Implementation of Dialogical Sequence Analysis as a Case Formulation for the 
Assessment of Patients at a Community Mental Health Centre: 
Randomized Controlled Pilot 
Enikö Éva SAVANDER  Contact / Kontakt / Kapcsolat, Mikko PÄNKÄLÄINEN, Mikael LEIMAN & Jukka HINTIKKA
EJMH Vol 14 Issue 2 (2019) 209-229;
Received: 19 October 2018; accepted: 15 June 2019; online date: 10 December 2019
Section: Research Papers
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Background: We implemented a case formulation method, which is based on dialogical sequence analysis (DSA) in a community mental health center. The aim was to achieve better congruence and collaboration between the patient and professionals concerning the tasks and goals of the assessments. Here we report a randomized clinical study in which we compare DSA-based and standard psychiatric assessments.

Methods: In this randomised clinical study, we compared DSA‑based and standard psychiatric assessments. There were 40 outpatients in both, the DSA and the assessment as usual (AAU) groups. We recorded the lengths of individual assessment periods, the number and durations of visits, and the numbers of clinicians who were involved in the various phases of assessment. The Working Alliance Inventory was completed by the patients (WAI-P) and the clinicians (WAI-T) during the treatment planning (i.e. final) visit.

Results: In our results, the total WAI-P and WAI-T scores and all WAI subscale scores correlated significantly in the DSA group (Spearman’s rho = 0.562–.667, < 0.01). In the AAU group, the only significant – albeit weaker – correlation was found in the WAI Bond subscale (rho = 0.369, < 0.05). Compared to the AAU group, assessment periods were shorter and the number of visits were fewer in the DSA group.

Conclusion: Our findings are clinically notable. They show that the patient-centred, DSA-based case formulation complements psychiatric assessment in a collaborative way and results in a better joint understanding regarding the patient’s problems and needs in a shorter time period than the standard assessment.


working alliance, case formulation, dialogical sequence analysis, patient‑centred approach, psychiatric assessment, mental health

Corresponding author


Päijät-Häme Central Hospital Department of Psychiatry, Keskussairaalankatu 7 FI-15850 Lahti Finland


Mikko PÄNKÄLÄINEN: Päijät-Häme Central Hospital, Department of Psychiatry; Finland
Prof. Mikael LEIMAN: University of Eastern Finland; Finland
Dr. Jukka HINTIKKA: Päijät-Häme Central Hospital, Department of Psychiatry & University of Tampere
Faculty of Medicine and Life Sciences; Finland