Over the past seven years, I have been teaching open dialogue principles and practices in a variety of settings. This blog will focus, in particular, on the development of a training program, now based in Manhattan, and what I’ve learned from running this program and teaching this approach in the US.
The Origins of the Institute for Dialogic Practice
In 2011, in connection with Open Dialogue developer Jaakko Seikkula, I started the Institute for Dialogic Practice, “IDP,” in Massachusetts and offered a two-year training program in Dialogic Practice & Open Dialogue, the first such initiative outside Finland (“Open Dialogue” refers to both a system of care and the form of therapy within that system, which is known as “Dialogic Practice”).1 Birgitta Alakare and the late Markku Sutela, two members of the original Finnish Open Dialogue team, soon joined our faculty along with psychologist Peter Rober, a major contributor to dialogic theory and practice. Since then, psychiatrist Nazlim Hagmann and family therapist/organizational consultant Jorma Ahonen have become members of the teaching faculty.
Establishing this program was part of a trajectory that I had begun many years’ earlier. In 2001, I received a Fulbright grant to teach and do research at the University of Jyvaskyla in the Department of Psychology in Jyvaskyla, Finland. While there, I went to the far north of the country to visit Keropudas Hospital where Open Dialogue was developed and first evaluated. I was interested in this way of working as a flowering of the systemic family therapy tradition that I had embraced, practiced and taught for fifteen years. Following the work of Gregory Bateson, this branch of family therapy sees language and communication as central to the therapeutic process. Open Dialogue has arisen from an intersection between systemic family therapy and the philosophy of Mikhail Bakhtin and his concept of dialogue as a model of the living world. During my time in Finland, I studied Open Dialogue and wrote a paper about it, which formed a personal and professional watershed, radically altering my work.2
When I returned to the US (Northampton, MA), I began adapting dialogical principles to my clinical practice as a family therapist and was astonished by the results.3 I incorporated this approach in my classes at Smith College. As a researcher, I also found a like-minded group at the University of Massachusetts Medical School, and we wrote the first pilot study. During this time, I kept having the feeling that something was ahead of me the way you can hear the distant sound of rapids when you are going down a river. I just did not know what.
Then, in 2010, Robert Whitaker published his revelatory book, Anatomy of an Epidemic. At the end, there was a slim chapter, entitled “Solutions,” in which Whitaker wrote about Finnish Open Dialogue and called attention to the remarkable outcomes with first-time psychosis. This recognition of the significance of Open Dialogue has been a major catalyst for the tangible progress we have made in setting up research and training programs in the US. In 2010, Whitaker introduced Seikkula and me to Chris Gordon, medical director at Advocates, at a conference in New York with the idea that Gordon’s Massachusetts-based mental health agency might be a site for our Open Dialogue research. Whitaker’s book quickly set in motion the formation of the Foundation for Excellence in Mental Health Care, which raised the funds for our project at UMass to develop needed research materials and for “Collaborative Pathways” at Advocates, a pilot study of Open Dialogue.
As part of the Collaborative Pathways pilot, Gordon, together with Brenda Miele Soares, asked me to train them, together with 12 others from Advocates, thus providing critical support for the new IDP training program. Others who have graduated from the training program then and since have also become important proponents and innovators. They include (alphabetically) Ed Altweis of Parachute-NYC, Ross Ellenhorn of Ellenhorn/Boston Dialogic Center, Will Hall of Maastricht University Medical Center, Karen Kieffer of Massachusetts DMH, Jane Linsley of Gould Farm, Louisa Putnam of the Arco Iris Institute, Nick Putnam of Open Dialogue-UK, Kayla Rosen of Harvard University, Rebecca Ross of the Ackerman Institute, Shannon Sennott of Smith College School for Social Work, Sandy Steingard of Vermont’s Howard Center and Phebe Walker of Windhorse. The training program has spawned the development of a network that is pushing forward a newly evolving field. Important research validating the approach in the US has also started to come from this network.4 5
Initially, we held our first training program in the “Brassworks” in Haydenville, MA. It was a beautiful old factory building located in a white-steeple New England village. We have now relocated our clinical offices to a more central location in downtown Northampton where I, together with other IDP faculty and associates, continue to work clinically with families, which is an important and perennial influence on how I teach Dialogic Practice. As part of this change, we have moved the training program to New York City in order to make it more accessible and diverse. I will say more about this below.
