Global Health Asia-Pacific July 2020 July 2020 | Page 55

the abuse as well as develop strategies to feel safer.
The overall message of formulation, Dr Johnstone
wrote in the Journal of Humanistic Psychology, is that
you can always make sense of any form of distress, no
matter how severe, as a an understandable response
to difficult life events from which you can recover with
the right kind of support.
It’s important to stress, though, that formulation
is only a best guess on why a specific person is
suffering. It doesn’t exclude other interpretations and it
might be re�ected by the sufferer, in which case further
exploration or other types of support are needed.
In contrast, the medical approach would interpret
the need for constant cleaning as a sympton of
obsessive compulsive disorder, a mental disease
that is typically treated with medications like SSRIs,
psychotherapy like CBT, or a combination of both.
The aim of letting individuals express their
distress without giving them a diagnosis is also at
the basis of the open dialogue (OD) approach, a
psychotherapeutically-oriented model developed in
Finland to manage acute psychiatric crises as soon as
they arise.
“The essence of open dialogue is to change the
whole way in which the system works to enable people
to tell their stories as early in the crisis as possible,”
Val Jackson, a retired family therapist and a trainer in
OD for the NHS, told �lobal Health Asia-�acific.
The basic idea is to create a space where sufferers
meet with their families, friends, mental health
practitioners to talk freely about their difficulties and
how to deal with them.
“The more people are involved the better the
conversation is because quite often the person who’s
unwell doesn’t have the words to describe what’s
going on in their life or, if they have the words, no one
has been listening,” said Jackson, noting that with
the help of OD families often learn how to cope with
their loved one’s distress in a way that doesn’t require
external help any more.
As is the case in formulation, OD involves giving a
shared meaning to experiences that cause distress
and are hard to make sense of. It’s an exercise where
people can ultimately decide the best way forward
for them, which could entail a standard one-on-one
psychotherapy session or other traditional treatments.
This is coupled with other forms of support like
helping people keep or find a �ob and encouraging
them to engage in social activities.
As a testament to its benefits, the OD approach
was effective in giving some relief to a young woman
who was agitated and having bizarre ideas, recalled
Jackson about one of her cases. “She had this idea
that her father had a hole in his body.”
�itting with �ackson, her colleagues and five family
members once a week for about a month, she had
a chance to put her worries into clearer words and
explained she was worried about her father, who
apparently had suffered a heart attack. As a result, she
Sufferers need the support of the family
became much calmer and stopped having incoherent
ideas about her father.
OD practitioners tend to avoid, or at least delay,
medications, diagnosis, and hospitalisation in order
to shield people from the stigma associated with
them as well as long-term pharmacological treatment.
Indeed, once doctors prescribe medications like
antipsychotics to treat delusions or hallucinations,
they’re reluctant to discontinue them fearing a relapse,
explained Jackson who has seen many people with
such problems staying on antipsychotics for several
years.
However, she acknowledges antipsychotics can be
helpful for those who can’t get on with their life and
connect with their loved ones due to their distressful
unusual beliefs and experiences, though her advice
would be to stay on the medications short term to
minimise their serious side effects, which include heart
disease, obesity, and diabetes.
“There are even times when you have to
compulsorily detain someone in a hospital [because
their distress is so intense that they could hurt
themselves or others],” said Jackson. “It’s not a
perfect world.”
Similarly, psychiatric drugs such as antidepressants
might be a part of the formulation plan too.
“Psychiatric drugs can help some people get through
the day by making their feelings more bearable,” said
Dr Johnstone, stressing though drugs should not be
promoted as a treatment that acts on the biology of
depression since there is no evidence to back up the
idea that depression is a chemical imbalance.
Both formulation and OD provide an alternative to
the medical model that empowers individuals to make
their own choices over how to confront their suffering. n
The basic idea is
to create a space
where sufferers
meet with their
families, friends,
mental health
practitioners to
talk freely about
their difficulties
and how to deal
with them
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