Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Miembro del equipo de Salud Mental del Hospital Keropudas de Tornio, Laponia Occidental, desde comienzos de
los 80 hasta 1998. Creador del enfoque Dilogo Abierto. Ha desarrollado intervenciones familiares y en red social
para el abordaje de la psicosis y otras crisis. Investigaciones sobre procesos y resultados en terapia familiar de la
psicosis y la depresin, y sobre intervenciones en red social en el entorno natural
seikkula@psyka.jyu.fii jaakko.seikkula@jyu.fi jaakko.a.t.seikkula@jyu.fi
/TRADUCCIN: Marisol Filgueira Bouza. Doctora en Psicologa (UAM Madrid), Especialista en Psicologa Clnica. Psicoterapeuta, Psicodramatista, Terapeuta Familiar, Docente y Supervisora (AEP,
FEAP, ATFMG, FEATF, AEN-AGSM). Traductora de textos (Institute of Linguists UK) e Intrprete de Conferencias (Estudio Internacional Sampere de Madrid). Fundadora y Directora del Instituto
Galego de Psicoterapia (antes Instituto de Tcnicas de Grupo y Psicodrama en Galicia). Programa de Trastorno Mental Grave (Subprogramas de Tratamiento Asertivo Comunitario,
Trauma&Disociacin). Hospital Martimo de Oza (A Corua).
https://institutogalegodepsicoterapia.wordpress.com/ psicoterapiagalicia@gmail.com
ma.soledad.filgueira.bouza@sergas.es marisol.filgueira@wanadoo.es
OPEN DIALOGUE in the new era of
mental health care
/ DILOGO ABIERTO en la nueva
era de la asistencia en salud mental
Jaakko Seikkula
Jaakko.seikkula@jyu.fi
Seikkula, J. & Arnkil, TE: Open dialogues and anticipations.
Respecting Otherness in the present moment. /Dilogos
abiertos y anticipaciones. Respetando la alteridad en el
momento presente. Helsinki: THL
www.thl.fi/bookshop (2014)
REFERENCES / BIBLIOGRAFA
Seikkula, J., Alakare, B., Aaltonen, J., Haarakangas, K., Kernen. J. & Lehtinen, K.
(2006). Five years experiences of first-episode non-affective psychosis in Open
Dialogue approach: Treatment principles, follow-up outcomes and two case analyses.
Psychotherapy Research, 17,
Aaltonen, J., Seikkula, J., & Lehtinen, K. (2011). Comprehensive open-dialogue
approach I: Developing a comprehensive culture of need-adapted approach in a
psychiatric public health catchment area the Western Lapland Project. Psychosis, 3,
179-191
Seikkula, J., Alakare, B., & Aaltonen, J. (2011). The comprehensive open-dialogue
approach (II). Long-term stability of acute psychosis outcomes in advanced community
care: The Western Lapland Project. Psychosis, 3, 192-204.
DOI:10.1080/17522439.2011.595819
Whitaker, R. (2010). Anatomy of an epidemic. Magic bullets, psychiatric drugs, and the
astonishing rise of mental illness in America. New York, NY: Crown.
.
Tornio
Jyvskyl
... authentic human life is the open-ended dialogue. Life by
its very nature is dialogic. To live means to participate in
dialogue: to ask questions, to heed, to respond, to agree,
and so forth. In this dialogue a person participates
wholly and throughout his whole life: with his eyes,
lips, hands, soul, spirit, with his whole body and
deeds. He invests his entire self in discourse, and this
discourse enters into the dialogic fabric of human life, into
the world symposium. (M. Bakhtin, 1984)
Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug
misuse had no significant associations when effects of the other variables were adjusted.
/Seguimiento ms largo correlacionaba con menor volumen de tejido cerebral y mayor volumen de
lquido cerebroespinal.
Mayor intensidad de tratamiento antipsictico se asociaba con indicadores de reduccin de tejido
cerebral especfica y generalizada una vez controlados los efectos de los otros 3 predictores.