The Philosophy of Training: An Evolving Tradition vs. a Method
Over the years, enthusiasm for this approach among trainees has generally run high, and their feedback on our program has been positive. Yet it has been the challenges I have encountered that have provided the opportunities for growth. I believe in a culture of reflexivity and self-improvement, so I will talk about what I have learned.
One of the primary lessons for me has been that the idea of bringing a method or system from another place is the wrong foundation. For instance, in the early days of the US training program, some trainees began to say that the training felt too white, Eurocentric, and male dominated. I began to think that Open Dialogue was becoming reified (turned into a “thing”) and transmitted as a top-down ideal, despite its radical and progressive nature and democratic implications.
This has led to a much greater emphasis on teaching formats that are more personal, experiential, diverse, and collaborative, which has been uniformly enlivening and well received. There has also been a shift toward teaching the whole tradition in which Dialogic Practice and Open Dialogue are embedded. Included are the practices of Milan systemic therapy revised, the reflecting process work of Tom Andersen & Magnus Hald, “the not-knowing position” of Harlene Andersen, and Michael White’s outsider witnessing practices. Tom Andersen has called this, “the art of creating social bonds with others.”
In clarifying a philosophy of training, I have drawn inspiration from the work of Paulo Freire.6 His central critique in the “Pedagogy of the Oppressed” rejects “a banking model” of education in which the teacher deposits knowledge into the empty account of the student in favor of a “midwife model” in which learning is a two-way process. His feminine image of the midwife and dedication to freeing the colonized mind make his work particularly suited to training in Dialogic Practice. Teaching is not about imparting truth, per se, but creating the capacity to be in dialogue with a tradition, thus fostering a critical consciousness.
Making Room for Differences: Multiculturalism
Along these same lines, the Italian systemic therapist Gianfranco Cecchin once said that an index of oppression is the absence of differences. A midwife model of education as a two-way process has meant improving our IDP curriculum to recognize and respect the multicultural, multiracial nature of our society. Since training a team at Emory’s Grady Hospital in Atlanta, GA that mainly serves low-income residents from the African-American community, I have been reinforced in my belief that there is an intrinsic social justice resonance to Dialogic Practice and Open Dialogue. I have had some hopeful experiences at Grady of how this relational approach builds networks and respects every person as a subject, rather than treating them as an object of intervention. The need for this kind of care in disenfranchised communities is pressing. Research reinforces this by showing that racism, poverty, trauma, immigration, isolation, and alienation correlate with higher rates of psychosis.
I am not advocating a brittle political correctness but a genuine responsiveness to the working conditions of a multicultural democracy. In the US, to support our trainees in different contexts and settings, we have found it important to interweave the contributions of the US family therapy field on the influence of the wider context and larger systems and bring attention to social justice issues that are particularly relevant to North American society, including psychiatric survivorship, gender, poverty/homelessness, race, ethnicity, class, and sexual orientation and diversity. Second, we also have started to bring forward previously neglected but important contributions to the dialogic-systemic approach by such voices, for instance, as Carolyn Attneave.7 Attneave was a Native American psychologist whose pioneering work on network therapy for people diagnosed with schizophrenia directly influenced Open Dialogue. In this way, we are widening the ecology of ideas and sources of identification and responsiveness that can inspire our trainees and fuel their creativity.
The Manhattan Training Program
Building on prior training sessions, the Institute for Dialogic Practice will offer, beginning in June 2017, a new 3-year International Certification Program in Dialogic Practice in New York City. It will take place at the New York Society for Ethical Culture, which is located in a historic brownstone on the Upper West Side overlooking Central Park.
There will be five senior teaching faculty (in alphabetical order): Jorma Ahonen, (Finland), Nazlim Hagmann, (USA), Peter Rober, (Belgium), Jaakko Seikkula, (Finland), and myself. Invited speakers will include peer specialist Leslie Nelson of the Parachute-NYC, journalist Robert Whitaker, and psychologist/researcher Keith Woods of Grady Hospital/Emory University, among others. The program will be delivered in a series of four intensive sessions per year and meet international standards for certification in Open Dialogue. There is a didactic seminar focused on theory, clinical supervision, and family-of-origin exploration emphasizing the trainee’s self-development. The three-year program can be completed flexibly, a year at a time, with or without gaps.
In doing training in Dialogic Practice and Open Dialogue, I continue to be inspired by what has been achieved in Finland and teach the specific principles and elements involved. But I think about it differently now. Instead of imparting a specific method or system, our training emphasizes the whole tradition of dialogical-reflecting ideas and legacy of related practices as a basis for fresh possibilities and ongoing evolution. At the same time, we integrate into our teaching curriculum writings, film clips, and other material that speak directly to a US context. There is a new sense of aliveness for us. Whether in therapy or training, dialogue is not a thing, a goal, or an outcome but a unique process that occurs in its own idiosyncratic way among the actual participants present.
- Olson, M., Seikkula, J., & Ziedonis, D. (2014). The key elements of dialogic practice in Open Dialogue: Fidelity criteria. The University of Massachusetts Medical School. Worcester, MA. Retrieved from: http://umassmed.edu/psychiatry/globalinitiatives/opendialogue/ ↩
- Seikkula, J. & Olson, M. (2003). The open dialogue approach to acute psychosis: Its poetics and micropolitics. Family Process. 42, 203-418. ↩
- Olson, M. (2015). An auto-ethnographic study of “Open Dialogue:” The illumination of snow. Family Process. 54, 716-729. ↩
- Gordon, C., Gidugu, V, E. Rogers, E.S., DeRonck, J. Ziedonis, D. (November 2016). Adapting open dialogue for early-onset psychosis into the US health care environment: A feasibility study. Psychiatric Services. 67(11), 1166-1168. Epub 2016 Jul 15. ↩
- Rosen, K. & Stoklosa, J. (2016 Sep 01). Finland in Boston? Applying open dialogue ideals on a psychotic disorders inpatient teaching unit.
Psychiatric Services. 67(12), 1283-1285. Retrieved from: http://dx.doi.org/10.1176/appi.ps.201600340 ↩
- Freire, P. (1971) Pedagogy of the Oppressed. New York: Seaview. ↩
- Attneave, C. (1969). Therapy in tribal Settings and urban network intervention. Family Process. 8:192-210. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
I am interested that you site Paolo Friere. I have recently been reading some training manuals based on Friere’s work and noticed how often the word, “Dialogue,” was used. I thought there was a connection to the work done by Open Dialogue practitioners so it is intersting to see you making that link.
Dialog is good. But the Mental Health system is a return to eugenics and social Darwinism. We need to be engaging in conflicts, selecting conflicts, and escalating them.
how I wish my wife’s counselor had involved me and our son in her approach. Instead I often found her ‘fighting against’ the things we were doing at home rather than collaborating together to speed my wife’s healing…
Thank you very much for your response. I appreciate it.
Thank you for sharing this history of the development of IDP and its ongoing evolution. I am deeply grateful to have been the benificiary of your teaching. The richness of this experience continues to have much resonance in my life. The links to social justice are important. In a related theme, we all need to consider how we can make this approach and these values available to all, especially those most disempowered in our society.
Thank you very much for your lovely comment.
I raise a critical voice with regards to Social Justice in Open Dialogue network therapy. One of my major inspirations being Paolo Freire. Freire described and explained how important dialogues are for respectful learning, whilst being clear that dialogue is insufficient and cannot be transformative without critical exploration of the unequal and unjust social conditions and power relations people live in (but that are partly silenced by dominating ideologies, normative idioms). This is necessary to plan transformative change.
Forward to more recent times and situations of growing inequality gaps also in the partly post-industrialised and increasingly precariat producing countries of the global North. Wilkinson and Picket have provided us with a detailed and in depth analysis of how inequality – as structural injustice and power (abuse) relations distributed across social settings, families included – how inequality impedes health as well as other resources (and the lack thereof) differently across social (sub)groups as well as trans-generationally.
In feminist research – but also in other critical social research – the detailed knowledge of how the personal (and intra-familiar) is political has been further developed under the new paradigm of intersectionalities. A paradigm that furthers the understanding of the workings of inequalities.
Social Justice? I ask. I ask with little interest in floating signifiers, words or emotions when artificially separated from the contentious social realities they arise from and seek to name; therefore I am critical of postmodernist psycho-verbalism usually a privilege of ivory tower academics; a genealogy of word, association and emotion ‘games’ in therapeutic spaces raises many concerns about patriarchy and supremacy on the hidden agenda; feminists certainly have critiqued the hidden agenda of ‘malestream’ privilege-informed therapy.
Social Justice? Official policy in OD is that people in families in crisis have all the resources – > cause we’re all human (assuming we’re all neoliberal too?). As a survivor of many injust and psychosocially destructive power effects (per example patriarchy in family, workplace, academia) I shall speak up against such a (be born from unanalysed privilege and its ignorance) ‘collective lie’ (Ignacio Martín-Baró). It seems an obvious aberration to pretend that people and families have all the resources. Such positive attitude therapy, that appears to mostly refer to its internal evaluations as relevant insight into ‘human and family resources’, inadvertently (and via the blind spot of privilege and patriarchy) hides inequalities. It consequently legitimises the prevailing but often silenced – apart from mad madness? or open resistance?- unjust und unfair power relations shot through all people’s lives but affecting them in extremely different ways.
Paolo Freire would have spoken up too! Fortunately there are many critically engaged scholars and activists who have built much more detailed and robust critical knowledge from ongoing explorations of differently positioned people’s lives in diverse subgroups impacted by the matrixes of unequal power distribution and its severely unfair and often harmful effects.
Very clearly described – and accessible – in the introduction and the chapter on empowerment in Patricia Hill Collins (freely available pdf) 2nd edition of Black Feminist Thought. As many others she exposes the complex societal manufacture of inequalities and injustice which lead to a hugely unfair distribution of social, educational, and psycho-relational resources.
Something to seriously think about within the overwhelmingly white and privileged circles of OD therapy trainings and conferences – would be to finally start to analyse the silenced white privilege and even benevolent patriarchy that it normalises in times of roaring neoliberalism. Going into people’s home is not sufficient to change a therapeutic space that is traditionally created by white privileged therapists with mostly male seniors, to a space of psychological and social learning where unequal resources and histories are no longer silenced.
We need a space where, in the contrary, those are actively explored. A space where a multi-perspective analysis of resources and needs – as Paolo Freire would have instigated, as it is already part of Intentional Peer Support work on world-view and unequal backgrounds. A multi-perspective of explorations of the issues created by unequal resources and power imbalances within and beyond families may call for developing new strategies and alliances with networks from the wider community or state organisation. Civil society networks responsive to the needs and empowering the desires of younger and older actors in families. These issues can’t be assumed family matters only, tout au contraire.
If the positing of families as ‘closed networks owning all resources needed’ (family as such a central category of the neoliberal state) should be intended by the Open Dialogue approach, we would suggest that an analysis of using many less privileged families (or members) as subordinate players in multi-layered power constellations seems of urgency. Otherwise the marginalised families / members may fall prey to a rather disempowering ideology of therapeutic families ‘who can all they need’ and ‘have all they need’- after successsful therapeutic facilitation of distress towards a pretty mystifying, phenomenologically celebrated ‘presentification’ of ‘liveliness’. This cruelly plays into the politics of a neoliberal smokescreen of individual meritocracy – a lie in the face of ever more drastic inequality of resources needed for agency – and excuses the abolition of affirmative action for many disempowered people with little or near no resources.
