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.