Abstract
Background: We implemented a case formulation method, which is based on dialogical sequence analysis (DSA) in a community mental health center. The aim was to achieve better congruence and collaboration between the patient and professionals concerning the tasks and goals of the assessments. Here we report a randomized clinical study in which we compare DSA-based and standard psychiatric assessments. Methods: In this randomised clinical study, we compared DSA-based and standard psychiatric assessments. There were 40 outpatients in both, the DSA and the assessment as usual (AAU) groups. We recorded the lengths of individual assessment periods, the number and durations of visits, and the numbers of clinicians who were involved in the various phases of assessment. The Working Alliance Inventory was completed by the patients (WAI-P) and the clinicians (WAI-T) during the treatment planning (i.e. final) visit. Results: In our results, the total WAI-P and WAI-T scores and all WAI subscale scores correlated significantly in the DSA group (Spearman’s rho = 0.562–.667, p < 0.01). In the AAU group, the only significant – albeit weaker – correlation was found in the WAI Bond subscale (rho = 0.369, p < 0.05). Compared to the AAU group, assessment periods were shorter and the number of visits were fewer in the DSA group. Conclusion: Our findings are clinically notable. They show that the patient-centred, DSA-based case formulation complements psychiatric assessment in a collaborative way and results in a better joint understanding regarding the patient’s problems and needs in a shorter time period than the standard assessment.
Highlights
We implemented a case formulation method, which is based on dialogical sequence analysis (DSA) in a community mental health center
Our aims were: 1) to determine how the DSA-based case formulation and the standard approach differed in terms of collaboration, especially in terms of patient and professional congruence concerning the goals and tasks of assessment; and 2) to examine whether there were any differences in the time and resources needed between the individualised and patient-focused assessment and the standard psychiatric assessment processes
The total score and all subscale Working Alliance Inventory (WAI) scores separately rated by clinicians and patients correlated significantly in the DSA group, whereas in the AAU group the only significant – albeit weaker – correlation was found in the WAI Bond subscale (Figure 3)
Summary
We implemented a case formulation method, which is based on dialogical sequence analysis (DSA) in a community mental health center. We report a randomized clinical study in which we compare DSA-based and standard psychiatric assessments. In addition to causing suffering to patients and their families, mental disorders place a burden on societies around the world. The aetiology and the pathophysiology of psychiatric illnesses are still mostly unidentified; the diagnostics of mental disorders are mainly determined (e.g. ICD-11 and DSM-5) by symptoms and as syndromes (World Health Organization 2018; American Psychiatric Association 2013). CRADDOCK and MYNORS-WALLIS (2014) state that psychiatric diagnosis is necessary and important, but the ‘diagnosis alone is insufficient in conceptualising psychopathology in any individual patient. In a quite recent editorial, MAJ (2018) suggested that the current diagnostic classifications would be complemented systematically with alternative approaches promoting the patients’ individual therapeutic management and prediction of outcome
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