona videotallennettiin. Tutkimuksen kohteena olivat asiakkaiden esittämät ja tulkkien suomeksi välittämät ilmaukset. Tutkimusmenetelmänä käytettiin aineistolähtöistä laadullista sisällönanalyysia. Analyysissä syntyi neljä hyödyllisen muutoksen kategoriaa. Hyödyllisen muutoksen kategorioita ovat helpottuneempi olotila, uusien ongelmiin ja elämään liittyvien hallintakeinojen omaksuminen, itseymmärryksen ja voimaantumisen tunteen lisääntyminen ja rakentavammat tavat suhtautua ongelmiin. Asiakkaiden kokemat hyödylliset muutokset ovat samansuuntaisia kuin mitä on havaittu myös aiemmissa turvapaikanhakija- ja pakolaisasiakkaiden ja muunlaisten asiakasryhmien parissa tehdyissä laadullisissa tutkimuksissa. Tämän tutkimuksen perusteella turvapaikanhakija- ja pakolaisasiakkaita voidaan auttaa terapeuttisella keskusteluavulla

Exploring the role of emotions and conversation content in interpersonal synchrony: A case study of a couple therapy session.

OBJECTIVE This exploratory study investigated the association between interpersonal movement and physiological synchronies, emotional processing, and the conversational structure of a couple therapy session using a multimodal, mixed-method approach. METHOD The video recordings of a couple therapy session, in which the participants' electrodermal activity was recorded, were analyzed. The session was divided into topical episodes, a qualitative analysis was conducted on each topical episode's emotional aspects, conversational structure and content. In addition, movement and physiological synchrony were calculated in each topical episode. Regression models were used to discover the associations between qualitative variables and synchronies. RESULTS Physiological synchrony was associated with the emotional aspects of the session and to episodes in which the spouses' relationship was addressed, while movement synchrony was only related to emotional valence. No association between synchrony and conversational structure was found. CONCLUSION The findings suggest that physiological and movement synchrony play distinct roles in psychotherapy. The exploratory study sheds light on the association between momentary synchrony, emotions, and conversational structure in a couple therapy session

Aikuisten turvapaikanhakijoiden ja pakolaisten mielenterveyden ja psyykkisten ongelmien erityispiirteet

Artikkelissa tarkastellaan aikuisten turvapaikanhakijoiden ja pakolaisten mielenterveyteen ja psyykkisiin ongelmiin liittyviä erityispiirteitä. Näiden ryhmien mielenterveyttä on tutkittu ja käsitteellistetty lähinnä psyykkisten häiriöiden ja niiden esiintyvyyden kautta. Syynä pahoinvointiin on tällöin lähes yksinomaan pidetty lähtömaassa tapahtuneita traumatisoivia tapahtumia. Ajankohtaisen tutkimustiedon pohjalta piirtyvä kuva turvapaikanhakijoiden ja pakolaisten mielenterveydestä ja siihen vaikuttavista tekijöistä ei kuitenkaan ole näin kapea-alainen. Turvapaikanhakijoiden ja pakolaisten psyykkisten häiriöiden esiintyvyydessä yleisesti ja eri ryhmien välillä on eri tutkimusten mukaan huomattavaa vaihtelua. Psyykkinen toiminta rakentuu ja kehittyy useiden tekijöiden yhteisvaikutuksessa. Ihmisillä on lisäksi huomattavia mielenterveyttä tuottavia resursseja ja pärjäävyyttä erilaisissa ongelmissa. Psyykkisen hyvinvoinnin ja toimivan auttamisen kannalta tärkeitä tekijöitä ovat perustarpeiden tyydyttyminen, toimivat stressinhallinnan keinot sekä toimijuuden tunnon palautuminen ja saavuttaminen oman elämän suhteen

Introduction: Open Dialogue around the world – implementation, outcomes, experiences and perspectives

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Generating dialogical practices in mental health : experiences from southern Norway, 1998-2008

Published version of an article in the journal: Administration and Policy in Mental Health and Mental Health Services Research. Also available from the publisher at: http://dx.doi.org/10.1007/s10488-013-0479-3In Norway and many other countries, political guidelines prescribe the development of mental health strategies with both a service user's perspective and a treatment system established by the local authority. The development of new strategies frequently involves challenges regarding procedures and treatment as well as a view of knowledge and humanity. Dialogical practices might provide a solution for these challenges not only because of its procedures but also due to its attitudes toward service users. The aim is to explore the implementation of three dialogical practice programs in Southern Norway from 1998 to 2008 and to critically analyze and discuss the authors' experiences during the implementation process. Three different programs of dialogical practices were initiated, established, and evaluated within the framework of participatory action research. Sustainable changes succeed individually and organizationally when all participants engage as partners during the implementation of new mental health practices. Generating dialogic practice requires shared understanding of the Open Dialogue Approach (ODA) and collaboration between professional networks and among the leaders. Developing a collaboration area that includes service users in all stages of the projects was one of the essential implementation factors. Other factors involved a common vision of ODA by the leaders and the actors, similar experiences, and a culture of collaboration. However, ODA challenged traditional medical therapy and encountered obstacles to collaboration. Perhaps the best way of surmounting those obstacles is to practice ODA itself during the implementation process

Five-year experience of first episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies

Abstract The open dialogue (OD) family and network approach aims at treating psychotic patients in their homes. The treatment involves the patient's social network and starts within 24 hr after contact. Responsibility for the entire treatment process rests with the same team in both inpatient and outpatient settings. The general aim is to generate dialogue with the family to construct words for the experiences that occur when psychotic symptoms exist. In the Finnish Western Lapland a historical comparison of 5-year follow-ups of two groups of first-episode nonaffective psychotic patients were compared, one before (API group; n 0/ 33) and the other during (ODAP group; n 0/42) the fully developed phase of using OD approach in all cases. In the ODAP group, the mean duration of untreated psychosis had declined to 3.3 months (p0/.069). The ODAP group had both fewer hospital days and fewer family meetings (p B/.001). Nonetheless, no significant differences emerged in the 5-year treatment outcomes. In the ODAP group, 82% did not have any residual psychotic symptoms, 86% had returned to their studies or a full-time job, and 14% were on disability allowance. Seventeen percent had relapsed during the first 2 years and 19% during the next 3 years. Twenty nine percent had used neuroleptic medication in some phase of the treatment. Two cases from both periods are presented to illustrate the approach

Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services

ObjectiveThis cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally.MethodsA structured questionnaire including a self-assessment scale to measure teams’ adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation.ResultsThe survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision.ConclusionThe findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts