This is the courtyard of the Monosasu editorial office.
This is a two-part report on the Beteru Festival and research meeting for people with disabilities, held at the end of July this year.
In the first part , we reported on Beteru Festival 2017. Today, in the second part, we will report on the National Interpersonal Studies Exchange Meeting (hereafter referred to as the Interpersonal Studies Meeting) held the day before the Beteru Festival, focusing in particular on the theme of the morning symposium, "Open Dialogue."
(If you are wondering what Beteru House and Beteru Festival are, please click here .)
The birthplace of Open Dialogue
The story of two people working at Keropudas Hospital
The 2017 National Participant Research Exchange Meeting, which is held annually in various locations, was held this year in Urakawa Town, Hokkaido, on July 28th, the day before the Beteru Festival.
Participant research is a psychotherapy approach that was developed at Bethel Home, in which people with schizophrenia or other conditions name their own illness, analyze their symptoms, and research and present the various difficulties they face and their unique experiences*.
This year, the national convention is being held in Urakawa Town, Hokkaido, where Beteru Home is based, so we decided to participate in it together with the Beteru Festival.
* " What is Participant Research? The Concept and Structure of Participant Research " Participant Research Network, as of August 2017
In the morning program, Helena, an experience specialist from Keropudas Hospital in Finland, and Riikka, a psychologist, talked about "Open Dialogue," sharing their own experiences.
On the far left sits psychologist Riikka, on the far right sits Helen, an experience specialist, and in the middle sits Keiko Morishita, a Moomin expert and interpreter who has lived in Finland for many years.
Keropudas Hospital in Finland is the birthplace of "Open Dialogue." Open Dialogue is a type of conversation therapy* that began about 30 years ago. It is currently one of the treatments that is gaining attention in the field of psychiatric care.
*Open Dialogues Approach in Acute Psychosis
Western Lapland, where Keropudas Hospital is located, has six municipalities and a population of 62,000. The population density is much lower than in Japan, and Riikka says that it may be precisely because of this environment that they have been able to achieve their goals.
By implementing a treatment method called "Open Dialogue" here, the average annual consultation time for mental illness patients has been reduced to nine days (the national average in Finland is 34 days), which is about a quarter (!), and the amount of medication required has also been dramatically reduced (most patients do not need medication at all).
I will go into more detail about this "Open Dialogue" in the next chapter, but there are many similarities with the "Participant Research" conducted by Bethel House. Helen and Riikka both felt that the two treatment methods, which originated in Finland and the northernmost part of Japan, were similar like twins, and it was striking that they both said, "When we came to Urakawa, we felt like we were coming home."
What is important in Open Dialogue
Riikka spoke from the perspective of a therapist about what is important in Open Dialogue.
First, it makes help available immediately .
We accept consultation calls 24 hours a day, and will meet with you (open dialogue) within 24 hours of the initial call.
At the first meeting, in addition to the treatment team (doctors, nurses, psychologists, etc.), we gather people close to the patient (mainly family members) and try to have everyone involved speak as much as possible.
As treatment progresses, the client's needs change, and meetings are reconstituted with the necessary members each time.
It also emphasizes how important family members are to the patients during treatment.
What we call "problems" arise from some kind of interaction with someone, and good times also come from relationships. The fact that there are good and bad things means that problems can also be solved through relationships with others.
That's why, says Riikka, in Open Dialogue, everyone present listens to what the client says and shares their problems.
"It can be difficult for the individual to put their problems into words, but once they have been able to put into words something that was originally difficult to talk about, a 'strength-like thing' is born. Talking about it with their family gives them strength, which makes everything else that follows go more smoothly.
Those of us who were involved in the event felt like we were on a journey together."
Also, when an experienced expert (peer supporter) is present, the client can be told more clearly and honestly what is happening. It is important for the listener to be open and honest, and to have the courage to put it into words.
In this way, open dialogue is a dialogue between the client and the therapist. In particular , listening is more important than asking questions , and we do not aim for a conclusion or agreement.* By listening to what the client's experience was like, without criticizing or diagnosing, and by honestly talking about what you felt, this can serve as an opportunity to reconstruct the client's experience.
*See Tamaki Saito, author and translator, "What is Open Dialogue?", 2012, Igaku Shoin
Riikka says that the thing she keeps in mind most is that " clients should be their own experts ." This is something that is said almost the same in research on people with disabilities, but she taught us the importance of the subject of treatment not being the medical side, but the people themselves, and of them regaining their own words.
An open dialogue work environment
Rikka also talked about the work environment in which she works.
"In Open Dialogue, there is never just one therapist. We always form teams or pairs, and we place importance on having multiple perspectives . Being able to hear the opinions of various therapists enriches our own lives, and it is also a learning opportunity for new therapists."
Furthermore, new recruits are welcomed not as people who lack experience, but as people who bring a fresh perspective .
In addition, " An organization that can show its weaknesses is strong ," is a phrase used by Mukaiyachi of Petel House, and Riikka deeply agreed with it. In her workplace, everyone knows each other's weaknesses, so even if something difficult has happened in the morning, she says, "I can just go to work as I am," and it doesn't feel hard to go to work.
I think Riikka shared her workplace environment because the attitude of not only the person in question but also the person providing treatment is important. I listened to her story with the feeling that it was not just about the mental health care field, but also about my own workplace, family, and community.
Helena, an experiential expert, says she regained her words through Open Dialogue
Helena, an experience specialist, is on the far right of the screen.
Meanwhile, Helena, who works as an experiential expert, shared her experience of suffering from severe depression due to the trauma she experienced as a child and receiving treatment at Keropudas Hospital.
"I'll tell you what I saw from my experience with the therapists. First of all, they respected me as a person and listened to what I had to say. And they were all very open.
I trusted them immediately, that they were being honest with me, that they weren't talking about me without me around, and that allowed me to speak in my own words about some very difficult issues.
In other words, I have to be honest with myself. If something difficult happens, I have to step in and not just turn a blind eye to it."
I felt that what Helena felt when she received the Open Dialogue session as a client resonated with what Riikka had said.
The honesty and openness of her therapist resonated with Helena, allowing her to confront her experiences and reclaim her own words.
Having undergone this type of treatment, Helena wanted to give back to her local community with her experience, and now works as an experiential expert at Kerobutas Hospital and other facilities.
Listening to the two of them, reflecting
After Ms. Riikka and Ms. Helen's talks, a reflecting session took place with the Bethel members as well as Mr. Kim and Mr. Song, who work in psychiatric care in Korea.
Reflecting in Open Dialogue means that listeners exchange their thoughts about what the speaker has said. The speaker then listens to what the listener has said. This reflecting is always done in Open Dialogue, and by repeating this exchange several times, the experience is put into words.
After listening to their story, the Bethel members related their own experiences and spoke about regaining the strength to struggle and share weaknesses.
When the topic turned to places where people can receive treatment and work with peace of mind, the discussion touched on Bethel Home's goal of "creating a company where you can slack off without worrying," as well as talking to people next to you and creating a warm place to belong.
Ms. Kim, who came from South Korea, said, "I learned a lot about the relationship between therapists and patients. In South Korea, it is considered dangerous for people with mental illnesses to live in the community, but I would like to work hard to make it possible for those with mental illnesses to live safely in the community." Mr. Song said, "In South Korea, treatment is centered on supporters, so I would like to make it centered on the patients themselves."
Of the three people in the center of the screen, Kim is holding the microphone in the middle, and Song is to his left.
Poster Presentations & Sessions
After lunch, poster presentations and breakout sessions were held in the afternoon.
Poster exhibition
In the poster presentations, volunteers will create posters on their research themes and display them. Many of the posters are from the perspective of the people involved, but some are from the perspective of supporters. Each poster has a unique perspective, and although the stories are serious, they also have humor, so you might find yourself chuckling while reading them. You can get a sense of the struggles each poster faces.
The presentation is not just written, but also includes illustrations, making it fun to give.