Ms tratamiento antipsictico se asociaba con menor volumen de materia gris. La
disminucin progresiva en el volumen de materia blanca era ms evidente en pacientes que
reciban ms tratamiento antipsictico.
During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and
gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95%
CI 2.06-3.90), and was 2.25 (95% CI1.61-3.15) after further adjusting for somatic diseases,
bloodpressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education.
The number of neuroleptics used at the time of the baseline survey showed a graded
relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk
factors for premature death, the relative risk was 2.50 (95% CI1.46-4.30) per increment of one
neuroleptic.
/Durante un seguimiento a 17 aos, murieron 39 de 99 personas con esquizofrenia. Ajustadas
las variables de edad y sexo, el riesgo de mortalidad relativo entre personas con
esquizofrenia y otros era de 2.84 (95% CI 2.06-3.90), y de 2.25 (95% CI 1.61-3.15) despus de
ajustar enfermedades somticas, presin sangunea, colesterol, ndice de masa corporal,
tabaquismo, ejercicio, consumo de alcohol y educacin. El nmero de neurolpticos
utilizados en la fase de lnea de base del estudio mostr una relacin graduada con
mortalidad. Una vez ajustadas las variables edad, sexo, enfermedades somticas y otros
factores potenciales de riesgo de muerte prematura, el riesgo relativo era de 2.50 (95% CI
1.46-4.30) por incremento de un neurolptico.
.
Psychiatry in change
/La psiquiatra en vas de cambio
Non medication or low dose fep patients had better social
outcome in seven years /Pacientes con primer episodio psictico
sin medicacin o con medicacin a dosis bajas presentan mejores
resultados sociales en siete aos (Wunderink et al., 2013)
Cognitive therapy effective in psychosis without neuroleptic
medication /La terapia cognitiva es eficaz en psicosis sin
medicacin neurolptica (Morrison et al.,2014)
Talking cure of psychosis is coming back 10 approaches, OD
one of them /Vuelve la Cura a travs del habla de la psicosis
10 enfoques, Dilogo Abierto es uno de ellos (Science, 3/2014)
RAISE study: Talking cure with the team and the family having
low dose of psychosis medication superior to TAU medication
practice /Estudio RAISE: la cura a travs del habla con el equipo y
la familia a dosis bajas de medicacin antipsictica es superior a
la prctica de medicacin TAU (American Jo Psych; 10/2015)
We need to rethink our practices
/Tenemos que repensar nuestras prcticas
8 provinces * 8 provincias
Trieste one of Trieste una de ellas
them * 80 profesionales
80 professionals en formacin 16
training 16 days das + supervisin
+ supervision * Investigacin
Research on the sobre eficacia y
effectiveness and procesos
processes
5 years follow-up of Open Dialogue in Acute psychosis
/Seguimiento de 5 aos con Dilogo Abierto en Psicosis Aguda
(Seikkula et al. Psychotherapy Research, March 2006: 16(2),214-228)
01.04.1992 31.03.1997 in * 01.04.1992 31.03.1997 en Laponia
Western Lapland, 72 000 Accidental, 72.000 habitantes
inhabitants * Comienzo como parte de un Tratamiento
Starting as a part of a Finnish Integrado de la Psicosis Aguda de mbito
National Integrated Treatment of Nacional Finlands (API) proyecto de
Acute Psychosis project of Need tratamiento Adaptado a Necesidades
Adapted treatment
* Estudio naturalista no ensayo
Naturalistic study not a aleatorizado
randomized trial * Objetivo 1: aumentar el tratamiento
Aim 1: To increase treatment extrahospitalario en el domicilio
outside hospital in home settings * Objetivo 2: aumentar el conocimiento
Aim 2: To increase knowledge of sobre el lugar de la medicacin no pautar
the place of medication not to medicacin neurolptica al inicio del
start neuroleptic medication in the tratamiento sino focalizar un tratamiento
beginning of treatment but to
