Patient-authored medical record II: A not-knowing approach to psychiatric nursing.

A patient-authored medical record (PAMR) is a narrative-based prescription that is written by a psychiatric patient with help from a nurse. It is a tool specifically designed and developed for psychiatric nursing. We have reported its notable therapeutic effects for Japanese patients and found that the patients had accurate views of how to improve their illness. The present paper, which broadens the scope of this examination, includes the entire process of using this tool, including both patient-authored medical records and follow-up dialogue. We aim to demonstrate how a patient's potentials are leveraged and expanded through the interpretation of such texts through dialogue, in which interpretation takes the form of a conversational question based on not-knowing. Follow-up meetings facilitate the therapeutic process and team collaboration for patients, medical staff, and families. We also reaffirm the soundness and legitimacy of psychiatric patients writing their own prescription with help from a nurse.

The effectiveness of a dialogical family guidance intervention regarding child treatment response in families with a child with neurodevelopmental disorders.

BACKGROUND: Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents` opinions regarding their child`s emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up. METHOD: Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children`s emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed. RESULTS: The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up. CONCLUSIONS: The result does not show any differences between parents` opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention`s effect regarding the child`s mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used. TRIAL REGISTRATION: ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021).

Therapeutic stance towards persons with psychosis - a Grounded Theory study.

OBJECTIVE: Over the last decades, psychotherapy of psychosis has increasingly gained attention. The quality of the therapeutic alliance has been shown to have an impact on therapy outcome. Yet, little is know about the influence of the therapeutic stance on the alliance. In this study, we explore psychotherapists' stance towards persons with psychosis with the aim of better understanding its characteristic-hindering and helpful-aspects. METHOD: 6 semi-structured interviews with psychotherapists from three different schools (CBT, PD, ST) were analysed with Grounded Theory. Credibility was checked through external and peer-researcher-supported debriefing. RESULTS: 4 core categories were generated and interrelated in a theoretical model. Therapists' stance was initially characterized by insecurity. Diffent ways of dealing with insecurity yielded different stances: a monological and an open one. A helpful stance was conceived as stemming from openness and was characterized by a dialogical structure. A co-presence (or "dosing") of you and I was conceived as its core aspect. CONCLUSION: These findings specify the interpersonal dynamics arising from different stances and their impact on the therapeutic alliance and process. Research is still needed to further understand the characteristics of helpful and hindering therapeutic stances, which should also inform the training of psychotherapists.

'Staying cool, calm and positive': A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer.

BACKGROUND: Patients with lung cancer suffer from physical, psychosocial and particularly emotional challenges. Twenty-five percent of patients with lung cancer are offered surgery as a potential cure. Nevertheless, 40% of surgically treated patients will experience recurrence. Paradoxically, research shows a dominant narrative of operable lung cancer patients 'being lucky', which silences other narratives about suffering, worries and emotional challenges. AIM: To explore narratives about operable lung cancer, particularly emotional reactions to illness and suffering in these narratives. METHODS: A qualitative design was applied. Six women and four men diagnosed with operable lung cancer were included from one university hospital in Denmark and interviewed 1 month after surgery using active interviews. The interviews were subject to dialogical narrative analysis. The theoretical foundation is social constructivism, with socio-narratological inspiration. FINDINGS: A typology of three emotional narratives emerged: 'staying cool', 'staying calm' and 'staying positive'. All three types of narrative are characterised by managing emotional reactions. Staying cool is characterised by not showing emotional reactions; staying calm narratives acknowledge emotional reactions, but that they need to be managed so that they do not burden relatives; and the last, staying positive, is characterised by managing emotional reactions in a positive direction. Together this typology of three emotional narratives revealed that operable lung cancer patients are under normative pressure from these socially preferred narratives of ideal emotional reactions to lung cancer. CONCLUSION: A typology of three emotional narratives were identified and can be called 'feeling rules' that guide patients after lung cancer surgery to manage their emotions. Consequently, if patients do not live up to these three emotional narratives of staying cool, calm and positive, they may be socially isolated and restricted from access to support.

Transforming self-experienced vulnerability into professional strength: a dialogical narrative analysis of medical students' reflective writing.

Medical students' efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians' life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one's future professional practice can inform first-year medical students' initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students' processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients' vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.

