Restituerende faktorer i gruppemusikterapi med psykiatriske patienter.

The aim of this paper is to suggest an alternative framework for understanding
schizophrenic delusions and incoherent discourse, based on principles of discursive
psychology, and guided by the sensibility of a "therapeutic alliance" between mental
health workers and their clients.
Og Botscher pointerer herefter at :
Such a framework is also consonant with a critical social psychology, which would
suggest that the evaluation of a person's functioning cannot be understood apart from
the social contexts in which both the evaluating and the person's behaviour occur.
(Botscher 1996, s.1)
I artiklen omtaler Botscher bl.a. GAF testens udfald, som han mener kan ændres i
lyset af samtalens karakter. Botscher argumenterer for at testerens opfattelse af
patientens ”crazy talk” er en medvirkende faktor til udfaldet af testen. Som
eksempel angiver Botscher at:
….a boy might assert his vulnerability to being eaten by a monster or to control from
another planet in the absence of any reasonable contextual features. A listener would
seem to be justified in concluding that the speaker is imagining things or
misinterpreting his feelings or surroundings. In the context of the interaction, the
listener is unable to make any meaning out of the child's discourse. Another way of
understanding this is to say that the listener does not understand what the boy may
be trying to do with his discourse. (Botscher 1996, s.7)
I forlængelse af betydningen af den interpersonelle relation ift. GAF testning skriver
Botchner videre at…
The framework also has implications for classification according to DSM
hierarchies. 14 Namely, an individual's position along axes IV (assessment of the
severity of psychosocial stressors), and V (global assessment of functioning), may
change in light of discursive considerations. For example, a concern for subjective
experience may suggest that stressor criteria be recast in terms of perceived, as
opposed to absolute, levels of stress. Additionally, an appreciation for the adaptive
value of certain discursive practices, and the shared responsibility for the emergent
meaning of a conversation imply the need for a reconceptualization of how a number
of functional criteria (such as relevance, coherence, or appropriateness of speech) are
to be used. Ultimately, it is my hope that by redefining the problem of "crazy talk" in
relational terms, we may, in the future, be able to conceptualize solutions as joint
endeavours, rather than as unidirectional interventions. ( ibid. s. 8- min
understregning)
Botschner påpeger dermed relationens betydning, som efter min opfattelse også
har betydning i mit projekt, hvor psykiater Hans Raben, som er psykoterapeutisk
14 Table from DSM-lll-R:Diagnostic and Statistical Manual of Mental Disorders. ed 3,
revised. Copyright American Psychiatric Association, Washington, DC, 1987; i
bogen Comprehensive textbook of Psychiatry V, side 466-467.
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