Soteria Berne: An alternative treatment of acute schizophrenia

Soteria Berne is a small therapeutic community where patients suffering from acute schizophrenic psychoses are treated by an innovative milieu-therapeutic and psychotherapeutic low-drug approach.

The term "Soteria" is of Greek origin and means protection and relaxation, in the present context. It was chosen in 1971 by Loren Mosher and his collaborators in San Francisco/USA as name for a pilot project focused on a no-drug or low-drug treatment of acute schizophrenia.

In 1984, Ciompi and his co-workers in Berne/Switzerland founded a first European Soteria house which continues to function successfully after more than 30 years. Eventually, the Soteria-idea spread out to Germany, Scandinavia and other parts of the world where it was realised under various forms.

In Soteria Berne, Moshers original approach was further developed and partly modified on the basis of Ciompi's concept of affect-logic and other more recent notions, speaking for the hypothesis that critically increasing emotional tensions play a key role for the outbreak and further development of psychotic states. Therefore, to induce a sustained emotional relaxation became a main therapeutic focus. This was not primarily achieved by neuroleptic drugs, but rather by continually and emphatically "being with" the psychotic patient, in an as normal, open, family-like, protecting and relaxing setting as possible.

Soteria Berne offers place for 8-9 patients and is based on the following therapeutic principles:

1. Small, relaxing, stimulus-protecting and as "normal" as possible therapeutic setting
2. Continual personalized "being with" the psychotic patient
3. Personal and conceptual continuity over the whole period of treatment
4. Continued close collaboration with family members and other important persons of reference
5. Clear and concordant information, for patients, family and staff, on the illness, its treatment and the existing risks and chances
6. Elaboration of common realistic goals and expectations for future housing and work
7. Consensual low dose neuroleptic strategies, with the aim of controlled self-medication
8. After-care and relapse prevention for at least two years

Evaluative research has proved that objectively at least equal and subjectively partly better 2-year outcomes were achieved with much less drugs at Soteria Berne, as compared to conventional approaches. In addition, the treatment of acute schizophrenia at Soteria Berne was during the last few years constantly 10-20% cheaper than in comparable local psychiatric institutions. Costs are lowered by the fact that all housework (cooking, shopping, cleaning, gardening etc.) is part of the therapeutic program and done by the members of the therapeutic community themselves.

In recent years, the Soteria-Berne concept has been completed by the development of specific methods for psychotic patients who simultaneaously depend on cannabis. Two protected appartments and an extended ambulatory post-care service for former Soteria-patients were added, and a special service for early dectection and prevention for patients at risk for psychosis was developed, on the base of the Soteria-approach, in collaboration with the local university department of psychiatry.

Soteria Bern (photo 2004)
Loren Mosher (Founder of Soteria San Francisco, †2004), Prof. Luc Ciompi (Founder of Soteria Berne), PD Dr. med. Holger Hoffmann (chief physician, Soteria Berne), Sabine Leisinger (director, Soteria Berne)

Video

A conversation with Luc Ciompi on the concept of affect logic and Soteria
(in German, with English subtitles)

Publications in English

• Ciompi L.: An alternative approach to acute schizophrenia: Soteria Berne, 32 years of experience. Swiss Archives of Psychiatry and Neurology 168:10-13, 2017 (PDF, 169 kB)
• Bola J.R., Lehtinen K., Cullberg, J., Ciompi, L. Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first episode psychosis. Psychosocial Treatment and Psychosis 1:4-18, 2009
• Calton T., Ferriter M., Huband N., Spandler H. A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia. Schizophrenia Bulletin, Advanced access published online on June 14, 2007. Abstract
• Ciompi, L. Hoffmann, H.: Soteria Berne. An innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic. World Psychiatry 3:140-146, 2004  (PDF, 116 kB)
• Ciompi, L., Maier, Ch., Dauwalder, H.P., Aebi, E.: An integrative biological-psychosocial evolutionary model of schizophrenia and its therapeutic consequences: First results of the pilot project "Soteria Berne". In: Benedetti, G. & Furlan, P.M. (eds.) Psychotherapy of schizophrenia. Hogrefe & Huber Publ., Seattle-Toronto-Bern-Göttingen 1993, pp. 319-333
• Ciompi, L., Dauwalder, H.P., Maier, Ch., Aebi, W., Trütsch, K., Kupper, Z., Rutishauser, Ch.: The pilot project "Soteria Berne". Clinical experiences and results. Brit. J. Psychiat. 161: 145-153, 1992
• Ciompi, L., Dauwalder, H.P., Aebi, E., Trütsch, K., Kupper, Z.: A new approach of acute schizophrenia. Further results of the pilot-project "Soteria Berne". In: Werbart, A. & Cullberg, J. Psychotherapy of Schizophrenia. Facilitating and obstructive factors. Scandinavian University Press, Oslo, pp. 95-109, 1992
• Dauwalder, H.-P.: Soteria Berne, treatment and prevention of schizophrenia without neuroleptic drugs. In: Zapotocky, H.G. & Wenzel, T. (eds): The scientific dialogue: from basic research to clinical intervention. Swets & Zeitlinger, Amsterdam 1990, pp. 267-276

See also:

• Soteria Bern website (soteria.ch, German language)