Paolo Freire, the knowledge built by various social groups at the margins of ‘manufacturing normal’, and Social Justice DEMAND that social power and resource injustices are explored and accounted for. Such is a necessary precondition for transformative prefiguration, and which can only be achieved through socially enlarged network dialogues as part of critical explorations of lives in unequal settings, in families, schools, workplaces, everywhere. Such is a precondition to build networks and alliances for meaningful learning and new collective forms empowerment – coming also from ‘beyond families’.
Not a nice comment. No, it can’t be. Sometimes, as Paolo Freire knew as well as the collective action of psychiatric survivors, ‘the subaltern’ must speak when issues at the core of our marginalisation are being misrepresented, silenced or excluded by all or any of the psychiatric providers in power. It is not right but harmful to the more disempowered that privileged circles of family focused therapies are allowed to delegitimise and take away from us the ethical and social means to create more adequate responses, collective action and political claims making.
In times of swelling inequality gaps and the co-optation of peer workers to foster happily thriving people – with a policy of disregard for many real resource inequalities pretty similar to the Open Dialogue principle that families have all the resources, should grow from present dialogues and dialogically create the best future all by themselves – it is urgent that some of us speak up. As I do here. To protest the mystification of families full of resources and ‘liveliness’ for everyone, and the simultaneous delegitimisation of the social harms and power inequalities, systemic marginalisation and precarisation that continue to impede our lives.
Having rectified some errors, a ‘Germanism’ had the upper hand: liveliness reads closer to Lebendigkeit. Instead of ‘liveliness’ it should read ‘aliveness’ in the above text, as in the title. Sorry for this.
Thank you for your comment. The network approach assumes the opposite of the assumption that families have all the resources they need and the term “aliveness” is not used here in reference to families, but to a quality of an interaction among participants learning something new.
What a wonderful, inspiring, informative overview of your foundational work here in the U.S. I love your description of how critical pedagogy and an emphasis on truly collaborative, contextual, social justice focused work continues to change practices. That aliveness and emphasis on becoming rather than being is so vitally important.
Thank you for your eloquent, beautifully stated summary of the main idea. I really appreciate your writing in.
Mary Olsen, I read what you have written and the problem is obvious. You are getting people to disclose personal affairs, as is standard in psychotherapy and life coaching. But then there is no teeth, no justice, no one is penalized. So it ends up that the victim survivors, the children, the adult children, are just selling themselves out, letting themselves be made into objects of scorn, contempt, and pity.
Family conflict should be handled in a court room. And when there are minor children involved, suspected cases of child abuse, including emotional abuse, must be reported so that they can be handled by the juvenile dependency court. Failure to report is a felony. We must all work together to see to it that these laws are enforced, and violators are prosecuted. And Scandinavia certainly had been a leader in child protection.
Gregory Bateson, Virginia Satir, and all of them of that era, they did interesting work. But today people understand that family therapy is for a juvenile, a hostage situation. Unless we are going to continue to allow therapists to be accomplice child abusers, these cases need to be gotten into court. A judge can melt the wax out of a parent’s ears, like no one else ever could.
And for myself, I helped to put a man into prison for molesting his daughters, and with the full backing of his church. Now, as his case is working its way through the appeals court, I am campaigning to make sure that if he should somehow beat this on a technicality, that they get another jury of 12 and try him again.
Civil judgments and criminal convictions, not accomplice child abusers with licenses and diploma’s on their office walls.
And don’t misunderstand me, Family Courts do everything they can to keep families together. Greatly helping them in this is the CASA volunteer program. But if you are doing family therapy with a juvenile, without court oversight, then that is child abuse.
We Need An Anti-Mental Health Anti-Recovery Forum: