Showing 22 of 22 comments.
Thank you very much for your response. I appreciate it.
Thank you for your eloquent, beautifully stated summary of the main idea. I really appreciate your writing in.
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.
Thank you very much for your lovely comment.
Thank you for recommending our paper, “The Key Elements of Dialogic Practice in Open Dialogue.”
The link you have is actually the next to last version. I’ll let Will and Ron know.
The final version of the document–September 2, 2014, Version 1.1–can be downloaded at:
There are only a few variations between the two; but the most recent version is the one we’d like to make available.
Thank you for your comments. I obviously believe that open dialogue therapy and reflecting process work have much to recommend them. (By the way, dialogical practices rarely have much to do with sympathy, advice, support, and happy faces.)
At the same time, I also believe that it is important to maintain a critical stance toward one’s own theories and practices. Experience is always more complex than any single theory or approach. Your comments are very useful in keeping alive a critical stance toward Open Dialogue, which is important, crucial really. There is no disagreement that the therapist has to be truly involved as a complete human being, and there is a place for confrontation, which actually can be an invitation to be in dialogue.
Finally, when I talk about stories, I mean story as a thought form. I think that stories are built into people, and even if you favor a directed approach, I still think the basic grammar of life is context and relevance.
Again, thank you for your input.
Thank you for writing. Your description of the series of events leading up to the terrible tragedy of your son’s death is unforgettable and gut wrenching. You have every reason to feel as you do. I believe every word you have written. Conventional mental health treatment is in the grip of a false idea with devastating consequences. Actual therapy has to do with hearing someone’s story, not trying immediately to eradicate their symptoms.
I know that there are no words to comfort a parent who has lost a child. It is the worst thing that can happen to someone. I won’t forget what you have written. Thank you for your words of encouragement.
Thank you for your comments.
When I am making an argument for research, it is in relation to a way of working that has shown success in a small province of Finland that has not been replicated anywhere else. There are significant cross-cultural issues, since the US has homelessness, poverty, more social isolation, and other issues that do not exist in Finland. At the same time, we are training experimental teams to work this way.
In terms of medication practices, Open Dialogue is the only way of working in the developed world that has used neuroleptics according to a discontinuation/tapering strategy and is consistent with the best research we have. Neuroleptics are avoided if possible.
This is not the biomedical model of psychiatry, but one in which all voices are heard and equal. The voice of the service user is equal to that of the psychiatrist, which makes it a radically different process.
Again, thank you for sharing your views.
Thanks for your comments.
Thank you for writing. Yes, Jaakko works with long-term service users. And, we have been collaborating on working with a family with long-term involvement with the mental health system. There are some differences with first time psychosis. But, as I mentioned below, Open Dialogue evolved from mental health work with people who had been hospitalized for many years. You have to go slowly.
Yes, Open Dialogue can be adapted to a long-term, chronic situation with someone who has been on antipsychotic drugs for a long time. I am working, together with a team, with such a family. There are some differences with a first time crisis that need to be taken into consideration. Open Dialogue started with inpatients who had been judged to be “incurable,” although the research is on first time psychosis. This approach isn’t widely available in the US. There is someone in Chicago whom I’ve contacted to see if I can give you his name. Also, the MIA directory is very helpful.
It is important to go slowly.
I hope this helps. I’ll let you know about the person in Chicago. Thank you for writing.
I could not agree with you more.
Thanks for your comments
Thank you for your comments. You raise the important questions, which really require a longer discussion but here are some ideas.
1. I think the greatest challenges to Open Dialogue in the US are the “challenges of isolation, fragmented and underfunded supports.” We are working with a family where the son has been receiving mental health services for many years, medication, many hospitalizations, and the biggest difficulty has been the psychological continuity. And, I do think its absence affects the outcome.
On the other hand, many of our trainees report, and it has been my clinical experience as well, introducing dialogical principles already improves things even without the treatment system ensuring continuity, immediate help, tolerance of uncertainty, etc.. But for the best outcomes in severe psychiatric crises, and to call it Open Dialogue, you need both a particular kind of treatment system and dialogical practice
2. Yes, Open Dialogue can assist people who have been on medication for a long time, but it has to be adapted.
3. You wrote: “And on another level, the Open Dialogue model seems a perfect fit for state and federal governments looking for a cheaper way to help people who have been labeled with a chronic mental illness.” Absolutely.
Thank you, again, for your perceptive comments and questions.
Thank you for your comments. I appreciate them.
Thank you very much for your comments. It is very valuable to have your perspective as a doctor involved in doing Open Dialogue. I look forward to our continued collaboration. Again, I appreciate your taking the time to write. Best wishes.
I both admire and am touched by what you wrote. And everything you say is absolutely true. I never believed in chemical imbalances. Perhaps this is because my background is social work, and my foundation has been Gregory Bateson, an anthropologist. I always have believed that “so-called symptoms” are forms of communication rooted in what are felt to be inexpressible or unspeakable dilemmas. The biomedical model of managed care, dispensing care as a commodified unit, has institutionalized a theory of symptoms, not as a form of communication, but instead as signs of something broken in the brain. It is an epistemology (rules for thinking) of billiard balls and stones and the cause-and-effect logic of inanimate things. The inappropriateness of this paradigm has been reinforced by basic science and the long history of clinical research that Robert Whitaker has synthesized and brought to public attention.
Bateson proposes that with so-called “schizophrenia,” learning, and the double bind,” we can misclassify phenomena as matters of individual psychology, which instead are part of “an ecology of ideas,” or “mind.” This assumption was foundational in family therapy. According to Bateson, mental phenomena are not diseases to be cured but social and relational events whose boundaries do not coincide with the skins of the participant individuals. So when you talk about people in trauma, I think that is an example. And, finally, understanding experience, which inherently involves other people, is not the same as blaming them.
Thank you very much for writing and sharing your thoughts. I really enjoyed reading your post.
Thank you for your thoughts. I have found reading what you wrote very valuable. I am touched by your beautiful statement:
“And, I do feel this foremost principle, this general idea of ‘transparency,’ is absolutely key — and must not become subverted in practice.”
Yes, the “openness” of Open Dialogue is that the professionals must be open and transparent, especially when we don’t know and are lost. Instead of having closed-door deliberations, staff meetings are eliminated, and all decisions are made with everyone present. The reflecting process allows the person and network to hear what the professionals have to say and comment on it.
I really appreciate your taking the time to write.
Thank you for your valid comments and taking the time to write. I like the phrase “growth psychotherapy,” rather than “talk psychotherapy.” I agree with you when you say that “emotions are not themselves suffering; it is the interference of them that causes suffering as well as the external events.” You articulate very clearly the idea of “withness.” That is a principle we try to follow in open dialogue therapy.
I do not subscribe to a biomedical model that sees symptoms as biochemical processes to be treated with drugs, but see all of human experience as a valid response to a context.
By reducing isolation, being with, accepting (as you say), Open Dialogue tries to listen, respond, and understand.
Thank you for your comments. I hadn’t thought of it that way before, but I think you are absolutely right about the flaws in logic. I appreciate your putting this in words and taking the time to write.
Thank you for your comment. Bateson does say more about what he means, but he says it better than I ever could, so I hope you do read his book. It has meant a lot to me. Again, thanks for taking the time to write.
Ron, thank you for your comment. I am glad that you found the post informative. It is good to hear from you.