Les programmes d’intervention précoce auprès de jeunes adultes avec troubles psychiques débutants valorisent et promeuvent la collaboration avec les familles. Il s’agit d’un partenariat justifié notamment par l’influence des tensions familiales sur les rechutes et l’importance de la redéfinition des liens à cette étape de vie. Or, la mise en pratique des interventions à destination des familles reste complexe et des écarts existent entre volonté affichée et pratiques effectives. L’approche familiale psycho-éducationnelle est principalement promue dans ce genre de programme largement développé dans le monde. Une pratique alternative avec de jeunes adultes a, cependant, été développée dans le cadre de la psychiatrie finlandaise sous le nom de « dialogue ouvert ». Celui-ci implique une discussion sur le processus des soins au cours des séances familiales dans le but d’améliorer celui-ci. S’inspirant de ce genre de pratiques, cette étude de cas présente la manière dont un dialogue réflexif peut être mis en place avec les familles, dans le contexte d’un programme clinique destiné aux jeunes adultes (18–25 ans) avec troubles psychiques débutants, afin de faciliter la collaboration avec elles. Les résultats de cette étude de cas encouragent une étude systématique de l’effet de cet interview sur une population clinique plus large.

Early intervention programs for young adults with early mental illness value and promote collaboration with families. Partnership is justified in particular by the influence of family tensions on relapse and the importance of redefining ties at this stage of life. However, in practice, implementing interventions with families is still complex and gaps exist between willingness and actual practices. Early intervention programs around the world often favor a psychoeducational approach with families. However, an alternative practice with young adults developed in Finnish psychiatry under the name of “open dialogue” involves a discussion about the process of care during family sessions with the aim of improving it. Inspired by this approach to clinical our case study presents how a reflexive dialogue can be established with families, in the context of observations done within a clinical program for young adults (18 to 25 years) with early mental illness, in order to facilitate collaboration with them. For our case study, reflexive dialogue was implemented through a reflexive interview organized for the family of a 23-year-old single man living in a foster care family and treated after a first psychotic episode. The interview was done in a context of tensions within clinical staff and the family. During this reflexive interview, a member of the clinical staff not directly involved in family sessions collectively interviewed the clinical staff and the families during a semi-structured interview (Example of question for staff: Are there any issues you haven’t talked about yet? Example of question for family: Have you ever felt that you have not been heard by caregivers?). This interview is presented to the families as a way of gathering everyone's impressions of their experiences of family sessions, as freely as possible. This interview is presented as an opportunity to reorient the continuation of therapy by allowing clinicians to better adjust to family expectations. The interview takes place in three stages: (1) The interviewer turns to the caregivers and asks them questions about the family sessions. Family members listen to the answers without intervening (close to the practice of the reflexive team). (2) The interviewer turns to family members and asks them questions. Caregivers listen to their answers without intervening. (3) Family and caregivers are invited to briefly share their impressions of what was said during this interview session. A few weeks after the intervention, quantitative (adaptation of SCORE scale) and qualitative feedback on the usefulness and perception of interview was taken from the clinicians as well as the family. Results suggested that the interview was judged useful by staff and family on several dimensions like positive change in therapeutic relation after reflexive interview. The interview also positively changed the way clinical staff and parents viewed each other within the system of care. Clinical staff saw more resources of parents and parents perceiving a better relationship within clinical staff. Our results seem promising and encourage a more systematic study of reflexive interview effect on collaboration with families.