Open Dialogue” is an innovative approach to acute psychiatric crises developed by Jaakko Seikkula, Markku Sutela, and their multidisciplinary team at Keropudas Hospital in Tornio, Finland.
Starting in the eighties, there have been a variety of research studies of Open Dialogue and its outcomes with early psychosis. Garnering widespread international attention, the results consistently show that this approach reduces hospitalization, the use of medication, and recidivism when compared with treatment as usual. For example, in a five-year study, 83% of patients had returned to their jobs or studies or were looking for a job (Seikkula et al. 2006), In the same study, 77% did not have any residual symptoms. Such outcomes led the Finnish National Research and Development Center for Welfare and Health to award a prize recognizing the Keropudas group for “the ongoing development of psychiatric care over a period of ten years.”
With strong foundations in philosophy and science, its principles are
- congruent with our knowledge of the best practices for treating early psychosis;
- rooted in systems and communication theories that have become widely accepted; and
- are consistent with the recovery perspective of consumer advocacy groups and the system-of-care initiatives.
Open Dialogue can be thought of as a double helix that meshes a dialogic process, or new style of psychotherapy, with an integrated treatment system that delivers care primarily in the community. The basic vehicle of Open Dialogue is its radically altered version of the treatment meeting. As soon as possible in a given situation, the team, which consists of at least two clinicians, gathers everyone connected to the crisis, including the person at the center, their family and social network, all professional helpers, and anyone else closely involved. There are no separate staff meetings to talk about the “case.” Rather all discussion and any decisions about medication and hospitalization take place with everyone present.
The aim of the treatment meeting is to generate dialogue that leads to common understandings, which become the basis of care. It begins first by eliciting the point of view of the person who has the overt symptoms. Often there is a special kind of meticulous, back-and-forth exchange between this person and the therapists to develop a more lucid way of expressing the situation and create a shared language. Building on this interaction, the therapists weave a common understanding of the crisis by bringing forward the voice of each of the participants. The exchange of voices creates a new fabric of meaning and engagement to which everyone has contributed important threads. This process can take one meeting or many meetings.
Fundamental to the approach is the shift away from an immediate emphasis on trying to eradicate symptoms. The conversation, or dialogue, is not “about” the person, but a way of “being with” them and living through the crisis together. ”Withness practices,” to quote Tom Andersen M.D., mitigate the sense of isolation and distance a frightening episode can produce. As the person at the center acquires greater voice and agency, they can participate meaningfully in both the conversation and the resulting decisions about their own lives, thus becoming more empowered. The perspective at work in Open Dialogue is that recovery from psychosis and other severe crises happens between people and with the help of important others. The result is that the open dialogue approach has achieved unique success in assisting people to navigate first time psychosis and other crises while relying much less on medication and hospitalization.
Resources Dialogic Practice and Open Dialogue Certification Training