focus on an active psychosocial psicosocial activo
treatment * N = 90 al inicio; n=80 a los 2 aos; n= 76 a
N = 90 at the outset; n=80 at 2 los 5 aos
year; n= 76 at 5 years * Entrevistas de seguimiento como foros de
aprendizaje
Follow-up interviews as learning
forums
Dialogical practice is effective
/La prctica dialgica es eficaz
Open Dialogues in Dilogos Abiertos en
Tornio 5 years Tornio seguimiento a
follow-up 1992- 1997 5 aos 1992- 1997
(Seikkula et al., (Seikkula et al., 2006):
2006): - 35 % con
- 35 % used antipsicticos
antipsychotic drugs - 81 % sin sntomas
- 81 % no remaining psicticos
psychotic symptoms - 81% volvi a pleno
empleo
- 81% returned to full
employment
Outcomes stable 2003 2005
/Resultados estables 2003 2005
(Aaltonen et al., 2011 and Seikkula et al, 2011):
Jaakko Seikkula
Seikkula, J. & Arnkil, TE (2014). Open dialogues and
anticipations: Respecting the Otherness in the present
moment.
Dilogos abiertos y anticipaciones: Respetando la alteridad
en el momento presente.
Helsinki: THL
* encarnacin/registro en el cuerpo
REFERENCES / BIBLIOGRAFA
.
Bakhtin, M. (1984) Problems of Dostojevskijs Poetics. Theory and History of
Literature:
Vol. 8. Manchester: Manchester University Press.
Bakhtin, M. (1990) Art and Answerability: Early Philosophical Essays of M. M. Bakhtin,
trans. Vadim Liapunov. Austin: University of Texas Press.
Bakhtin, M. (1993) Toward a Philosophy of the Act, trans. Vadim Liapunov. Austin:
University of Texas Press.
Brten, S. (2007). On bein g moved: From mirror neurons to empathy. Amsterdam:
John Benjamins-
Iacoboni, M (2008) Mirroring People: The new science of how we connect with others.
Farrar, Straus and Giroux
Carman, T. (2008). Merleau-Ponty. London:Routledge.
Hermans, H. & Dimaggio, A. (2005).Dialogical self in psychotherapy.
Stern, D.N. (2004). The present moment in psychotherapy and every day life. NY:
Norton
Trevarthen, C. (1990) Signs before speech. In T. A. Seveok and J. Umiker Sebeok
(eds), The Semiotic Web. Amsterdam: Mouton de Gruyter.
Whitaker, R. (2010). Anatomy of an epidemic. New York: Crown Publ..
... authentic human life is the open-ended dialogue.
Life by its very nature is dialogic. To live means to
participate in dialogue: to ask questions, to heed, to
respond, to agree, and so forth. In this dialogue a
person participates wholly and throughout his
whole life: with his eyes, lips, hands, soul, spirit,
with his whole body and deeds. He invests his
entire self in discourse, and this discourse enters
into the dialogic fabric of human life, into the world
symposium. (M. Bakhtin, 1984)
Emotions /Emociones
William James (1890): From looking at
patterns to sensing similarities
/De observar patrones a sentir similaridades
Our experiences are feelings of tendency, often so vague that we are unable to
name them at all (p.254); /Nuestras experiencias son sentimientos de
tendencias, a menudo tan vagos que somos incapaces de nombrarlos
such feelings can function as signs of direction in thought of which we have an
acutely discriminative sense, though no definite sensorial image plays any part in
it whatsoever (p.253). /dichos sentimientos pueden funcionar como seales de
direccin en el pensamiento de las que tenemos un agudo sentido discriminativo,
aunque ninguna imagen sensorial definida juega papel alguno en ello
Thus we can have an acutely discriminative sense of such feelings of tendency,
and it is our inner sensing of similarities rather than of our seeing of patterns out
in the world that is basic to our making sense of what is happening to us in our
lives. /As podemos tener un agudo sentido discriminativo de dichos sentimientos
de tendencias, y es nuestra sensacin interna de similaridades ms que nuestra
observacin de patrones en el mundo externo- la que resulta fundamental para
atribuir sentido a lo que nos ocurre en la vida.
