Electrodermal and respiratory synchrony in couple therapy in distinct therapeutic subsystems and reflection periods.

Objective Synchrony in the multi-person context of systemic therapy is a complex and understudied phenomenon. We analyzed respiratory and electrodermal synchronies within a couple therapy system with two therapists to determine whether dyadic subsystems between each client and therapist synchronized differently. We also studied synchrony in reflection periods, in which the therapists discussed the therapy process with clients listening. Finally, we examined the association of synchronies with alliance and outcome.Method: A sample of 22 therapy sessions in which electrodermal activity (EDA) and respiration were recorded were analyzed. Self-report measures of session alliance and outcome were obtained. Synchrony computation was based on windowed cross-correlation using surrogate synchrony and segment-wise shuffling of physiological time series.Results: The results supported the presence of EDA synchrony for the client-therapist and therapist-therapist dyads but not client-client dyads across entire sessions. No significant synchronies were found for respiration behavior. A similar picture was found in reflection periods. Clients' well-being as well as therapists' alliance ratings were significant predictors of client-client EDA synchrony.Conclusion: Our results point to the relational meaning of synchrony and its importance for understanding couple psychotherapy, particularly the reflection periods. Challenges involved in extending synchrony computation to multi-person settings were highlighted.

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

Objective: This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. Methods: A 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. Results: The 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. Conclusion: The 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.

A 5-Year Suicide Rate of Adolescents Who Enrolled to an Open Dialogue-Based Services: A Nationwide Longitudinal Register-Based Comparison.

In the Open Dialogue (OD) based psychiatric services adolescent patients receive less medication and are more often treated within an outpatient setting as compared to standard services. An evaluation of the possible risks of implementing OD are required. The aim of this longitudinal register-based study was to evaluate how treatment under OD is associated with the probability of suicide as compared standard psychiatric care. Study included all 13- to 20-year-old adolescents who enrolled to a psychiatric service in Finland in 2003-2013. The OD-group included adolescents whose treatment commenced in the Western Lapland area (n = 2107), this being the only region where OD covered all psychiatric services. The comparison group (CG) included rest of Finland (n = 121,658). Information was gathered from onset of treatment to the end of the 5-year follow-up or death. In a multivariate Cox regression there were no statistically significant differences in 5-year suicide hazard ratios between OD and CG.

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.

The 10-year treatment outcome of open dialogue-based psychiatric services for adolescents: A nationwide longitudinal register-based study.

AIM: To evaluate the 10-year treatment outcomes and cost-effectiveness of adolescents' mental health treatment initiated under the social network-oriented open dialogue (OD) approach. METHODS: This longitudinal register-based study included all persons who, for the first time, received psychiatric treatment in Finland during the period 1 January 2003-31 December 2008, and who were aged 13-20 at onset (n = 44 868). The OD group included all persons whose treatment commenced in the Western Lapland catchment area (n = 780), this being the only region in Finland where OD covered the entire mental healthcare service at the time of inclusion. The comparison group (CG) included the rest of Finland (n = 44 088). The primary outcome variables were psychiatric treatment and/or disability allowances at the end of the 10-year follow-up, or death. The secondary outcome variables were treatment and disability expenses. Generalized linear models weighted by inverse probability of treatment were used to study the association between OD and the primary outcomes. Population proportions were used to evaluate the cost-effectiveness of the approaches. RESULTS: Treatment that commenced outside OD was associated with higher odds of continuing to receive treatment (adjusted odds ratio [aOR] 1.4; 95%CI 1.2-1.6) and disability allowances (aOR 1.6; 95%CI 1.2-2.1) at the end of the 10-year follow-up. No significant difference in the mortality ratio emerged. The cumulative 10-year expenses per capita were lower under OD. CONCLUSIONS: OD associated with favourable long-term outcomes, but due the observational design and possible residual confounding, further studies with a more robust research design are required.

Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study.