Some of them have even been made into manga. It's sad, but not dark.
Afterwards, a two-hour breakout session was held. The program is as follows:
- e-kurou LIVE! Last-minute research by people involved
・Conduct live participant research - Becoming your own "expert"
- A meeting to ask questions and talk with Rikka and Helena - SupA (Supporters' Anonymous) Association
・ Conduct research on supporters - Local Participant Research
・Workshop to talk about hardships in local language
Participants choose one of these programs to participate in. I didn't understand how it worked until just before, so I decided to participate in the first half of the program, which was a live program, and in the second half, in the supporter's research program, which was a live program. (Although there were no particular rules, most people seemed to participate in one program from start to finish.)
Session 1 e-kurou LIVE! Last-minute research by people involved
In the first session, the participants in the study were asked to speak to two moderators and five or six candidates. The participants were asked to speak about their own illnesses, which always drew laughter and sympathy.
The topics were written on the whiteboard, and one of the topics that came up was "Research on loneliness after the Beteru Festival." The research topic was somehow chaotic, and progressed in a warm atmosphere with endless laughter. I had read about research by people involved in the project in books, but this was my first experience of actually experiencing it in the field.
Subcommittee 2: Supporters' Anonymous (SupA)
The second session of the "SupA Group" that I participated in was a forum for supporters to conduct research on themselves. I participated because I wanted to hear as much from supporters as from the people involved.
There were 68 participants in this workshop that day. We were divided into eight groups by drawing lots, and each group talked about their struggles at their own table. I couldn't participate in the first half, but I received a document from the SupA group called "Eight Steps to Recovery for Friends Who Support Each Other," so I joined in the middle.
The table I attended was mostly made up of people from the medical profession and social workers, and many of their concerns and questions applied to me as well, so we were able to think about them together.
At the end of the meeting, everyone gathered in a circle and shared their thoughts one by one. I learned that people from all walks of life had come to the event. Of course, there were medical professionals and social workers, but also people involved, their families, lawyers (for some reason there were a lot of them), journalists, general counselors, students, and more. One of the good things about participating in this event was learning about the kinds of people who had come to the event and what their thoughts were.
After the breakout sessions, everyone gathered for a general meeting where they reflected on the poster displays and shared what had happened in each breakout session.
Next year's meeting for people with disabilities will be held in Nagoya. The Nagoya organizing committee members presented a song expressing their enthusiasm for next year, and the meeting ended.
How does everyone recover from hardship?
Looking back on the research meeting for people with disabilities
As this was my first time participating in a participant research gathering like the Beteru Festival Eve Festival, I was a little nervous as I was out of place professionally, but I gradually became engrossed in the enthusiasm of the presenters and participants, and by the end I was feeling the excitement as well.
I was particularly drawn in by the talk on open dialogue given by the two Finnish speakers. I think it is also effective as a way of interacting with people in daily life and listening to them.
I was also impressed by Riikka's choice to talk about the working environment of the therapists. This seems to suggest that open dialogue is a collaborative effort between the client and the therapist.
Mukaiyachi states the following in his book "Non-Aid Theory":
Being cured or healed from mental illness is in fact closely related to the richness of the "whole place" in which the person lives, including the healer. In that sense, the phrase "restoration of the whole place" has recently become popular in Urakawa. The catchphrases "Creating a workshop where doctors and nurses can recover" and "A workshop where local people can recover" were born from this commitment.
(Urakawa Beteru House, "Beteru House's Theory of "Non" Support", Igaku Shoin, 2002)
I think that "restoring the whole field" is not a one-way process, but an action that occurs along multiple vectors. And this is exactly what an open dialogue is like.
Rather than a conflict between patient and therapist, we need a relationship in which both parties can recover, a place where multiple people can recover... Isn't it necessary to create such a space in hospitals and in the community? This question was raised in the above passage and in this symposium.
I look back at my surroundings and wonder if the place we are in is a place where "restoration of the whole place" is possible.
The Open Dialogue atmosphere of Bethel House makes me ask myself many questions.
NAKANIWA Keiko