Liisa Teacher Siiri mother Aunt/sister
Maija madre
ta/hermana
profesora
Jaakko
Anni
Social worker Therapist
trabajadora social terapeuta
Family therapist Siiri
terapeuta familiar Anni Mother
Mother
madre
Father madre
Satu
padre Female Husband
Male mujer marido
varn Ex husband Daughters
ex marido hijas
memory of death Mothers death Sister
recuerdo de la muerte Spouse hermana
cnyuge muerte de la madre
T1 Liisa
Family therapist Technician
terapeuta familiar Teacher
Mother tcnico profesora
Father madre Father Mother
padre
Female padre madre
Male mujer
Son spouse
varn cnyugge
Spouse
ma hijo
cnyuge Daughter
Father death hija
memory of death muerte del padre Sister
recuerdo de la muerte
hermana
From top to
bottom:
Female client
Male client
Psychologist
Trainee in
psychotherapy
/De arriba a
abajo:
* Cliente mujer
* Cliente varn
* Psiclogo/a
* Alumno de
Anu Karvonen ja Virpi-Liisa Kykyri
psicoterapia
Lasse (C2) and Heli (C1): Concordance of skin conductance
during the 2nd session /Lasse (C2) y Heli (C1): Concordancia
de la conductancia de la piel durante la 2 sesin
Very first notions
/Nociones preliminares
Reactions of ANS (Sympathetic nervous system arousal) in concordance to
each other embodied emphatetic experience? /Las reacciones del SNA
(activacin del sistema nervioso simptico) en concordancia recproca -
experiencia emptica incorporada?
In a single episode not all in relation to each other /En un episodio aislado no
todo se relaciona entre s
Most stressfull episodes may happen during the speech of others in the
meetings, even during the reflective talks sensitivity of saying /Los episodios
ms estresantes pueden presentarse durante el discurso de otros en las
reuniones, incluso durante las charlas reflexivas sensibilidad a lo que se dice
Change in prosody and rhytmicity of dialogue enhance the clients dealing with
emotional issues silent moments /Los cambios en la prosodia y el ritmo del
dilogo potencian el enfrentamiento de cuestiones emocionales por parte de
los clientes momentos de silencio
Critisism of the identity of the other SNS arousal / Crtica de la identidad del
otro activacin del Sistema Nervioso Simptico
SIMPLE GUIDES FOR THE DIALOGUE IN PRESENT
MOMENT
/GUAS SIMPLES PARA EL DILOGO EN EL
MOMENTO PRESENTE
Prefer themes of the actual conversation instead of narratives of past - be realistic
/Mejor temas de la conversacin presente que narrativas del pasado ser realistas
Follow clients stories and be careful with your own openings repeat the said (and
imitate movements) /Seguir los relatos de los clientes y tener cautela con las
propias revelaciones repetir lo dicho (e imitar los movimientos)
Guarantee response to spoken utterances. Responses are embodied,
comprehensive /Garantizar respuesta a las expresiones verbalizadas. Las
respuestas son incorporadas, integrales
Note different voices, both inner and horizontal /Dar cuenta de las diferentes voces,
tanto internas como horizontales
Listen to your own embodied responses /Escucha tus propias respuestas
incorporadas
Take time for reflective talks with your collegues /Tmate tiempo para charlas
reflexivas con tus colegas
Dialogical utterances, speak in first person /Expresiones dialgicas, habla en
primera persona
Proceed peacefully, silences are good for dialogue /Procede pacficamente, los
silencios son buenos para el dilogo
Love is the life force, the soul, the idea. There is no
dialogical relation without love, just as there is no
love in isolation. Love is dialogic.