First Impressions: Using DIALOG+ in PIECEs pilot phase
*written by Dr. Padmavati Ramachandran, Co-Investigator on PIECEs and Director at Schizophrenia Research Foundation (SCARF)
Psychosocial interventions, that impact recovery for persons with psychosis, are contingent upon several aspects – the person with psychosis, family, the care provider, available resources and in all likelihood, the passage of time! Hence, development of a new comprehensive intervention in the field of psychosocial interventions is in itself a challenge and testing the intervention even more so.
The DIALOG + an intervention designed to promote better patient-clinician interaction, brings in a structure to the conversations in routine clinical interactions. Being a part of the team piloting the tool at SCARF, it became very clear, right at the outset that tool was actually facilitating a dialogue with the patient that would not just improve conversation , but also facilitate a solution focussed discussion.
The first participant, a 43 year old women, was someone I have occasionally met in clinical encounters. She would always complain that she had a lot to speak about – but the doctors were so busy in the OPD, that she didn’t think it was right for her to take more time. The first session with the app – actually left her feeling that she was listened to – in her own words “l feel that for the first time – I have said all that has been bothering me in terms of my functioning” And, she adds, “you have spoken to me and not my husband… that makes me feel even better”
One interesting observation with the third participant was something that I least anticipated. In the domain related to Job situation – the participant a home maker, spontaneously stated that her action plan would be to learn to create an email id for herself – so that she can apply for jobs. This was something that was never picked up during clinical interactions! Similarly, a male participant who works as a tailor, who wanted to feel more energetic – reported that he could exercise and we then engaged in a discussion of what he could do to exercise. He left the session , saying that he liked the idea of exercising – an activity that he had not thought of before!
The experience of handling a gadget – the tablet in this case – is a very new experience, even for me as a clinician! While I do use the electronic medical records system for client data storage, using the tablet as a medium to communicate to the client is quite a task, especially when the participant is not very familiar with using the electronic medium. But as I realised over the next few sessions , it was a matter of practice.
The app driven technology is very user friendly and simple. This enables the participant to be able to read and relate easily to the visual analogue scale. The use of the Tamil language has made the interaction even more suitable! There are of course, sections that will need adaptation to the Indian lifestyle and the PIECES project aims to do just that!
Overall, I feel pretty excited at using this tool – it has brought in a structure to a patient centric engagement, meaningful enough to hopefully improve on functioning.
Alongside with Dr. Padmavati’s first impressions in India, in Pakistan Dr. Aneela Mushtaq , clinical psychologist at hospital Karwan-e-Hayaat, gives her account of the experience with the intervention so far:
Since I have started using DIALOG+, I have found this exceptional intervention, convenient for both therapist and patient; reliable, time-saving and specific in targeting the main issue which is causing distress. It helps both therapist and patient to understand problems in more depth. Before, both sides had to do a lot of paperwork during psychotherapy sessions, however ever since I have started utilising DIALOG+ in my therapy sessions, my paperwork has noticeably decreased. If I talk about my patients’ views regarding DIALOG+ – according to them it is very easy to work with the instrument, and they can easily highlight the core issue which is the main source of problems. Previously both the therapist and the patient needed to take part in four to five sessions to come to the conclusion of the main problem, as normally either we are doing it verbally or performing some paperwork for clear understanding. Furthermore, another very effective part of the intervention is the action plan. This option helps to form smart goals for the rest of the week: patients have to achieve those goals while working on it.
To understand more about DIALOG+ and how it’s used, please access the official website
Reflexive Analysis: Clinical sciences & the other sides, coming together for a common goal
*written by Kausar Khan, Co-I in PIECEs, social scientist and expert in community engagement
The clinician, armed with scientific know how, is well equipped to deal with the medical side of psychosis, but the challenges rises from the socio-cultural context of the patient with psychosis. The patient is not alone, his/her family is vested in the well being of the patient. The optimal use of clinical sciences becomes possible with the help of reflexivity, ecological framework, meaning of participation, SALT, Theatre of the Oppressed
Reflexivity is an honest act, & you are its sole witness. The reflexive practitioners examines their own attitudes and assumptions that shape their teaching/learning methods, and thus continually improve their experiences and learn from them. To become reflexive, you must begin to practice reflexivity
The ecological framework draws attention to the relationships between individuals and their families, and the individual/families with their communities/neighbourhood. A patient with psychosis, like any individual, is caught in a web of relationship s. Medical treatment of an individual has to be nested in the understanding of the family, neighbourhood and social norms that control individuals and families.
Participation. What is the nature of participation of a patient and his/her family in the wellbeing of the patient? Participation is a central concept in primary health care, as well as in all community development efforts. Typology of Participation helps understand this notion, and also reflect on the type pursued in one’s work. SALT is committed to the type of participation/engagement that would be based on community’s ownership of the issue; and taking action to take forward their aspirations/dream. Theatre of the Oppressed, ideologically resonating SALT’s aspirations of ownership, uses powerful theatre-techniques developed by the founders of this approach.
For further resources on the subject, this article might also be useful.
