Open Dialogue is a development of Family Therapy and has proven to be very effective in situations of acute mental illness, particularly psychosis.

 

What is Open Dialogue?

Open Dialogue was developed in Finland in the 1980s by clinical psychologist, Jaakko Seikkula. It is a development of family therapy and has proven to be very effective in situations of acute mental illness, and in particular, psychosis. It is a social network approach to care, in that it involves meetings with the individual with his or her family members and extended social network, and 2 or more open dialogue therapists.

The emphasis in Open Dialogue is on the generation of dialogue, rather than promoting change directly. The aim is for the dialogue to allow the members of the network to summon their own psychological resources, with which to deal with the problem.

 

A different understanding of psychosis

Psychosis is understood as a response to emotional trauma or highly stressful dilemmas, that cannot be given expression through language. It may be impossible to put the experience into words, so the person has a difficulty in understanding himself and in making himself understood by others. 

 

When is it helpful?

It is particularly helpful in situations of acute mental illness, such as first onset psychosis, however, this approach is also being used in other situations, such as, chronic psychosis, depression and with other non-psychotic presentations. 

What happens in an Open Dialogue meeting?

Meetings are convened as quickly as possible after a crisis, and often in the individual’s home. This is because crises are seen as opportunities to make sense and therefore find meaning of the individual’s experience and context. Family members, friends, and key professional helpers are invited to this meeting. Families and the person’s social network are seen as valuable resources.

A small team of qualified systemic therapists convene this meeting, where every decision is negotiated by the group and is “open” to all. A key concept in Open Dialogue is transparency. No decisions about the person in distress are made outside of the network meetings, and within this setting the clinicians openly discuss their observations.

 

What the research says

There is now ample and strong evidence of the Open Dialogue’s superiority to normal treatment of acute psychosis. For example, after 5 years (1992–1997) of Open Dialogue treatment in Lapland, 81 % of participants had no remaining psychotic symptoms and 81% had returned to full employment. Only 35 % had used antipsychotic drugs (Seikkula et al., 2006). 

Roxanne and her colleague, Jennifer Brown, are using this approach.

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