Paper short abstract:

Clinicians working with dialogic practice in Germany take on the task of orienting their clients to a slower, more ambivalent temporality of care than is generally found in biomedical treatment models. This involves reconfiguring risk, uncertainty, and the imagined future of a life with crisis.

Paper long abstract:

Clinicians working with dialogic practice in Germany take on the task of creating a temporal space for crisis care that is slower, more ambivalent, and more uncertain than the "anticipatory regimes" (Adams et al. 2009) of biomedical treatment-as-usual. As a response to crisis, dialogic practice aims to slow down processes of diagnosis, medication, and hospitalization, which are often the first recourse for biomedical providers. The community-based crisis team that I worked with learn this alternative temporality over years of practice and training, yet they continue to inhabit a marginalized position in the broader landscape of care in their city. This is, in many ways, because the insurance providers they partner with oscillate between admiring a slower approach to crisis (one they believe would reduce hospitalization costs) and the desire to control and contain crisis as soon as it occurs (a kind of security offered in hospital settings). This results in clashing conceptions of "risk": the risk of psychiatric crisis, of medication, of hospitalization, of slowing down, of imagining the possibility of recovery. These risks - as they are variously identified by insurers, hospitals, dialogic clinicians, and clients - present as incommensurate or irreconcilable because they are differently positioned in the broader temporal ecology of psychiatric care (Duclos and Criado 2019). These actors actually share the same goals in many respects, yet the divergences between their short and long term horizons of care mean they often end up working at cross-purposes while attuned to radically different conceptions of risk.