Open Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20-F29) were asked about their treatment of FEP, initiated under OD 10-23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enabled interactions with other people and the chance to go through difficult experiences. A minority of the participants had mixed experiences regarding family involvement and immediate home visits. OD may have the potential to promote therapeutic relationships, but replications from other catchment areas are needed.

Nonverbal Synchrony in Couple Therapy Linked to Clients' Well-Being and the Therapeutic Alliance.

Nonverbal synchrony between individuals has a robust relation to the positive aspects of relationships. In psychotherapy, where talking is the cure, nonverbal synchrony has been related to a positive outcome of therapy and to a stronger therapeutic alliance between therapist and client in dyadic settings. Only a few studies have focused on nonverbal synchrony in multi-actor therapy conversations. Here, we studied the synchrony of head and body movements in couple therapy, with four participants present (spouses and two therapists). We analyzed more than 2000min of couple therapy videos from 11 couple therapy cases using Motion Energy Analysis and a Surrogate Synchrony (SUSY), a procedure used earlier in dyadic psychotherapy settings. SUSY was calculated for all six dyads per session, leading to synchrony computations for 66 different dyads. Significant synchrony occurred in all 29 analyzed sessions and between the majority of dyads. Complex models were used to determine the relations between nonverbal synchrony and the clients' well-being and all participants' evaluations of the therapeutic alliance. The clients' well-being was related to body synchronies in the sessions. Differences were found between the clients' and therapists' alliance evaluations: the clients' alliance evaluations were related to synchrony between both dyads of opposite gender, whereas the therapists' alliance evaluations were related to synchrony between dyads of the same gender, but opposite to themselves. With four participants present, our study introduces a new aspect of nonverbal synchrony, since as a dyad synchronizes, the other two participants are observing it. Nonverbal synchrony seems to be as important in couple therapy as in individual psychotherapy, but the presence of multiple participants makes the patterns more complex.

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach.

In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD's internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.

Dialogue and Dominance in Couple Therapy for Depression: Exploring Therapists' Responses in Creating Collaborative Moments.

Previous investigations have found specific communication patterns in couples dealing with depression, specifically when depression concurs with conjugal conflicts. The presence of these patterns can reflect couples' difficulties in engaging in collaborative communication during their sessions, posing a real challenge for therapists. This exploratory study uses a dialogical approach to examine issues of dominance and type of dialogue in two couples who differed in terms of their levels of dyadic adjustment. The therapists' reactions were explored in order to detect the kinds of responses that were most effective at engendering a collaborative attitude in therapy sessions. The method used to analyze the dialogue was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the degree of quantitative and semantic dominance displayed by a different member of the couple in each case was illustrative of their relational dynamics, while in both cases interactional dominance was exercised by the therapists. Results on dialogue revealed that dialogic dialogue might help to coconstruct new shared meanings of depression. The findings indicated that certain responses by therapists as part of the dialogue could be useful in bringing about a reduction in hostility between the members of a couple, provided that the responses are maintained over the course of the session. Some research and clinical implications that emerge from the results are discussed.

En investigaciones previas se han descubierto patrones de comunicación específicos en parejas que afrontan la depresión, particularmente cuando la depresión coincide con conflictos conyugales. La presencia de estos patrones puede reflejar las dificultades de las parejas para entablar una comunicación colaborativa durante sus sesiones, lo cual plantea un verdadero desafío para los terapeutas. Este estudio exploratorio utiliza un enfoque dialógico para analizar las cuestiones de dominación y el tipo de diálogo en dos parejas que diferían en cuanto a sus niveles de ajuste diádico. Se analizaron las reacciones de los terapeutas a fin de detectar los tipos de respuestas que fueron más eficaces para generar una actitud colaborativa en las sesiones de terapia. El método utilizado para analizar el diálogo fue "Investigaciones Dialógicas de Sucesos de Cambio" (Dialogical Investigations of Happenings of Change, DIHC). Los resultados sobre la dominación indicaron que el grado de dominación cuantitativa y semántica demostrado por un integrante diferente de la pareja en cada caso fue ilustrativo de su dinámica relacional, mientras que en ambos casos los terapeutas ejercieron dominación interaccional. Los resultados sobre el diálogo revelaron que el diálogo dialógico podría contribuir a coconstruir nuevos significados comunes de la depresión. Los resultados indicaron que ciertas respuestas de los terapeutas como parte del diálogo podrían ser útiles para producir una reducción de la hostilidad entre los integrantes de una pareja, siempre y cuando se mantengan las respuestas durante el transcurso de la sesión. Se debaten algunas implicancias científicas y clínicas que surgen de los resultados.

