The Importance of Openness and Authenticity in Psychotherapy

Openness and authenticity are emphasized a critical to the Open Dialogue approach to psychotherapy

Zenobia Morrill
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Researchers Dr. Laura Galbusera and Dr. Miriam Kyselo at the Technical University in Berlin have recently put forth a conceptual paper building on the Finnish Open Dialogue (OD) approach to psychotherapy. Their new paper highlights openness and authenticity as central to effectively delivering therapy.

“In contrast to biological psychiatry, the OD approach does not view psychiatric disorders as brain diseases but considers instead each symptom of a person’s psychological distress as an adaptive and meaningful reaction to a specific difficult life situation or context,” Galbusera and Kyselo write.

Photo Credit: “Communication,” by Joan M. Mas (Flickr)

The OD approach was developed in the early 1980s as a continuation of the Finnish National Schizophrenia Project. Rather than focusing on the elimination of symptoms, OD first aims to understand their meaning through attending to the client’s perspective as well as those in their social network. The background of this approach stems from the OD intent to radically reorganize treatment systems overall to respond more closely to client needs.

In this way, the preferred mode of treatment through the OD approach is psychotherapy. Galbusera and Kyselo make the argument that this approach shows promise, highlighting studies outlining its efficacy in responding to experiences of psychosis, marked by outcomes such as returning to work or school, or the reduction in symptoms.

The authors outline the core principles of OD, including the following:

  • Immediate help for the client. This involves getting in touch with the client no later than a day after they’ve reached out.
  • Adopting a network perspective. This principle involves not just individual contact with a client but also requires inviting all relevant people in their life to participate in treatment team meetings. Additionally, all meetings and decisions are made in the presence, and with the agreement, of the client.
  • Flexibility and mobility. Mainly, this stresses tailoring approaches to the individual needs of the client, including logistical details such as location and frequency of meetings.
  • Guaranteeing responsibility. This principle is related to the idea of psychological continuity and asserts that the professionals organizing the details of treatment ought to remain consistent throughout its duration.

Galbusera and Kyselor focus on the dialogical process of OD. Stressing the crucial role that this stance takes in psychotherapy, they write:

“Proponents of OD assume that therapeutic change happens through dialogical interactions with the client instead of being steered unidirectionally by professionals. An important element of this dialogical attitude is that all participants are encouraged to tolerate uncertainty about process and outcome of the treatment, instead of trying to predefine and control the situation. Tolerance of uncertainty is thus the last basic principle of OD.”

Furthermore, this dialogic process is based on the ideas that the process of psychotherapy involves more than just the spoken words in an exchange, acknowledging a “pre-reflective reality in which the things we live through cannot be always explicitly and linguistically grasped.” This necessitates the ability of the therapist to be present yet spontaneous and open in their attention.

While the process itself is dynamic and interactive, these researchers contend that the therapist plays an active role in initiating dialogue and setting up the appropriate conditions to facilitate dialogue. Drawing from the works of theorists such as Bateson (1972), Buber (1987), Bakhtin (1984), and Rogers (1966), the authors aim to understand the specific factors that facilitate the emergence of a successful dialogic process. Following Bateson, they ask, “what is the difference that makes the difference?”

Galbusera and Kyselo maintain that openness and authenticity are the “necessary and sufficient conditions for a dialogical attitude.” Openness, as previously described, requires that therapists embrace uncertainty, acknowledging both that they can neither fully know the person in front of them nor script the specific course of therapy. This involves a skilled attentiveness and ability to meaningfully respond to the contingencies that naturally arise in the dialogic exchange. A meaningful response is defined by the extent to which it has been adapted to the client. They elaborate, saying:

“Attentive listening, acknowledging and accepting the other, respecting and taking her seriously, adapting one’s own utterances and behaviour to the ones of the other person – all this implies a basic attitude of opening up to the other.”

Yet, the authors assert that openness in and of itself is not sufficient. To only be open risks simply reversing the psychotherapeutic dynamic, positioning the therapist as a witness rather than an active participant. This, they note, strips the exchange of its “intersubjectivity,” by reducing the therapist’s participation as a subject. Therefore, the authors make an argument to include authenticity.

Their understanding of authenticity is likened to Carl Rogers’ concept of genuineness, except they integrate professionalism as a complementary, rather than a competing force. “Simply said,” the authors write, “professionals are expected to be resonating as fellow human beings.” This involves therapists not only acting upon their personal thoughts and feelings but also upon their “professional concern and knowledge.”

