Development and Structures of Trialogue for Bipolar Disorders in Germany and Guidelines of the German Society for Bipolar Disorders.

Martin Schaefer,Nadja Stehlin,Barbara Wagenblast,Marylou Selo,Thomas Bock

doi:10.3390/medicina57111213

Abstract

The German concept of a trialogue in medicine is at its best a cooperation between patients, relatives, and professionals as partners on equal footing. Prerequisites, and also the aim of the trialogue, are mutual respect, an open attitude from professionals, and self-confidence from patients and relatives. The expertise of each of these groups is to be strengthened through the trialogue and should benefit all. Trialogue cooperation brings about a change of perspective and promotes mutual understanding. By establishing a therapeutic relationship on equal footing with the patient with involvement of their relatives, individual and family resources can be better utilized, professional assistance can be designed to better meet the patient’s needs, and acceptance of and commitment to treatment can be increased. In addition, early symptoms and new phases of the disease can be recognized earlier and adequate treatment can be initiated more quickly. A favorable course of the disease is thus more likely, and relapses are less likely to present. The use of peers has proven to be quite helpful. The consistently trialogue structure within the German Society for Bipolar Disorder (Deutsche Gesellschaft für Bipolare Störungen e.V./DGBS: Heinrich-Hoffmann-Straße 10, 60528 Frankfurt am Main) as a medical society enables further development of the trialogue on many levels, for example, the drafting and updating of the German guidelines for bipolar disorder with the trialogue in mind.

Highlights

In Germany, the idea of a “trialogue” in psychiatry arose at the end of the 1980s from a meeting between Dorothea Buck and the clinical psychologist Thomas Bock, where it was jointly decided to promote the exchange between professionals and patients and to include relatives in the therapeutic process
The German Society for Bipolar Disorders (DGBS), as a medical-scientific professional society based on trialogue, has developed guidelines for diagnosis and treatment of bipolar disorders, in which one chapter deals exclusively with the evidence and importance of trialogue [9,11]
German psychiatry played a dramatic role during the Nazi era

Summary

Introduction

In Germany, the idea of a “trialogue” in psychiatry arose at the end of the 1980s from a meeting between Dorothea Buck and the clinical psychologist Thomas Bock, where it was jointly decided to promote the exchange between professionals and patients and to include relatives in the therapeutic process. The focus is on mutual learning, a common language, an exchange of subjective experiences, and the opportunities for a change of perspective These narrative processes have their own therapeutic effect (“psychotherapy without intention”). Through trialogue-designed learning processes, new forms of treatment may be cautiously tested and developed into structures that better enable the participation of patients and relatives in making important decisions. These include, most importantly, home treatment and peer support for experts by experience [7] and relatives [8] or projects that combine both. Outreach services in particular might need a trialogue character, an open understanding of mental disorders, an appropriate culture of encounter, and an awareness of family and social resources

Types of Trialogue

Trialogue Guidelines and their Significance for Therapeutic Trialogue

Therapeutic Trialogue in Psychiatric Treatment

Limitations

Conclusions