Open dialogue therapy: 7 principles of this mental health model

Open dialogue therapy or open dialogue model, Is a therapeutic approach that reinforces the creation of dialogic spaces as an effective alternative to reduce psychiatric symptoms.

This model has had a major impact in recent decades, especially in Europe, but has already started to spread around the world. This is because of his results and also because he was able to reformulate much of the psychiatric concepts and practices that were considered the best, if not the only, option for care.

    What is Open Dialogue Therapy?

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

    It has recently gained popularity as it has positioned itself as a fairly effective therapeutic option, which offers alternatives to psychiatry. In other words, it reformulates the traditional knowledge and practices of psychiatry, in particular those which may be more coercive.

    More than a defined method, the authors of the open dialogue model define it as an epistemological position (a way of thinking, which can affect the way we work) in psychiatric contexts.

    Where is he from?

    Open Dialogue Therapy is occurring in the northern region of Finland, particularly in a context where lifestyles have rapidly shifted from an agricultural economy to a focus on urban economies; question it significantly affected the mental health of a large part of the population the characteristics were very homogeneous.

    In response, psychiatric care developed a personalized approach in the early 1980s, which notably succeeded in reducing psychotic symptoms while strengthening family and professional networks, hospitalizations were reduced and medicalization was reduced.

    Research evaluating the effectiveness of this model led to the following conclusion, which was then turned into a concrete proposition: to facilitate dialogical communication (equal dialogue between people) in psychiatric treatment systems, it is a very effective.

    7 Fundamentals of Open Dialogue Therapy

    Treatment sessions in the open dialogue model seek collect information to generate a collective diagnosisNext, 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. This is a series of guidelines that have had results in different people who also have different diagnoses.

    1. Immediate intervention

    It is essential that the first meeting be scheduled no later than 24 hours after the first approach of the diagnosed person, his family or his institution.

    For the intervening team, the crisis can generate a great possibility of action, because a large amount of resources and items are generated that are not visible outside of the crisis. In this first moment, it is important to mobilize the support networks of the person.

    2. The social network and support systems

    While mental health (and therefore illness) involves individual experience, it is a collective matter. For that, family and nearby support groups are active participants in the recovery process.

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

    3. Flexibility and mobilization

    Once the the specific needs of the person and the characteristics of their immediate context, The treatment is always designed appropriately for this.

    Likewise, in its design, the possibility is open that the needs of the person and the characteristics of their context are changed, which means that the treatment is flexible.

    An example given by the authors is to hold a daily meeting at the home of the person in crisis; instead of starting immediately with prescribed and preconceived protocols by the establishment.

    4. Teamwork and responsibility

    The person who manages the first meeting is the one who was initially contacted. Depending on the needs detected, a work team is formed which may include both ambulatory and hospital staff, and who will assume responsibilities throughout the follow-up.

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

    5. Psychological continuity

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

    Which means the work team acquires a long-term commitment (In some cases, the process can take several years). They can also integrate different therapeutic models, which is agreed during treatment meetings.

    6. Uncertainty tolerance

    In traditional psychiatric care, it is quite common that the first or only option considered during acute attacks is forced closure, hospitalization or neuroleptic medication. However, sometimes these are hasty decisions that do more to calm the therapist’s anxiety about what he has not planned.

    The open dialogue model works with the therapist i he invites him to avoid hasty conclusions, both for the person diagnosed and for the family. To achieve this, it is necessary to create a network, a team and a safe working environment, which will offer this same security to the therapist.

    7. Dialogue

    The basis of the open dialogue model is precisely to generate a dialogue between all the people involved in the treatment meetings. Dialogue is understood as a practice which creates new meanings and explanations, which it creates possibilities for action and cooperation between actors.

    For this to happen, the team must be prepared to create a safe and open environment for discussion and collective understanding of what is going on. Generally, it is about creating a forum where the diagnosed person, his family and the intervention team generate new meanings for the behavior of the diagnosed person and his symptoms; question that promotes the autonomy of the person and his family.

    In other words, it is organized a treatment model based on support and social networks, Which promotes dialogical equality between the people involved: the arguments aim to expose the validity of certain knowledge or experiences, and not to reaffirm 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 4, 2018.Available in Open Dialogue: An Approach to Psychotherapeutic Treatment of Psychosis in Northern Finland.
    • Seikkula, J. (2012). Does it become dialogic: psychotherapy or way of life? Australian and New Zealand Journal of Family Therapy, 32 (3): 179-193.
    • Seikkula, J. (2004) online. The open dialogue approach to acute psychosis: its poetics and its micropolitics. Family Process, 42 (3): 403-418.
    • Alanen, Y. (1997). Schizophrenia. Its origins and treatment adapted to needs. London: Karnac.

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