Reviewer Polly Mortimer
Leading lights of this newish movement all turned up to this hopeful and fascinating conference. Keynote speaker Jaako Seikkula of the University of Jyvaskyala, Finland and leading proponent of Open Dialogue (OD) filled us in about the three-year programme outside Finland in the UK.
Open Dialogue is a practice where all contradictory voices are accepted and treatment is adapted to the unique needs of clients. Precise diagnoses are not emphasized and the meeting is of human beings. It is non-hierarchical and one of the main tenets is that it is not possible to control the patient. Embodied experiences of relationships become the ‘construction’ of the mind. It is a shared open meeting, with a treatment system organised through dialogue. Everyone participates, there is no advance planning, all the voices have space – “How would you like to use the time?”
There is an emphasis on the present moment and an open sharing of thought. The first meeting is organised as soon as the client makes contact with psychiatric services; it is an exploration, not a search for answers. In two consecutive follow-ups (1992-3 and 1994-7) carried out in Western Lapland, 81% of clients had no residual psychotic symptoms and 84% were back in full-time employment or studies; only 33% had used neuroleptic medication (Seikkula et al, 2011).
The challenges for proponents of Open Dialogue are:
- to envisage psychotic problems as part of human life
- to identify the tasks of the treatment system
- to consider the relational basis of human life
- to employ dialogicity as the main form of psychotherapeutic orientation.
Another tenet of the OD approach is that love is a prime mover; there is no dialogical reflection without love just as there is no love in isolation.
This is a mere skim of the surface, and a short introduction to something that could be revolutionary. It struck me as a mixture of family therapy and group therapy with added features. There are questions to be asked: What if the family are toxic to the client? Do clients have to be heavily medicated at first and wouldn’t this impede progress?
But OD is taking hold here in the UK and, in the US, there is the NYC Parachute Project; these developments are exciting. Russell Razzaque of North East London Foundation Trust is pioneering OD here in the UK and taking referrals across the country.
Polly Mortimer is librarian at the Minster Centre and has had personal experience as a voluntary and sectioned patient in the psychiatric system.
Seikkula, J., Olson, M. E. (2003) The Open Dialogue Approach to Acute Psychosis: its Poetics and Micropolitics. In Family Process 42(3) pp403-418
Seikkula, J., Alakare B., Aaitonen J. (2011) The Comprehensive Open Dialogue Approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care. In Psychosis 3(3) pp192-204