Sympathetic nervous system synchrony: An exploratory study of its relationship with the therapeutic alliance and outcome in couple therapy.

In previous research, we found that sympathetic nervous system synchrony, measured via electrodermal activity (EDA), occurs between participants at the start of couple therapy. The aim now was to test whether this synchrony changes during the therapy process, and how any changes may be related to clients' and therapists' evaluations of the working alliance, and the outcome of therapy. Twelve different couple therapy processes were analyzed (24 clients, plus 10 therapists, working in pairs; hence, 4 persons per session) using EDA concordance indices and questionnaires (Outcome Rating Scale, Session Rating Scale, and Clinical Outcomes in Routine Evaluation-Outcome Measure). EDA synchrony between the couples increased from the beginning to the end of therapy. This seemed to be connected to a positive linear trend in female clients' well-being during the therapy process. There were no statistically significant changes in the EDA synchrony between the cotherapists, or between the clients and the therapists. We found specific changes in the EDA synchrony to be related to changes in the therapeutic alliance, and/or changes in the clients' well-being. Heightened EDA synchrony was frequently related to a better outcome; nevertheless, there was one instance in which decreasing synchrony seemed to be more beneficial. It appears that couple therapy can bring spouses closer together also on a physiological level, which could be especially important for the well-being of women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychosis Is Not Illness but a Survival Strategy in Severe Stress: A Proposal for an Addition to a Phenomenological Point of View.

Phenomenology often looks at psychosis as a defined pathological state. In this paper, psychosis is not seen as a (pathological) state but as a way to respond in extreme stress. It is psychological functioning of the embodied and relational mind, and psychotic experience can be seen as one form of affective arousal among any other affects. Taken the point of views of Emmanuel Levinas and Mikhail Bakhtin about the primacy of living in responsive relationships, psychotic behavior is seen as emerging in relationships that do not guarantee adequate responses and thus the subject is imposed to isolate from social relationships and developing odd behavior. If dialogical responses are guaranteed, recovery from psychotic behavior can occur. Some guidelines for such dialogues are given.

Open Dialogue as a Human Rights-Aligned Approach.

Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council. It is shown that OD aligns well with discourses on human rights, being a largely non-institutional and non-medicalizing approach that both depends on and fosters local and context-bound forms of knowledge and practice. Its fundamental network perspective facilitates a contextual and relational understanding of mental well-being, as postulated by contemporary human rights approaches. OD opens the space for anyone to speak (out), for mutual respect and equality, for autonomy, and to address power differentials, making it well suited to preventing coercion and other forms of human rights violation. It is concluded that OD can be understood as a human rights-aligned approach.

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study.

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single-case study comprise couple therapy process videotapes recorded in a multi-camera setting, and measurements of participants' SNS activity. The voluntary participants were a marital couple in their late thirties and two middle-aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.