Unpacking a female language teacher's identity transformations: a perspective of multiple I-positions.

The narrative inquiry investigates the construction and evolution of a female Chinese language teacher's identity across her pre-service and in-service phases. Utilising data from interviews, class observation and written reflections, the research examines how internal and external aspects shape her identity development. It specifically explores the role of third positions, meta positions, and promoter positions drawing on the dialogical self theory. The findings reaffirm that a teacher's identity is fluid and influenced by personal and professional factors. Over time, however, strong teaching beliefs and a growth mindset emerge as pivotal drivers for sustained and positive teacher development. The paper concludes by offering implications for pre-service teacher education and female teachers' continuing professional development.

Challenges and Concerns in Assisting Indigenous People with Suicide Attempts.

There has been an alarming rise in suicide attempts among Indigenous people in Brazil, leading to national concerns about the provision of psychosocial care and professional support. In this study, we make an attempt to understand the perspectives of professionals in assisting Indigenous people from a specific group, the Iny, and identify the specific challenges of addressing issues through the mental health care system related specifically to suicide prevention. Using a qualitative approach with participant observation and semi-structured interviews, the research included Indigenous and their families assisted by three public institutions and the professionals that work in public psychosocial assistance. For this paper, we examined the tensions, conflicts, and challenges of the healthcare professionals at one of these institutions, a Psychosocial Care Center in the state of Goiás/Brazil. For data analysis, a sociocultural protocol was built to identify dialogical tensions between the different thematic fields of mental health care. The findings reveal that the theme of suicide was an important concern in the daily work with the community. Still, there were significant issues related to the assumptions, methodology, and meaning of care between the professionals and the community, on account of which the objective of the programme to address suicide attempts had not been effective or successful. The discussion of the results raises several critical questions about the possible contributions of dialogical cultural psychology in the context of Indigenous health. Also, it has important implications for the global issue of the wellbeing of Indigenous people.

Healthcare chaplains' conflicting and ambivalent positions regarding meaning in life and worldview.

Western society is increasingly a spiritual society, but not so much a society that draws on clearly delineated religious or worldview pillars anymore. Within healthcare, there's a growing attention to the spiritual dimension of health and the collaborative spiritual care that is needed for person-centered care. This changing religious/worldview and healthcare landscape is influencing healthcare chaplaincy. In this case study in-depth interviews were conducted with a chaplaincy team within a large healthcare organization in The Netherlands. Dialogical Self Theory was used as the theoretical framework in the narrative analysis of these stories. This provided insights into how these chaplains negotiate their professional identity within a changing healthcare landscape. It is concluded that there are multiple and often contradictory and conflicting positions within and between chaplains and that it is a challenge for healthcare chaplains to integrate the "old" and "new" representations of chaplaincy.

Trauma therapies for psychosis: A state-of-the-art review.

BACKGROUND: Traumatic events, particularly childhood interpersonal victimisation, have been found to play a causal role in the occurrence of psychosis and shape the phenomenology of psychotic experiences. Higher rates of post-traumatic stress disorder (PTSD) and other trauma-related mental health problems are also found in people with psychosis diagnoses compared to the general population. It is, therefore, imperative that therapists are willing and able to address trauma and its consequences when supporting recovery from distressing psychosis. METHOD: This paper will support this need by providing a state-of-the-art overview of the safety, acceptability and effects of trauma therapies for psychosis. RESULTS: We will first introduce how seminal cognitive-behavioural models of psychosis shed light on the mechanisms by which trauma may give rise to psychotic experiences, including a putative role for trauma-related emotions, beliefs and episodic memories. The initial application of prolonged exposure and eye movement and desensitation and reprocessing therapy (EMDR) for treating PTSD in psychosis will be described, followed by consideration of integrative approaches. These integrative approaches aim to address the impact of trauma on both post-traumatic stress symptoms and trauma-related psychosis. Integrative approaches include EMDR for psychosis (EMDRp) and trauma-focused Cognitive-Behavioural Therapy for psychosis (tf-CBTp). Finally, emerging dialogic approaches for targeting trauma-related voice-hearing will be considered, demonstrating the potential value of adopting co-produced (Talking with Voices) and digitally augmented (AVATAR) therapies. CONCLUSION: We will conclude by reflecting on current issues in the area, and implications for research and clinical practice.

