Open Door Review

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In Denmark, all TaU-treatment was consistently conducted by a doctor and contact persons from the staff. TaU consisted of different treatment modalities administered according to the patients’ individual needs and available resources at the psychiatric unit at the moment of treatment. Treatment encompassed short psychoeducation programmes, individual meetings with contact persons (mainly nurses and assistant nurses) and other consultants (psychologist, social worker), group meetings, and medical advice (including low-dosis medication). /647#)&4*29$7!6B11)%($Y0!1647#)(#0%214! The SPP was based on a model of psychosis that understands the condition as a result of pathogenetic pathways that involve an array of biological, psychological and social risk factors that lead to a disturbed development and functioning in several basic psychological capacities. The supportive elements in this approach contained, among others, the following: Helping the patient to understand his/her feelings, attitudes and subjective intentions in the concrete interpersonal relationships Helping the patient recover from the psychosocial losses related to his or her suffering from psychosis by, in a trusting manner, reformulate the patient’s story of development with elements of hope and realistic optimism counterbalancing the patient’s negative and self-denigrating attitude Applying an array of supportive techniques, including: clarifications, affirmations and suggestions; holding and containing the patient’s painful state of mind; maximising adaptive strategies, encouraging patient activities; helping the the patient to understand how psychotic mechanisms work psychologically in the individual and in the specific interactions with others, and how other people might be expected to react with common sense reactions. The term ‘ psychodynamic ’ refers to the following characteristics of the therapeutic approach: It aims to establish a working alliance that functions even in the periods marked by the patient’s ambivalent, confusing or negative attitude (transference) towards the therapist It uses the dynamics of the therapeutic relationship and setting (‘transference’ in a broad sense) to understand communication processes in other relationships outside the setting of psychotherapy It emphasises the role and influence of the counter-transference on the therapist’s understanding and responses It understands emotions and thoughts communicated in the therapy as instances that illustrate for both patient and therapist what may happen in daily life situations in which the patient communicates and interact with others It emphasises the importance and presence of unconscious processes It empathises with the patient’s affective states and unresolved states of mind based on a theoretical model for understanding the patient's difficulties in dealing with emotional experience It recognises and respects the co-existence of both psychotic and non-psychotic aspects of the personality (Bion) It acknowledges the importance of developing levels of mental functioning enabling the patient to deal with emotional experiences in a more adaptive way, i.e. ‘turning the raw sense impressions into thoughts’ and ‘thoughts into thinking’ (Bion).

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