Authenticity is further described by the authors through the use of Bakhtin’s notion of a “penetrated word.” They write:

“Even when literally repeating another person’s words, we always add something to it, for instance, a particular tone or pitch. A response thus implies something different from what it relates to, i.e. it is penetrated by the respondent’s voice. This captures the idea of authenticity as it refers to the person’s owning of her voice in the dialogue. Authenticity thus means that the person enacting the response expresses her original contribution and through her enactment, she also ‘interferes’ with the other.”

The authors suggest that enacting openness and authenticity in this way creates a therapeutic environment characterized by both transparency and active inquiry infused with personal resonance, and professional responsibility. They conclude:

“The twofold and circular structure of openness and authenticity enables an intersubjective process in which both subjects can move and are being moved. Openness implies a certain readiness to ‘being perturbed’ by the other’s self-affirmation, whereas authenticity implies a certain willingness to ‘perturb’ the other with one’s own self-affirmation. This means that the therapist acknowledges and takes the client seriously, thus being affected by her, and at the same time she takes responsibility for her own stance and affirms it, thus also affecting the client. By this circular movement of caring for oneself and for the other, we can ensure therapeutic change is not unidirectional but instead co-evolving, and thus pertaining to the intrinsic transformative nature of dialogue.”

 

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Galbusera, L., & Kyselo, M. (2017). The difference that makes the difference: a conceptual analysis of the open dialogue approach. Psychosis, 1-8. (Link)

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15 COMMENTS

  2. “In contrast to biological psychiatry, the OD approach does not view psychiatric disorders as brain diseases but considers instead each symptom of a person’s psychological distress as an adaptive and meaningful reaction to a specific difficult life situation or context.”

    But it still considers that there is such a thing as psychiatric disorders. There’s the rub.

      • I’m not sure either and I would also want this clarified but if you look at your standard Google Results, there doesn’t appear to be any evidence that they are not utilizing the DSM. (There is no link between PDM and OD for example and most studies appear to be DSM labels based.)

        What OD appears to be saying is that the authority figure must be “open” to a diagnosis being uncertain and the treatment to also being uncertain. Seems like a weak argument but it doesn’t contradict what OD is about so I think a trained personnel should elaborate on this.

        • That’s not how I understand it. I participated in a training on OD a few years back led by Will Hall, and got a pretty good idea how it works.

          “Open Dialog” starts without any assumption regarding what, if anything, is “wrong.” It also steps down the power of the therapists by including larger numbers of people and regarding all as having important things to say, including the client, which is a VERY big shift from most US psychiatry in my experience. The therapists further break down their “authority” by talking about the case with each other in front of the client and other participants, acknowledging when they don’t understand things and asking the other participants for their ideas of what is going on or what might be helpful. It was about the most empowering therapy modality that I’ve ever seen. And it works not on techniques, but on principles of how people should treat each other in the present moment to give the best chance of finding a solution or a path forward.

          Does this mean someone might not coopt the name OD and do something else with it? Of course not. But it is not a “manualized therapy” like DBT where all of the “clients” are lumped together and assumed to need the same things. It is VERY individualized and requires therapists who are comfortable not knowing where exactly they’re going to end up or how they’ll get there, and are not afraid to show that vulnerability to the other participants in the process.

    • Hey, on this one, I’ve got to disagree with you, though I generally support almost anything you post. We are operating in a Western industrialized society, and in such societies, voice-hearers and the like are feared and treated like lepers. If there is an approach based on COMMUNICATION that allows 80% of such people to sort out what’s going on and figure out how to make their way in this insane world, I have to support it. It’s true that the concept of “mental illness” is a crock, but sometimes people still need help finding their way, and Western industrialized society isn’t making any big changes any time soon. If we can get people free of a life sentence of incarceration and forced drugging, I don’t think we have to be such ideological purists as to oppose the workable concept on principle.

      • But is it a workable concept beyond the principle? I guess that’s an entire debate right there.

        True though something has to be adopted urgently towards the masses. If it’s OD then it has to be OD but I hope the principle is actually addressed here rather than just the catchy title because to me it seems OD’s success is mostly based on the title.

        Edit: (There are studies of course on the technique but it’s not like this is the first transparent technique that has gained traction. There are concepts like DBT or even just the general principles of therapy that sound swell until the ones applying the technique work around the principle.)

