“In his article “Combining the Use of Open Dialogue with Narrative Therapy” Hugh Fox discusses ideas that are relevant to the use of the narrative therapy approach within an Open Dialogue training and an Open Dialogue Service.”
I decided to review this article because I had heard a great deal about Hugh Fox as a supervisor through conversations with Val Jackson, (a family therapist who has been pivotal to the development of Open Dialogue training within the UK) and I have attended many of her workshops. I therefore felt I was one step removed from knowing him and was interested in the topic of combining the Open Dialogue course with Narrative Therapy.
As Jaakko Seikkula has discussed in various presentations and workshops I have attended, Open Dialogue training can be combined with a number of therapeutic approaches and is needs adapted, the therapist working with the client would however attend the network meeting.The individual and their network who are working with the Open Dialogue Service are not precluded from further interventions, CBT, psychoeducation, motivational interviewing etc. In his article Hugh Fox discusses how in Open Dialogue training the listening is not to assess , hypotheses or interpret it is to understand, it is having two “I” ‘s in the room, not another object but two subjects. Fox concentrates on the commonality of the approaches he does not discuss the first principle of Open Dialogue training which is the immediate response to a crisis, this is more practical and relates to the formation of Open Dialogue Services.Foxalso doesn’tdwell on the bodily response to the individual, an important concept within Open Dialogue training. There are Fox perceives a similarity in the approaches in the way they explore the development of language, the acceptance of the literal expression and the experience without judgement or interpretation, “the being with”. The importance of what the voices represent, their polyphony and the acknowledgement of the experience is fundamental to both approaches and they both eschew the medical model which is dismissive of the meaning. The narrative discourse and Open Dialogue training both dispense with the professional as being the sole source of wisdom, in Open Dialogue Services the network meeting is seen as a resourcefor the individual’s recovery and their expertise is recognised and valued.There is an encouragement to treat conversations seriously and an invitation to the family to participate and they are encouraged to do so but there no compulsion.
The differences are that narrative therapy has little interest in organisations and does not see psychotic experience as a direct consequence of life events whereas Open Dialogue training regards these experiences as formative. Hugh Fox also feels that narrative therapy is more proactive in its approach to change and making new meaning than a purist Open Dialogue training, although both approaches emphasise personal agency.
The discussion in relation to the reflecting teams in the article is helpful and relates tokeeping to the network meetings own words and using the reflecting period to introduce and experiment with new ideas, thus creating a space. Jackson discussed using the reflecting space for narrative ideas to speed up the process, because there are more frequent meetings in Open DialogueServices than in narrative therapy(initially an Open Dialogue Service may be meeting daily with the family network). This use of the reflective space is similar to the narrative therapy use of the concept of outsider-witness. Initially the therapeutic encounter requires listening but later with the development of the relationship increased reflection is deemed necessary.
The conclusion being that Hugh Fox not unsurprisingly experiences a compatibility and a fit between the two approaches. He feels that narrative therapy used in conjunction with Open Dialogue training will move the process of change forward faster.
Author Bio: Jane Hetherington, Principal Psychotherapist at KMPT and an employee at Early Intervention Services in Kent, has completed Open Dialogue course and will be a part of the new Open Dialogue service. She is trained as an integrative psychotherapist and has experience working in primary care, substance misuse, and psychosis services. Here, she writes about a few psychotherapeutic theories.
