La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Bendigo, Australia.
School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
J Psychiatr Ment Health Nurs. 2024 Aug;31(4):681-698. doi: 10.1111/jpm.13023. Epub 2024 Jan 17.
WHAT IS KNOWN ON THE SUBJECT?: Open Dialogue was developed in Finland in the 1980s by clinical psychologist, Jaakko Seikkula. It is a development of family therapy, recognises previous trauma and has proven to be very effective in situations of acute mental illness, and in particular psychosis. Trauma Informed Care is a practice based on the understanding of and responsiveness to the impact of trauma. When people have experienced trauma, they may have difficulties in their everyday life and experience negative physical health outcomes as well as the risk of developing mental ill health. Open Dialogue is aligned to mental health care which aims to be trauma-informed, person-centred and rights-based. Examples exist of the use of both approaches for service delivery with limited evaluation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, no formal evaluation has been made of the use of open dialogue as a Trauma Informed therapy approach to support individuals and their family networks. Although both approaches recognise the impact of trauma on individuals, no study has explored the effectiveness of this treatment combination for use by mental health nurses. This review is timely as it provides insights into contemporary services that are trauma informed and have used Open Dialogue to extend therapy work with individuals and their family/networks. This scoping review was able to determine whether recommendations for clinical practice and training in Open Dialogue with Trauma Informed Care approaches could be identified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review provided a broad overview on the current types of trauma-informed care services incorporating Open Dialogue approaches into their practice. The literature, though sparce, identifies that Trauma Informed Care recognises multiple origins for mental ill health. Open dialogue has an affinity with the common values of mental health nurses. As combined therapies, they are demonstrating usefulness in engaging families and people in their journey towards recovery. Rigid adherence to Open Dialogue focus and delivery as well as training practices could be revised to make them more open to what people and their families wish to discuss. The person with mental ill health and previous trauma should be able to direct the narrative. Trauma Informed Practice principles could be adapted to improve consumer satisfaction with Open Dialogue approaches.
INTRODUCTION: A large proportion of people who access mental health services have a lived experienced of trauma and are more likely to have a history of complex trauma. Open Dialogue and Trauma Informed Care practices identify previous trauma as a factor related to later psychosis. This scoping review has identified similarities and contrasts in how an Open Dialogue and Trauma Informed Care approach have been combined to complement one another for clinical work with people presenting with psychosis and previous trauma.
We aimed to answer the following research question in this scoping review: What is known of the combined use of Open Dialogue and Trauma Informed Care practice when working with consumers and their family networks? As such, the purpose of this paper was to explore the application to practice and identify if any training existed and been evaluated.
This scoping review was based on the Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Grey literature was also searched through Psyche Info and Google Scholar for books, Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2013 to January 2023.
Five distinct themes were identified from the literature: (1) Linking open dialogue with trauma, (2) Response to treatment, (3) Empowerment and information sharing, (4) Interpretation by clinical services, (5) Staff training outcomes.
Some tentative recommendations for practice recognised the individuals' unique story and perspective, suggested that trauma is an important concept to assess. Services practising as Trauma Informed Services that have incorporated an Open Dialogue approach have mixed experiences. The use of Open Dialogue may have some benefits for family work and exploring consumer narratives while building a network of support. However, consumers identified similar frustrations with service delivery as with the family therapy literature. For example, it was difficult to bring family members together and difficult to discuss previous traumatic events in front of family. People experiencing training in Open Dialogue reported it taking a slow pace and not what they were familiar with.
Open Dialogue can facilitate engagement of consumers and their family networks and greater recognition of the peer workforce to promote collaboration in therapy is needed. Future research should also focus on evaluating the effectiveness of such services and comparing their outcomes across regions.
未加标签部分：关于主题已知的内容是什么？：开放式对话是由临床心理学家雅科·西库拉（Jaakko Seikkula）于 20 世纪 80 年代在芬兰开发的。它是家庭治疗的一种发展，承认先前的创伤，并已被证明在急性精神疾病情况下非常有效，特别是在精神病方面。创伤知情护理是一种基于对创伤的影响的理解和回应的实践。当人们经历创伤时，他们可能会在日常生活中遇到困难，并出现负面的身体健康结果，以及心理健康不良的风险。开放式对话是一种心理健康护理，旨在做到创伤知情、以患者为中心和以权利为基础。在服务提供方面，存在着使用这两种方法的例子，只是评估有限。本文添加了什么内容：据我们所知，没有对开放式对话作为一种支持个人及其家庭网络的创伤知情治疗方法的使用进行正式评估。尽管这两种方法都认识到创伤对个人的影响，但没有研究探索这种治疗组合对精神健康护士的使用效果。由于提供了有关当代创伤知情服务的见解，这些服务使用开放式对话来扩展个人及其家庭/网络的治疗工作，因此这次审查是及时的。本综述能够确定是否可以为开放式对话与创伤知情护理方法的临床实践和培训提出建议。实践的影响是什么：本综述对当前将开放式对话方法纳入其实践的各种创伤知情护理服务进行了广泛概述。尽管文献很少，但它确定了创伤知情护理认识到心理健康不良的多种原因。开放式对话与精神健康护士的共同价值观有亲和力。作为联合疗法，它们在让家庭和人们参与康复之旅方面显示出有用性。对开放式对话的重点和交付以及培训实践的严格遵守可以进行修订，使其对人们及其家人希望讨论的内容更加开放。有精神健康问题和先前创伤的人应该能够指导叙述。可以调整创伤知情实践原则，以提高人们对开放式对话方法的满意度。
