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When we look at mental health and mental health problems from the family and carers viewpoint there are many theoretical perspectives to be found (for example, humanistic, psychodynamic, social and systems theory). Today emotional intelligence as well as knowledge on carer burden, stress and coping in crisis are also recognized as important perspectives. As a background for interaction with families we would like to briefly discuss the Open dialogue approach.
The background to the philosophy and practical implementation of open dialogue can be found in the thinking of: Mikhail Bakhtin, Gregory Bateson, Milan team in systemic family therapy, the narrative therapy of Michael White, the constructivist ideas of Lev Vygotsky, the reflective team ideas of Tom Andersen and the collaborative language systems approach by Galveston group. (Seikkula & Olson 2003)
Open dialogue is based on the idea of the importance of networks in care and the significance of language. Working with families and other social networks is one of the cornerstones of mental health care.
The open dialogue approach includes the importance of trust and mutual understanding, but this should not be mistaken with a consensus or a need for similarity in participants' ideas and thoughts, but more like a space for different opinions and viewpoints to be heard and shared in a safe and secure social environment. Dialogue is not only about talk, but it is about co-creating meaning, a dialogue in which a sense of self and identity might also arise. Key concepts such as polyphony, dialogism and tolerance of uncertainty are central in open dialogue.
Polyphony means that in the meeting there are multiple subjects, multiple voices, and these are all equally valuable. Each person can enter the discussion in the way he or she wants and everyone has the right to comment; the presence of different "voices" is made possible. Professionals can ask and reflect, but in a way that fits to ongoing themes. This enables service users and family members to re-construe their experiences.
Dialogism has its background in the thinking of Mikhail Bakhtin. In open dialogue dialogism has a therapeutic aim to enable the family "to develop a common verbal language for the experiences that otherwise remain embodied within person's psychotic speech and private, inner voices and hallucinatory signs" (Seikkula & Olson 2003, p.409). Dialogism is seen as a process of listening and understanding, in which listening is more important than interviewing. "The therapeutic process requires creative participation in language that attends not only what people say, but also to the existing feelings and sensuous responses that flow between them" (Seikkula & Olson 2003, pp. 409).
These following resources will give you more information about open dialogue and its practical implementations:
Other websites with materials and information:
Several to be found in here, search with Seikkula as a last name.
Carr A. 1991. Milan systemic family therapy: a review of ten empirical investigations. Journal of Family Therapy 13, 237-263.
Holmesland AL, Seikkula J & Hopfenbeck M. 2003. Inter-agency work in Open Dialogue: the significance of listening and authenticity. Family Process 42(3),331-43.
Rober P. 2005. The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation. Family Process 44(4), 477-95.
Guilfoyle M. 2003. Dialogue and power: a critical analysis of power in dialogical therapy.. Family Process 42(3), 331-43.
Seikkula J & Olson M E. 2003. The open dialogue approach to acute psychosis: its poetics and micropolitics. Family Process 42(3), 403-18.
Seikkula J, Alakare B & Aaltonen J. 2011. The comprehensive open-dialogue approach in Western Lapland: II Long-term stability of acute psychosis outcomes in advanced community care. Psychosis 3, 192-204.
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