Collaborer avec les familles des jeunes adultes lors d’un premier épisode psychotique : psychoéducation ou dialogue réflexif ?

Abstract

Early intervention programs for young adults with a first psychotic épisode value and promote collaboration with families. This collaboration is justified in particular by the influence of family tensions on relapse and the importance of redefining ties at this stage of life. However, the implementation of interventions for families remains complex and there are often differences between displayed will and effective practices. Early intervention programs around the world often favor a psychoeducational approach with families. However, an alternative practice with young adults developed in Finnish psychiatry under the name of “open dialogue” involves a discussion about the process of care during family sessions with the aim of improving it. The purpose of this article is to present these two common forms of intervention that differ in how collaboration is implemented. On one hand, we present a psychoeducational approach that is widely developed in the Anglo-Saxon world. In order to illustrate the actual implementation of this practice we present the behavioural family therapy approach of Ian Falloon, a New Zealand psychiatrist and psychotherapist. This approach is based on a neurodevelopmental model of psychotic disorders and has the overall aim of transforming strong destructive expressed emotions into more nuanced and supportive ones. It also aims to teach family members some basic care skills and rehabilitation strategies. On the other hand, we present approaches adopting a more reflexive position (i.e. “Open Dialogue”) that have been successfully developed in Finnish psychiatry in particular by Jakko Seikkulla, a psychologist and psychotherapist. Concretely, it is a networking practice which brings together the necessary conditions for a dialogue to take place between the different partners. Thus, with the term “open dialogue”, these authors are following a practice of “treatment adapted to needs” which aims to rely as much as possible on the resources of the patient and his network. This practice of “open dialogue” is characterised by three central principles named (1) tolerance of uncertainty, (2) dialogism and (3) polyphony of the social network. Our article discusses these approaches, underlining both their differences and their similarities. Among their differences we note in particular the representation of psychotic disorders as the manifestations of a neurodevelopmental disease to be central in psychoeducational approach; in contrast in open dialogue the diagnosis is not considered as a prerequisite for the prescription of the most suitable drug treatment and for complementary psychosocial interventions. Among their similarities, we note, that both approaches show a centrality of a intervention on young adult autonomisation, the importance of constructing a good alliance with families, an interest in changing the way they communicate.