“Open Dialogue has evolved because of a series of psychotherapeutic theories, philosophical and psychological concepts. This article will tell you more.”
Over the course of the last 6 years I have developed an interest in Open Dialogue training initially attending workshops run by Val Jackson in Leeds and Nick Putman in various locations the most interesting and dynamic being the series of weekends Nick ran 5 years ago in Hackney. These Hackney Open Dialogue Course weekends which were well attended by professionals, carers and service users were where I initially met the team from Western Lapland that we had heard and read so much about and the legendary Jakkoo Seikkula. The second weekend was an unforgettable experience in that myself and a work colleague ended up volunteering for a family network meeting role play on the stage with Jakkoo something I would ordinarily avoid at all costs. The feeling of being contained and heard in such a setting further encouraged me to extend my understanding of Open Dialogue training.
I think that experience of role play highlighted to me the difficulty I encounter teaching and practising as a trainer and clinician Behavioural Family Therapy (BFT) as a model, at work within the NHS. I work in Early Intervention Services in Kent and the NICE guidelines for psychosis and schizophrenia state that we should be offering behavioural family therapy ( BFT) the framework and evidence base is geared towards and influenced by the work carried out by the Meridien team in Birmingham commencing in the 90's. Since participating in the Open Dialogue training I have found BFT increasingly restrictive.
As an integrative psychotherapist who has been practising for 12 years I have found the increasing focus on behavioural therapies within the NHS concerning. We are told that it is because of the evidence base but having managed services employing a wide range of psychological practitioners using CORE 34 I am aware that it is the practitioner as opposed to the approach that produces change, which research confirms. The focus in services appears to be to reduce the range of therapeutic interventions offered with the emphasis being on behavioural therapies which are offered in increasingly reduced session numbers as a one size fits all solution. BFT can be useful with some families because it provides a precise framework for the delivery of a weekly intervention clearly documented in the manual, tests and exercises are incorporated in the homework which the family is expected to continue with between sessions. The approach is designed to assist carers as much as the service user and to facilitate improved communication and understanding of the service user's presenting issue. BFT is a manualised approach which can be delivered after a week's training by any member of the team and is increasingly being used in a number of settings including dementia services, older adults, substance misuse etc.
The Open Dialogue training which provides the foundation for the new Open Dialogue service in Kent, is at the opposite end of the therapeutic spectrum to BFT. The POD training consists of 4 one week modules with study, self awareness and reading between the residentials. There is a lack of enforced structure beyond the basic 7 principles of, immediate help, social network perspective, flexibility and mobility, responsibility, psychological continuity, tolerance of uncertainty and dialogism. Meetings can occur regularly or irregularly and their duration varies but normally they last well over the conventional therapeutic hour, their composition can also vary in that the service user can request that anyone they feel is important to them can attend. There are no expectations of tasks or homework to be completed and the change occurs within the generation of dialogue in the network meeting. The aim is to discover a language to express experiences that remains embodied in the individual's personal language and inner disturbances and to recognise the multiplicity of voices within the meeting - what Bakhtin identifies as 'the polyphony'.
What angers me is that instead of being able to utilise these two approaches within EIS services we are forced by the dictates of NICE guidelines and the new strictures for EIS to employ BFT as the only family therapy approach offered. This is in-spite of the well documented research on Open Dialogue which confirms a 72% recovery rate a figure that far exceeds are current EIP success rates.
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.
