It is so heartening to hear of the spread of Open Dialogue, and to see such a thoughtful account from Marion! One thing about outcomes: it isn’t surprising that, after using OD for only a few years, she has not seen much difference between OD and FACT outcomes . The OD research is for 5-year outcomes – which have been very good re quality of life: living independently in the community, working and/or attending school, and lack of dependency on psych drugs. It seems pretty clear that if outcome measures had been at 1, 2, 3 or 4 years, they would have been uneven. OD’s “Tolerance of uncertainty” is a wonderful – it opens up thoughts, feelings and possible futures. It also seems a euphemism that pushes “professionals,” family/friends and so-called “patients” to not freak out when things don’t go the way we think/hope they will. The current “mental health” system is driven by people getting scared and resorting to panic-y anti-human “treatments” to get the “patient” back into other people’s comfort zones. We often don’t notice how damaging these “treatments” are because we are so relieved the “patient” isn’t upsetting us so much anymore. I am struck reading accounts of individuals’ successes with Open Dialogue, that many arrived at five years in a pretty good place, but they clearly got there via trial and error, with ups and downs. OD’s principle of “tolerance of uncertainty” helps people and their teams to persist through a messy process, trying again, making mistakes, and fixing things. Just like most of us move through life!! So, again, I am not surprised that Marion doesn’t see great changes after a few years, but I suspect there will be great changes eventually – OD works by simply treating everyone the way we all want to be treated. That pays off long term; short term “diagnosing” and “treating” works badly in the short term and even worse long term.