Open Dialogue Therapy: 7 principles of this mental health model

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

This model has had a significant impact in recent 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 concepts and psychiatric practices that were considered the best, or even the only, option for care.

• Related article: "Types of psychological therapies"

What is Open Dialogue Therapy?

Open Dialogue Therapy, better known as the Open Dialogue Model, is a set of Socio-constructionist proposals that arise in the field of psychiatric care in Finland.

It has gained a lot of popularity recently because it has been positioned as a fairly effective therapeutic option, which also offers alternatives to psychiatrization. In other words, it reformulates the traditional knowledge and practices of psychiatry, especially those that may be more coercive.

More than a defined method, the authors of the Open Dialogue Model define it as a position epistemological (a way of thinking, which can affect the way of working) in contexts psychiatric

Where does it arise?

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

In response, a tailored-to-the-needs (of users) approach was developed within mental health care in the early 1980s, other things, it managed to reduce psychotic symptoms while strengthening family and professional networks, reducing hospitalization and reducing medicalization.

The investigations that evaluated the effectiveness of this model resulted in the following conclusion, which later became a proposal concrete: facilitating dialogical communication (equal dialogue between people) in psychiatric treatment systems, is a very cash.

7 Fundamental Principles of Open Dialogue Therapy

Treatment sessions in the Open Dialogue Model seek collect information to generate a collective diagnosis, then create a treatment plan based on the diagnosis that has been made, and then 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 critically important that the first meeting be scheduled no later than 24 hours from that the first approach of the person with the diagnosis, his or her family, or institution.

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

2. The social network and support systems

Although mental health (and therefore disease) involves an individual experience, it is a collective matter. That's why, family and close support groups are active participants in the recovery process.

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

3. flexibility and mobility

Once the detected specific needs of the person and the characteristics of their immediate context, the treatment is always designed in a way adapted to this.

Likewise, its design leaves open the possibility that the person's needs and the characteristics of their context are modified, which means that the treatment is flexible.

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

4. Teamwork and responsibility

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

In this case, the authors give as an example the case of the psychosis, in which it has been effective to create a team of three members: a psychiatrist specializing in crisis, a psychologist from the local clinic of the person diagnosed, and an emergency room nurse hospital.

5. psychological continuity

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

That is the work team acquires a long-term commitment (in some cases the process can take several years). Likewise, different therapeutic models can be integrated, which is agreed through treatment meetings.

6. tolerance for uncertainty

In traditional psychiatric care it is quite common that the first or only option that is considered during acute crises is forced confinement, hospitalization or medication neuroleptic. However, sometimes these turn out to be hasty decisions that work more to calm the therapist's anxiety about what he does not anticipate.

The Open Dialogue Model works with the therapist and invites you to avoid hasty conclusions, both towards the person diagnosed and towards the family. To achieve this, it is necessary to create a network, a team and a safe work 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 between those involved.

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

That is, it is organized a treatment model based on support and social networks, which promotes dialogical equality between the people who participate: the arguments have the objective of exposing the validity of certain knowledge or experiences, and not to reaffirm positions of power or positions authoritarian.

Bibliographic 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 4, 2018. Available in 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. Process Family, 42(3): 403-418.
• Alanen, Y. (1997). Schizophrenia. Its Origins and Need-Adapted Treatment. London: Karnac.