The Weddinger Modell – A Systematic Review of the Scientific Findings to Date and Experiences from Clinical Practice

Main Article Content

Anna Oster Celline Cole, M.Sc. Psych. Lieselotte Mahler, Dr. med.

Abstract

Establishing a stable and trusting therapeutic relationship is of particular relevance in the treatment of people with (severe) mental disorders and plays a crucial role in preventing escalations and avoiding coercive measures. However, rigid ward structures and rules leave little room and flexibility for the individual needs and explanatory models of persons in acute crises. Considering this background and based on practical experience, a new recovery-oriented treatment concept, the Weddinger Modell, was developed and implemented in 2010 at the Department of Psychiatry of the Charité at the St. Hedwig Hospital (PUK SHK) in Berlin. After having worked with the Weddinger Modell for over 10 years, the model’s effectiveness for promoting treatment quality and therapeutic relationship and preventing coercion has been proven in numerous scientific studies and in daily clinical practice. This literature review aims at providing a systematic overview of the scientific findings to date on mechanisms and effects of the Weddinger Modell. For this purpose, a literature search was conducted in all relevant bibliographic databases. Overall, eight studies examining the Weddinger Modell, either as a whole model or focusing on specific parts of the model, were included in this study and systematically analyzed with regard to the following variables: aim of the study, sample, evaluated aspect of the Weddinger Modell, measured variable (method used), date of evaluation, and outcome. Three main dimensions of effects (promotion of treatment quality, prevention of coercion, reduction of negative effects after coercion) of the Weddinger Modell were found. The findings of this review are presented with regard to the specific requirements in the treatment of people in acute psychiatric crises and linked with different phases in the course of psychiatric treatment (Fig. 2). Furthermore, the findings are considered in light of their practical relevance and the flexible and resource-efficient implementation of the Weddinger Modell in (acute) psychiatric settings is discussed.

Article Details

How to Cite
OSTER, Anna; COLE, Celline; MAHLER, Lieselotte. The Weddinger Modell – A Systematic Review of the Scientific Findings to Date and Experiences from Clinical Practice. Medical Research Archives, [S.l.], v. 9, n. 8, aug. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2521>. Date accessed: 20 sep. 2021. doi: https://doi.org/10.18103/mra.v9i8.2521.
Section
Review Articles

