Peer Supported Open Dialogue A Trainee's Perspective

My name is Jane Hetherington and I am Principal Psychotherapist with Early Intervention Services (EIS) in Kent, I work for the Kent and Medway Partnership Trust which supplies the mental health service provision in the county. I have completed the Peer Supported Open Dialogue training and I am now a mentor supporting the dissemination of Open Dialogue within my Trust and assisting with the POD training. By way of introduction I came to psychotherapy and KMPT after a career in law followed by management of third sector substance misuse projects and primary care and community counselling and psychotherapy services.

My interest in Open Dialogue started after joining EIS when I became aware of this approach through Open Dialogue workshops held by Val Jackson and Nick Putman. The Open Dialogue approach was also being discussed at the ISPS Conferences and on various sites and forums, it seemed to be an approach which resonated with service users, carers and clinicians. It was exciting to find a way of working which could replace what I perceived as many of the deficits in the current system, continuity of care, dialogue, compassion, family work and lest we forget vastly improved outcomes.

I was fortunate to attend a series of Open Dialogue trainings on some very hot, summer weekends in Hackney a few years ago when Jaakko Seikkula and his colleagues from the Finnish team enthused us with their introduction to this way of working and gave us an idea of the essence of Open Dialogue (OD). My colleague and I offered to work on the stage with Jaakoo and members of his team bringing are own material to the enactment of a network meeting. I was hugely anxious but this Finnish way of working in a gentle, dialogic manner allayed my performance anxiety and further enforced my instincts that an Open Dialogue service is the way forward for mental health provision in the NHS. I felt that it was important for us to be receiving training in Open Dialogue ideas and thinking. In order that we could implement this in psychosis services and more generic mental health presentations as they do in Tornio in Western Lapland, Finland where it is the sole form of treatment.

Open Dialogue is a deceptively simple approach and many health professionals say " this is what we do anyway" unfortunately this is not the case. There is not the quality of listening to the utterances or the attunement to the embodied dialogue. Many health care professionals are trained to have an agenda, the clients concerns will be raised in relation to medication, risk, normalisation, making changes, returning to work/ study/ volunteering etc. Peer supported open dialogue services allow the client and their family the space to be listened to in a non judgemental person centred manner that allows a healing dialogue to develop naturally without an.

As a psychotherapist who is trained to reflect on the every nuance of the spoken word and the physical language of the body, my work is perhaps mostly closely allied to this approach. I was however trained to see the service user as an individual so working with other members of the family or peer group in a network meeting adds another dimension to the process. I was also encouraged to think in terms of formulation and interpretation or alternatively to work using behavioural concepts to illicit change. The Open Dialogue training requires a re-examination of my psychotherapeutic work within the NHS which is driven by the requirements of the NICE guidelines.

The concept of POD has led me to return to the core aspects of the integrative psychotherapy training, aspects of which I had lost in my current role. I feel that my fellow professionals from a number of other approaches feel that the Open Dialogue training and service has allowed them to return to the values that attracted them to mental health work.

About Author: I am Declan Coleman Principal Psychotherapist with KMPT currently working in Early Intervention Services n Kent. I trained as an integrative psychotherapist and have worked in substance misuse, primary care and psychosis services. I have completed the Open Dialogue training and will be involved in the new Open Dialogue Service.