Open Dialogue Therapy: 7 principles of this mental health model

This alternative to psychiatrization appeared in Finland and is based on cooperation.

Open Dialogue Therapy, or Open Dialogue Model, is a therapeutic approach that reinforces the creation of dialogic spaces for dialogue.is a therapeutic approach that reinforces the creation of dialogic spaces as an effective alternative in the reduction of psychiatric symptoms.

This model has had an important impact in the last decades, especially in Europe, but it has already begun to spread around the world. This is due to its results and also because it has managed to reformulate a large part of the psychiatric concepts and practices that were considered the best, or even the only, option for assistance.

What is Open Dialogue Therapy?

Open Dialogue Therapy, better known as the Open Dialogue Model, is a set of socioconstructionist proposals emerging in the field of psychiatric care in Finland..

It has gained a lot of popularity recently because it has positioned itself as a quite effective therapeutic option, which in addition offers alternatives to psychiatrization. That is, it reformulates the traditional knowledge and practices of psychiatry, especially those that may be more coercive.

Rather than a defined method, the authors of the Open Dialogue Model define it as an epistemological position (a way of thinking, which can have repercussions on the way of working) in psychiatric contexts.

Where does it emerge?

Open Dialogue Therapy arose in the northern region of Finland, specifically in a context where lifestyles rapidly shifted from being based on agrarian economies to being concentrated in urban economies; a matter which significantly affected the mental health of a large part of the population whose characteristics had been very homogeneous. whose characteristics had been very homogeneous.

In response, a needs-based approach was developed within psychiatric care in the early 1980s, which, among other things, succeeded in reducing psychotic symptoms while strengthening family and professional networks, reducing hospitalization and reducing medicalization.

Research evaluating the effectiveness of this model resulted in the following conclusion, which was later transformed into a concrete proposal: facilitating dialogic communication (egalitarian dialogue between people) in psychiatric treatment systems is a very effective approach.

7 fundamental principles of Open Dialogue Therapy

The treatment sessions in the Open Dialogue Model aim at gather information to generate a collective diagnosis, then create a treatment plan based on the diagnosis that has been made, and then generate a psychotherapeutic dialoguethen create a treatment plan based on the diagnosis that has been made, and subsequently generate a psychotherapeutic dialogue (Alanen, 1997).

The latter follows seven fundamental principles that have been identified through clinical practice and research on this model. They are a series of guidelines that have had results in different people who also have different diagnoses

1. Immediate intervention

It is of fundamental importance that the first meeting be scheduled no later than 24 hours after the first approach by the person with the diagnosis, his or her family or institution.

For the intervention team, the crisis can generate a great possibility of actions, because it a great amount of resources and elements that are not visible outside the crisis are generated.. At this early stage, it is important to mobilize the person's support networks.

2. The social network and support systems

Although mental health (and thus illness) involves an individual experience, it is a collective issue. That is why, family and close support groups are active participants in the recovery process. in the recovery process.

They are invited to participate in meetings and long-term follow-up. Not only the family or the nuclear group, but also co-workers, employers, social service personnel, etc.

3. Flexibility and mobilization

Once the specific needs of the person and the the specific needs of the person and the characteristics of his or her close context have been detectedthe treatment is always designed in a way that is adapted to this.

Likewise, its design leaves open the possibility that the person's needs and the characteristics of his or her context may change, which means that the treatment is flexible.

An example given by the authors is to hold a daily meeting in the home of the person in a crisis situation, instead of starting immediately with the institutionally prescribed and pre-designed protocols.

4. Teamwork and accountability

The person who manages the first meeting is the one who has been contacted at the beginning. Based on the needs detected, a team is formed, which may include which may include both outpatient and hospital staff, and which will assume responsibilities throughout the follow-up.

In this case, the authors give as an example the case of psychosis, where it has been effective to create a three-member team: a crisis psychiatrist, a psychologist from the diagnosed person's local clinic, and a hospital ward nurse.

5. Psychological continuity

In line with the previous point, the team members remain active throughout the process, regardless of where the diagnosed person is (at home or in the hospital).

In other words the working team acquires a long-term commitment (in some cases the process can last several years). Different therapeutic models can also be integrated, which is agreed upon through treatment meetings.

6. Tolerance of uncertainty

In traditional psychiatric care it is quite common that the first or only option considered during acute crises is forced seclusion, hospitalization or neuroleptic medication. However, sometimes these turn out to be hasty decisions that function more to calm the therapist's anxiety in the face of what he or she does not plan for.

The Open Dialogue Model works with the therapist and invites him or her to avoid hasty conclusions. invites the therapist to avoid jumping to conclusions, both toward the person with the diagnosis and toward the family.. To achieve this, it is necessary to create a network, a team and a safe working environment that provides the same security to the therapist.

7. The Dialogue

The basis of the Open Dialogue Model is precisely to generate dialogue among all the people who participate in the treatment meetings. Dialogue is understood as a practice that creates new meanings and explanations, which in turn creates possibilities for action and cooperation among those involved.

For this to occur, the team must be prepared to create a safe and open environment for discussion and collective understanding of what is happening. Broadly speaking, it is about creating a forum where the person with the diagnosis, his family, and the interventional team generate new meanings for the behavior of the person with the diagnosis and his symptoms; an issue that favors the autonomy of the person and his family.

In other words, a treatment model based on a model of treatment based on support and social networks, which fosters dialogic equality among the people involved: the arguments are aimed at exposing the validity of certain knowledge or experiences, and not at reaffirming positions of power or authoritarian positions.

Bibliographical references:

• Haarakangas, K., Seikkula, J., Alakare, B., Aaltonen, J. (2016). Open Dialogue: An Approach to the Psychotherapeutic Treatment of Psychosis in Northern Finland. Retrieved May 04, 2018. Available at Open Dialogue: An Approach to the Psychotherapeutic Treatment of Psychosis in Northern Finland.
• Seikkula, J. (2012). Becoming Dialogical: Psychotherapy or a Way of Life? Australian and New Zealand Journal of Family Therapy, 32(3): 179-193.
• Seikkula, J. (2004). The Open Dialogue Approach to Acute Psychosis: Its Poetics and Micropolitics. Family Process, 42(3): 403-418.
• Alanen, Y. (1997). Schizophrenia. Its Origins and Need-Adapted Treatment. London: Karnac.