Este artículo informa sobre el valor agregado de las respuestas materializadas reconocidas mediante la actividad del sistema nervioso simpático (SNS) en la investigación sobre la terapia de pareja. Se centra en los momentos de cambio y en la elección del momento oportuno de las intervenciones terapéuticas o en los pasos terapéuticos de una sesión de terapia de pareja. Los datos para este estudio de un solo caso comprenden las cintas de vídeo del proceso de terapia de pareja grabadas en un entorno con varias cámaras y las mediciones de la actividad del SNS de los participantes. Los participantes voluntarios fueron un matrimonio de treintaimuchos y dos psicoterapeutas hombres de mediana edad. La división en segmentos por temas demostró cómo el asunto clave de buscar ayuda, que ahora sabemos que consta de tres componentes individuales, se trató repetidamente en la sesión. La actividad del SNS demostró diferentes grados de sincronización entre la pareja, entre los terapeutas, y entre la pareja y los terapeutas durante el diálogo relativo a estos tres componentes. La cuestión de la elección del momento oportuno surgió como un fenómeno complejo e incluso ambivalente. La agitación en los terapeutas fue acorde con su actividad terapéutica, mientras que en los pacientes fue más anticipatoria. El enfoque utilizado aquí dejó ver algo de la intensidad que puede generar el diálogo terapéutico cuando se tratan cuestiones de cambio en las relaciones en el contexto de la pareja y demostró cómo esta intensidad puede regularse dialógicamente en el sistema terapéutico.

The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen-year outcomes.

Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19-20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach.

The Relational Mind in Couple Therapy: A Bateson-Inspired View of Human Life as an Embodied Stream.

Research on human intersubjectivity has found that humans participate in a dialogue throughout their life, and that this is manifested not only via language, but also nonverbally, with the entire body. Such an understanding of human life has brought into focus some basic systemic ideas concerning the human relational mind. For Gregory Bateson, the mind works as a system, formed from components that are in continuous interaction with each other. In our Relational Mind research project, we followed twelve couple therapy processes involving two therapists per session, looking at the ways in which the four participants attuned to each other with their bodies, including their autonomic nervous system activity. Using observations from the project, we here describe the ways through which the relational and embodied mind can be realized in a couple therapy setting.

Sympathetic Nervous System Synchrony in Couple Therapy.

The aim of this study was to test whether there is statistically significant sympathetic nervous system (SNS) synchrony between participants in couple therapy. To our knowledge, this is the first study to measure psychophysiological synchrony during therapy in a multiactor setting. The study focuses on electrodermal activity (EDA) in the second couple therapy session from 10 different cases (20 clients, 10 therapists working in pairs). The EDA concordance index was used as a measure of SNS synchrony between dyads, and synchrony was found in 85% of all the dyads. Surprisingly, co-therapists exhibited the highest levels of synchrony, whereas couples exhibited the lowest synchrony. The client-therapist synchrony was lower than that of the co-therapists, but higher than that of the couples. A Video Abstract is available next to the online version of this article on the JMFT web site.

The Embodied Attunement of Therapists and a Couple within Dialogical Psychotherapy: An Introduction to the Relational Mind Research Project.

In dialogical practice, therapists seek to respond to the utterances of clients by including in their own response what the client said. No research so far exists on how, in dialogs, therapists and clients attune themselves to each other with their entire bodies. The research program The Relational Mind is the first to look at dialog in terms of both the outer and the inner dialogs of participants (clients and therapists), observed in parallel with autonomic nervous system (ANS) measurements. In the ANS, the response occurs immediately, even before conscious thought, making it possible to follow how participants in a multiactor dialog synchronize their reactions and attune themselves to each other. The couple therapy case presented in this article demonstrates how attunement is often not a simple "all at the same time" phenomenon, but rather a complex, dyadic or triadic phenomenon which changes over time. In the case presented, there was strong synchrony between one therapist and one client in terms of their arousal level throughout the therapy session. It was also observed that high stress could occur when someone else was talking about something related to the participant, or if that person mirrored the participant's words. Overall, it seems that in evaluating the rhythmic attunement between therapists and clients it is not enough to look at single variables; instead, integrated information from several channels is needed when one is seeking to make sense of the embodiment.