Open Dialogue Therapy, or Open Dialogue Model , 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 a major impact in recent decades, especially in Europe, but has already begun to spread around the world. This is due to its results and also because it has managed to reformulate many of the psychiatric concepts and practices that were considered the best, or even the only, option for care.

What is Open Dialogue Therapy?

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

It has gained much popularity recently because it has positioned itself as a fairly effective therapeutic option, which also offers alternatives to psychiatry . 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 an epistemological position (a way of thinking, which can have an impact on the way of working) in psychiatric contexts.

Where does it come from?

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

In response, a need-based approach to psychiatric care was developed 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 dialogical communication (equal 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 seek to gather information to generate a collective diagnosis , then 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 have also 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 team that makes the intervention, the crisis can generate a great possibility of actions, because a great amount of resources and elements are generated that outside the crisis are not visible . In 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 illness) involves an individual experience, it is a collective issue. Therefore, the 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 core group, but also co-workers, employers, social service personnel, etc.

3. Flexibility and mobilization

Once the specific needs of the person and the characteristics of their immediate context have been detected, the treatment is always designed in an adapted way.

Also, its design leaves open the possibility that the needs of the person and the characteristics of their context are modified, 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 who has a crisis situation; instead of starting immediately with the prescribed and institutionally pre-designed protocols.

4. Teamwork and responsibility

The person who manages the first meeting is the one who has been contacted in the beginning. Based on the needs detected, a work team is formed that can 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, 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 with diagnosis, and a hospital ward nurse.

5. Psychological continuity

In line with the previous point, team members remain active throughout the process, no matter where the person with the diagnosis is located (at home or in the hospital).

This means that the team makes a long-term commitment (in some cases the process may take several years). Different therapeutic models can also be integrated, which is agreed upon through the treatment meetings.

6. Uncertainty tolerance

In traditional psychiatric care it is quite common that the first or only option considered during acute crises is forced confinement, hospitalization or neuroleptic medication. Sometimes, however, these turn out to be hasty decisions that work better to calm the therapist’s anxiety about what he or she is not expecting.

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

7. Dialogue

The basis of the Open Dialogue Model is precisely to generate dialogue between all the people who participate in 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 happen, 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 a matter of creating a forum where the person with a diagnosis, his/her family, and the intervention team generate new meanings for the behavior of the person with a diagnosis and his/her symptoms; a matter that favors the autonomy of the person and his/her family.

In other words, a treatment model based on support and social networks is organized , which promotes dialogical equality among the people who participate: the arguments aim to expose the validity of certain knowledge or experiences, and not to reaffirm positions of power or authoritarian positions.

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.