        I hope we’re not setting up the world for another “Life Coach” title that appeal to audiences so much that the general techniques become an umbrella term instead.

  3. I absolutely agree there is a need for openness and authenticity in psychotherapy. But given the reality that historically, and still today, the primary actual function of the “mental health” industries, according to your own medical literature, is covering up and silencing child abuse victims.

    Today, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

    The treatments for “borderline” and the “psychotic” disorders, which call for combining the antidepressants and/or antipsychotics (aka neuroleptics), can create the negative symptoms of ‘schizophrenia,’ via neuroleptic induced deficit syndrome. And they can create the positive symptoms of ‘schizophrenia,’ via antidepressant and/or antipsychotic induced anticholinergic toxidrome.

    If the psychiatrists and psychologists get out of the secretive and deceptive, multibillion dollar business of turning child abuse victims into the “mentally ill” with the psychiatric drugs on a massive scale. There really won’t be much of a demand or market for the services of the psychiatrists. And our country would have to actually address the multibillion dollar, pedophilia and child sex trafficking run amok problems in our world, including actually starting to arrest the pedophiles.

    But rumor on the internet is that Western civilization is currently ruled by ‘luciferian’ pedophiles, which of course would mean these ‘elite,’ pedophile ‘powers that be’ wouldn’t want to change the current, satanic, status quo.

    I will say the “dirty little secret of the two original educated professions,” has run amok and created a lawless and despicable NWO. We really do need a return of the rule of law, we should start arresting the pedophiles and fiscally irresponsible globalist banksters instead.

    But this would greatly decrease the need for any “mental health services.” Which would be a great thing for all in society, except the “mental health professionals” and the ‘elite’ pedophiles, whose crimes against children the “mental health professionals” have been covering up on a massive scale for decades.

    • They are “inseparable” only in YOUR MIND, “Slaying/Dragon”. I usually agree 99% with your comments, but your radical ideology has carried you too far this time. So-called “mental illness” is exactly the myth that you say it is. Yeah, I read Szasz, too. But psychotherapy really DOES WORK. People often feel better after good psychotherapy, but not because that psychotherapy actually “treated” their (imaginary) “mental illness”. Pretty much everybody enjoys spending an hour or 2 talking about themselves. So-called “psychotherapy” is nothing more than formalizing normal human interaction, and then sometimes pretending that it’s treating some imaginary “mental illness”. I’m suggesting that your disdain for the pseudoscience of psychiatry has affected your thinking where “talk therapy” is concerned. Even people who aren’t labelled have regular “therapy sessions”. It’s called “going out bowling with friends”, or joining your buddies at the bar”, etc. Think of the gab sessions at any urban barber shop or beauty parlor or hair salon. The personal relationships that grow in these places are in fact more important than any other “work” which goes on there. No, I’m not trying to defend “psychotherapy” *per* *se*, but I am challenging your dogmatic, reflexive, and extremist ideology. You so hate the trees of psychiatry and psychotherapy, that you can’t see the forest of humanity…. None of us are beyond self-reflection, so let me adjust this mirror for you…. RSVP? ~B./

      • @Bradford

        Agree on almost every point except this:

        “Pretty much everybody enjoys spending an hour or 2 talking about themselves. So-called “psychotherapy” is nothing more than formalizing normal human interaction,”

        There are plenty of people who don’t enjoy spending time with someone who may be gaslighting them for example and that’s just a sort of “finding yourself in a bad situation” example of psychotherapy. There are other less obvious ways of faux empathy occurring in those sessions – ones that both help people and also worsens people.

        This is because therapy has expanded beyond formalizing normal human interaction. It has techniques that go beyond just bowling with someone and this distinction needs to be made especially on a post involving a specific form of therapy called Open Dialogue.

        The loose way of describing psychotherapy as talk sessions is in itself just as wrong as saying psychotherapy is inseparable from mental illness. There are plenty of techniques that seem like the therapist is just talking that are not actually talk sessions.

  5. Unlike the above posters I haven’t had the luxury of sampling many different kinds of psychotherapy and so can’t really be as bold about it as I can be about forced treatment with thermonuclear brain-bombs.

    I do not trust Open Dialogue in the UK. The UK mental health system is now very closely aligned to a new regionalised secret service system and they are also routinely involved in various human rights abuses in terms of covert surveillance. Considering that laws have been passed in this country of the “neither confirm nor deny” type, I have absolutely no reason to believe that any dialogue within the mental health system could be considered open or transparent.