A Virtual COVID-19 Youth Ambassador Program: The UI Health CHAMPIONS Experience.

The COVID-19 pandemic continues to exacerbate socioeconomic and educational hardships rooted in systemic inequities for youth across the United States. (Virtual) youth resilience and health promotion efforts are viable mechanisms to address these hardships in the context of a double pandemic: COVID-19 and structural racism. Health professions training programs hold a unique opportunity to incorporate COVID-19 health education to train and empower youth to become community health ambassadors. Grounded on a Grow-Your-Own (GYO) approach, UI Health CHAMPIONS spearheaded the development of the COVID-19 Youth Ambassador Program (COVID-19 YAP), a virtual multistage and multipartner effort. Its mission is to equip youth with knowledge, perspective, and tools to have empathetic, informative conversations within their networks about COVID-19. Via e-learning, modules cover viruses and the immune system; vaccine development; health disparities/equity; and health advocacy. Participants are introduced to Human-Centered Design Thinking to guide the development of advocacy projects. COVID-19 YAP's uniqueness lies in the team of program coordinators consisting of (pre-)health professional student workers with a desire to engage in health equity efforts and community health ambassadorship. Freirean principles are applied across program design and delivery; Dialogical Education encourages the educator to become the student and the student to become an educator. This co-learning process empowers students and educators to become agents of social change. COVID-19 YAP can serve as a collaborative effort addressing a public health priority, contributing toward digital health equity, and creating community resilience while encouraging youth to pursue a health profession and become community health advocates.

Training in Open Dialogue and Dialogical Practice: creatively responding as trainers and writers.

This paper emerges from a series of conversations about training in Open Dialogue and dialogical practice. In our dialogue, we found ourselves moving away from seeking definitive answers about content (what to include) or process (how to include). We asked, "Why are we asking this question about training at all?" Maybe it is because many helpers and all kinds of professionals all over the world are truly asking, "How do we do, or how do we learn how to do 'open dialogue'?." That question starts with "How to train others in the practice?" We moved toward responding to our own questions-what are we offering as trainers and what are the trainees seeking? We sought to explore what is required for a training space that accommodates the hopes of both trainers and trainees. Words arose during our talking, and we listened to them, let them sink in, and reflected on them. Some words resonated with us as trainers; some linked with observing trainees' experiences (including our own); some showed a glimpse of the relationship between trainer and trainees. These emergent words point to a series of learnings, aspects of the training that we as trainers have come to believe are important. The following paper expands upon these words while also including actual portions of our dialogues and vignettes from training. As such, we illustrate our ongoing learning as trainers of Open Dialogue and dialogical practice as it occurs within the unique nature of each training we provide.

The Dialogical Self of Taoistic Dynamics: How scientists and practitioners can trigger the discovery of a harmonious self.

In the present paper, I relate the Dialogical Self Theory with the philosophy of Taoism. For that purpose, I instance the premises of Taoism such as that human being use open ideograms (signs and symbols) that grow constantly in their meaning, that the meaning of life can be only unraveled if the unity of opposites is integrated in one's worldview and that the human being listens to his natural intuition and does not force himself to do things (wuwei = effortless action which has its origins in Laozi's TaoTeChing). When those premises are applied to the Dialogical Self Theory, psychologists can help people to develop a harmonious self because the self is operationalized as an open system that is constantly in flux of meaning. Hidden I-positions might be shifted to the foreground while helping the human being to listen to a multitude of positions and to not act in a rigid fashion. In order for scientists and practitioners to use the insights of what I call the Dialogical Self of Taoistic Dynamics, I propose an open interview guide that could help people to realize their harmonious pluralistic self.

'A Story of Being Invisible': A Single Case Study on the Significance of Being Recognised When Needing Acute Healthcare in the Early COVID-19 Pandemic.

Severe illness is often an existential threat that triggers emotions like fear, stress, and anxiousness. Such emotions can affect ill patients' encounters with healthcare personnel. We present a single case study of an older woman who contracted COVID-19 and her challenge to be recognised by healthcare personnel in the early pandemic. Storytelling is vital to understand how patients can create meaning in illness as it gives them the opportunity to reshape and restore their past and to project a future. We used Arthur Frank's dialogical narrative analysis to explore how one patient experienced her encounters with healthcare personnel. Although she felt very ill from COVID-19, she experienced being almost invisible and not being believed by healthcare personnel in a system marked by high stress levels and uncertainty. Despite rejections and illness, she managed to mobilise her resources, even though she depended on significant others. Her story brings forward altered self-understanding and growth. The importance of facilitating dialogical settings for healthcare professionals through patient storytelling also contributes to a broader societal understanding of illness beyond a biological perspective.

Towards a dialogical and progressive educational policy framework: Manoeuvring a middle way among the polarised constructs.

Policy science and practice around the world, including educational policies, are dominated by popular, extreme approaches such as market-orientated approaches at one end and critical argumentative approaches at the other end. This study therefore aims to manoeuvre a middle way to propose a dialogical and progressive educational policy framework and explores the research question: 'how could a middle way (a dialogical and progressive framework) be manoeuvred among the polarised policy constructs?' The study embraces Lynham's five phases of theory building as the basis for this research, which includes conceptual development, operationalisation, confirmation/disconfirmation, application, and continuous refinement. The study explores some of the known existing policy frameworks for conceptual mapping, investigates the underlying dynamics and discourses to operationalise, uses diverse arguments in the literature to confirm/disconfirm and proposes to mark the emerging patterns, trends, and gaps in policy research to apply and refine. The study contends that if it is possible to have a polarised market-oriented and critical argumentative policy frameworks, it is then possible to have a dialogical, progressive middle-way policy framework. The study had to limit to the most important and related theories, and models to focus. Future works could explore a wide range of other relevant theories and models to further investigate this framework. Furthermore, application of the proposed dialogical, progressive educational policy framework in specific context/case may help to refine it. The study contends that the proposed middle way is not a perfect space but a potential space in which a dialogical and progressive educational policy may thrive.

The Inexhaustible Experience of the Inner Voice: An Answer to Marioka (2023), Fadeev (2023) and Machková (2023).

This article reflects on the analyzes and comments of Marioka (2023), Fadeev (2023) and Machková (2023) on the book New Perspectives on Inner Speech (Fossa, 2022a). First, I focus on responding and expanding the ideas presented by the authors, to later integrate the elements highlighted by them. By integrating the reflections and comments of the authors, it is evident that in inner speech there is an intersection between two continua. On the one hand, the control-lack of control continuum and, on the other hand, the diffuse-clear continuum. The level of clarity and control varies permanently during each act of internal speech, accounting for a phenomenon that advances from infinite interiority to infinite exteriority, and vice versa. This complex interaction of two continua - based on the level of control and the level of sharpness - defies empirical applications and demands methodological innovation in research centers interested in the Inexhaustible Experience of the Inner Voice.

The Contribution of Moral Case Deliberation to Teaching RCR to PhD Students.

Teaching responsible conduct of research (RCR) to PhD students is crucial for fostering responsible research practice. In this paper, we show how the use of Moral Case Deliberation-a case reflection method used in the Amsterdam UMC RCR PhD course-is particularity valuable to address three goals of RCR education: (1) making students aware of, and internalize, RCR principles and values, (2) supporting reflection on good conduct in personal daily practice, and (3) developing students' dialogical attitude and skills so that they can deliberate on RCR issues when they arise. What makes this method relevant for RCR education is the focus on values and personal motivations, the structured reflection on real experiences and dilemmas and the cultivation of participants' dialogical skills. During these structured conversations, students reflect on the personal motives that drive them to adhere to the principles of good science, thereby building connections between those principles and their personal values and motives. Moreover, by exploring personal questions and dilemmas related to RCR, they learn how to address these with colleagues and supervisors. The reflection on personal experiences with RCR issues and questions combined with the study of relevant normative frameworks, support students to act responsibly and to pursue RCR in their day-to-day research practice in spite of difficulties and external constraints.

Enacting Inner Speech on the Academic Stage. A Dialogical Review on Fossa, P. (Ed.). (2022). New Perspectives on Inner Speech. Springer.

The recently published Springer Brief in cultural psychology presents theoretical and empirical advances on inner speech. The editor Pablo Fossa suggests viewing inner speech as a private area to remember, play and dream, rather than a mere psychological function connected to problem solving. Along the lines of this suggestion, I adopt a playful approach in order to review the volume. Rather than delivering results of an analysis, I invite us to use the academic journal platform to take part in a dialogical encounter. In the first part of this essay, I offer a transparent step-by-step process of researcher's positioning, based on remembering and playing. In the second part, I dream of research methodologies, which would allow us to explore inner speech as dynamic movements experienced by whole and dialogical beings. This experiment, in which I enact my inner speech on the academic stage, eventually lets three key-moments of Fossa's book come forward as gamechangers for future inquiries: 1. The importance of hearing one's voice in audio-diary based research, 2. the shift of attention towards experiential contexts of inner speech (such as bodily sensations or felt knowledge), and 3. the notion of thirdness as a meta-position, pointing at the mutual permeability of reflective and pre-reflective realms of inner speech. This performing review is inspired by a theatre-based practice called Dialogical Acting with the Inner Partners and represents an original contribution to researcher's self-reflexive positioning practices, as well as to inner speech qualitative research methodologies.

Advancing inclusive research with people with profound and multiple learning disabilities through a sensory-dialogical approach.

People with profound and multiple learning disabilities are often excluded from the processes of knowledge production and face barriers to inclusion in research due to cognitive and communicative challenges. Inclusive research-even when intending to be inclusive-tends to operate within criteria that exclude people with profound and multiple learning disabilities. The aim of this article is to provide a state-of-the-art review of the topic of inclusive research involving people with profound disabilities and thereby challenge traditional assumptions of inclusive research. The review presents themes that will inform a discussion on how to challenge the criteria in ways that make it possible to understand inclusive research for people who communicate in unconventional ways. We argue that a fruitful way of rethinking inclusive research is by applying a sensory-dialogical approach that privileges the dialogical and sensory foundations of the research. We suggest this might be a way to understand inclusive research that regards the person's communicative and cognitive distinctiveness.

Separation in Unity: Dialogical Transformation of Maternal Bond.

The objective of this paper is to explore mothers' psychological adaptation related to separation from their newborn children immediately after birth. Mother and child separation has traditionally received attention from the child's perspective, but given that the bond is dyadic, the mother's wellbeing should also be considered. This qualitative study is based on interview data with mothers of premature infants. From the analysis, three themes emerged: concerns during pregnancy about premature birth; emotional strain caused by separation; and the need to protect and to be close to the newborn. Drawing on the perspectives of dialogical self theory and semiotic regulation model, the paper will focus on intra-psychological dynamics and will analyze the adaptation process in terms of I-positions. Based on the analysis, the maternal bond represents the integration of the I-position I-as-mother and My child, which is integrated during the pregnancy into the core of the self. It can be assumed that rupture of the self-continuity is activated by the birth of the child, which is then compounded if the child leaves. The maternal superordinate viewpoint (meta-I-position) directs a woman's behavior and allows for a sense of coherence under dynamic organization related to the birth of the child. The potential for psychological adaptation is presented as an ability to establish self-continuity.

The Ethics Laboratory: A Dialogical Practice for Interdisciplinary Moral Deliberation.

Recent advancements in therapeutic and diagnostic medicine, along with the creation of large biobanks and methods for monitoring health technologies, have improved the prospects for preventing, treating, and curing illness. These same advancements, however, give rise to a plethora of ethical questions concerning good decision-making and best action. These ethical questions engage policymakers, practitioners, scientists, and researchers from a variety of fields in different ways. Collaborations between professionals in the medical and health sciences and the social sciences and humanities often take an asymmetrical form, as when social scientists use ethnographic approaches to study the moral issues and practices of physicians. The ethics laboratory described in this article is a cross-sectoral and inter-disciplinary forum for collaborative investigation on important moral topics. It offers an experimental way of unpacking implied assumptions, underlying values, and comparable notions from different professional healthcare fields. The aim of this article is to present the ethics laboratory's methodology. The article offers a model and a hermeneutical framework that rests on a dialogical approach to ethical questions. The model and the framework derive from a Danish research project, Personalized Medicine in the Welfare State. This article uses personalized medicine as a point of reference, though it offers an argument for the applicability of the model more broadly.