About Open Dialogue
Open Dialogue is an innovative, network-based approach to psychiatric care that was first developed in the 1980s by Jaakko Seikkula, Birgitta Alakare, Markku Sutela and their multidisciplinary team at Keropudas Hospital in Tornio, Finland. In contrast to standard treatments for early psychosis and other crises, Open Dialogue emphasizes listening and collaboration and uses professional knowledge with a “light touch” – rather than relying solely on medication and hospitalization. It comprises both a way of organizing a treatment system and a form of therapeutic conversation, or Dialogic Practice, within that system.
The basic vehicle of Open Dialogue is its radically altered version of the treatment meeting, which typically occurs within 24 hours of the initial call to the crisis service. This treatment meeting gathers together everyone connected to the crisis, including the person at the center, their family and social network, all professional helpers and anyone else closely involved. Throughout this process there are no separate staff meetings to talk about the “case.” Rather, all discussions and decisions take place in the treatment meeting with everyone present.
Several Key Principles of Open Dialogue
- Immediate help that begins with a treatment meeting within 24 hours
- A social perspective that includes the gathering of clinicians, family members, friends, co-workers and other relevant persons for a joint discussion
- Embracing uncertainty by encouraging open conversation and avoiding premature conclusions and treatment plans
- Creating a dialogue, or a sense of “with-ness” rather than “about-ness” with meeting participants by dropping the clinical gaze and listening to what people say – rather than what we think they mean
With an emphasis on being responsive to the needs of the whole person, instead of trying to eradicate symptoms, studies have shown that the Open Dialogue approach leads to a reduction in hospitalization, the use of medication and recidivism when compared with standard treatments. In one five-year study, for example, 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.
I, the peer and the family therapist have had many wonderful network meetings with different types of families all throughout Brooklyn. The work so far has only deepened my confidence in the need for this type of dialogic and network based approach; that it can be applied in context very different from Lapland and other parts of Europe. The majority of the families are grateful for the approach – for its patience, it kindness and intimacy.
Ed Altwies, Psy.D.
Level II Graduate – IDP