References

[1] Barber ME. Recovery as the new medical model for psychiatry. Psychiatr Serv. 2012. 63(3):277-2799. doi: 10.1176/appi.ps.201100248. PMID: 22388534.
[2] Mahler L, Oster A & Vandamme A. Weddinger Modell: strengthening the therapeutic relationship and preventing coercion in the treatment of persons with psychosis. Nervenheilkunde. 2021; 40:430-435. Doi: 10.1055/a-1389-7279.
[3] Gooding P, McSherry B, & Roper C. Preventing and reducing ‘coercion’ in mental
health services: an international scoping review of English-language studies. Psychiatr Scand. 2020; 142: 27–39. Doi: 10.1111/acps.13152
[4] Dahm KT, Jensen JO, Husm TL, & Leiknes KA. Interventions for reducing coercion in mental health for adults: a systematic review and the impact of updating. Journal of Brain Sciences, 2015, 1(1): 1-23. Doi: 10.18488/journal.83/2015.1.1/83.1.1.23
[5] Frueh, B. C., Knapp, R. G., Cusack, et al. Special section on seclusion and restraint: Patients' reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr. Serv. 2005; 56 (9): 1123-1133. Doi:10.1176/appi.ps.56.9.1123.
[6] Priebe, S., Katsakou, C., Amos, et al. Patients' views and readmissions 1 year after involuntary hospitalisation. Br. J. Psychiatry. 2009; 194 (1), 49-54. Doi:10.1192/bjp.bp.108.052266.
[7] Pausch MJ. Behandlung von Gewalterfahrungen: Sozialpsychiatrie, Gewalt, Trauma und Posttraumatische Belastungsstörung. Sozialpsychiatrische Informationen. 2019; 49: 28-31.
[8] Wullschleger A, Vandamme A, Mielau J. et al. Effect of standardized post-coercion review session on symptoms of PTSD: results from randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2020. doi:10.1007/s00406-020-01215-x.
[9] DGPPN. S3-Leitlinie:Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen. AWMF online.
[10] Bowers L, James K, Quirk A, et al. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial [published correction appears in Int J Nurs Stud. 2016 Jun;58:102]. Int J Nurs Stud. 2015;52(9):1412-1422. doi:10.1016/j.ijnurstu.2015.05.001
[11] Putkonen A, Kuivalainen S, Louheranta O, Repo-Tiihonen E, Ryynänen OP, Kautiainen H, Tiihonen J. Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. Psychiatr Serv. 2013; 64(9):850-5. doi: 10.1176/appi.ps.201200393. PMID: 23771480.
[12] Murphy T. Restraint and seclusion : the model for eliminating their use in healthcare. HC Pro press, Marblehead, MA. 2005.
[13] Mahler L, Jarchov-Jádi I, Montag C, Gallinat J. Das Weddinger Modell: Resilienz- und Ressourcenorientierung im klinischen Kontext. Köln: Psychiatrie Verlag; 2014.
[14] Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
[15] Mahler L, Jarchov-Jadi I, Gervink A, et al. Multiperspectivity and peers on acute wards: the Weddinger Modell. Nervenheilkunde. 2015; 34(04): 249-252.
[16] Mahler L, Heinz A, Jarchov-Jàdi I. et al. Therapeutic attitudes and structures in (open) acute psychiatry: the Wedding Modell. Nervenarzt. 2019; 90: 700–704. doi:10.1007/s00115-019-0741-3
[17] Mahler L, Mielau J, Heinz A, Wullschleger A. Same, Same But Different: How the Interplay of Legal Procedures and Structural Factors Can Influence the Use of Coercion. Front Psychiatry. 2019; 10:249. doi:10.3389/fpsyt.2019.00249
[18] von Haebler D & Montag C Self-determination with side effects: experiences and desiderata for a low-coercive/low-compulsory psychiatry. Forens Psychiatr Psychol Kriminol. 2019; 13: 22-35.
[19] Jacob T. Recovery-orientiertes Arbeiten im klinischen Kontext: stärkt das „Weddinger Modell“ die Selbstwirksamkeitserwartung und Resilienz? 2021. Unpublished dissertation.
[20] Jeschke SA. Das Weddinger Modell: Stationäres Arbeiten im Trialog- eine Vergleichsstudie. 2015. Unpublished dissertation.
[21] Cole C, Vandamme A, Bermpohl F et al. Correlates of Seclusion and Restraint of Patients Admitted to Psychiatric Inpatient Treatment via a German Emergency Room. J Psychiatr Res 2020; 130: 201-206. doi:10.1016/j.jpsychires.2020.07.033
[22] Czernin K, Bermpohl F, Heinz A et al. Auswirkungen der Etablierung des psychiatrischen Behandlungskonzeptes „Weddinger Modell“ auf mechanische Zwangsmaßnahmen. Psychiatrische Praxis 2020; 47: 242-248. doi:10.1055/a-1116-0720
[23] Czernin K, Bermpohl F, Wullschleger A et al. Effects of the Recovery-oriented psychiatric care concept "Weddinger Modell“ on forced medication and maximum daily drug doses. Under review.
[24] Wullschleger A, Vandamme A, Ried J et al. Standardisierte Nachbesprechung von Zwangsmaßnahmen auf psychiatrischen Akutstationen: Ergebnisse einer Pilotstudie. Psychiatr Prax 2018; 46: 128-134. doi:10.1055/a-0651-6812
[25] Wilmers F, Munder T, Leonhart R et al. Die deutschsprachige Version des Working Alliance Inventory – short revised (WAI-SR) – Ein schulenübergreifendes, ökonomisches und empirisch validiertes Instrument zur Erfassung der therapeutischen Allianz. Klinische Diagnostik und Evaluation 2008; 1: 343-358.
[26] Baier S. Goal Attainment Scale. 2009. Im Internet: https://www.baier-smolaglueck.de/fileadmin/files/downloads/pdf/1.2.3.1_Dok_Zielerreichungsskala.pdf; Stand: 28.01.2021
[27] Weiss DS. The impact of event scale: revised. InWilson JP, So-kum Tang C. Eds. Cross-cultural assessment of psychological trauma and PTSD. Boston: Springer 2007; 219-238
[28] Steinert T, Bechdof A, Mahler, L et al. Implementation of Guidelines on Prevention of Coercion and Violence (PreVCo) in Psychiatry: Study Protocol of a Randomized Controlled Trial (RCT). Front. Psychiatry 2020; 11: 579176. doi:10.3389/fpsyt.2020.579176
[29] Guidance on community mental health services: promoting person-centred and rights-based approaches. Geneva: World Health Organization; 2021 (Guidance and technical packages on community mental health services: promoting person-centred and rights-based approaches). Licence: CC BY-NC-SA 3.0 IGO. Available at: https://www.who.int/publications/i/item/guidance-and-technical-packages-on-community-mental-health-services