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Open Dialogues with Clie and Their Families

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Open Dialogues with Clie and Their Families practitioners of some of the ways they are introducing the organisational principles Open dialogues with clie of open dialogue and/or dialogical practices into their agency settings, and discussions of new UK-based trainings in and their families the approach. There are also discussions of links between open dialogue and contemporary theatrical-approaches, Jaakko Seikkula while there are several contributions expanding the conversation with other In a psychotic or other severe mental Keränen, 1992; Seikkula et al., 2003; 2006; therapeutic modalities, including narrative, health crisis, it should be normal 2011). psychoanalytic and mindfulness-based psychiatric practice for the fi rst meeting By summarising the observations in approaches. Although open dialogue to take place within a day of hearing about these studies, seven main principles of the was initially developed as a therapeutic the crisis. Furthermore, both the client system emerged: approach to psychosis, it has much wider and family should be invited to participate Immediate support; applications and this issue includes an in the fi rst meeting and throughout the A social networks perspective; account of an innovative network-based treatment process, for as long as is needed. Flexibility and mobility; approach to helping a service user with In these meetings, all relevant Responsibility; learning diffi culties. professionals are invited to participate Psychological continuity; We are particularly delighted to include and openly share their thoughts and Tolerance of uncertainty; articles by Ray Middleton and Jan Kilyon, opinions about the crisis. Th ey should Dialogism. who write from their experiences of being stay involved for as long as help is needed. Th ese principles came out of the research a service user and a carer, calling for the All discussions and treatment decisions and were not planned before. Later on, wider adoption of dialogical approaches by should be made openly in the presence of more general ideas about good treatment services. the client and family. Th e fi rst aim is to were added. Th e approach is not diagnosis generate a collaboration that tolerates the specifi c, but describes an entire network- References uncertainty of the crisis to mobilise the based treatment that is especially practical Alanen, Y.O. (1997) Schizophrenia: It’s Origins and Need-Adapted Treatment. London: Karnac. psychological resources of all involved. in crisis situations. Andersen, T. (1990) (ed.) The Refl ecting Team: Starting medication should be discussed Dialogues and Dialogues about the Dialogues. and decided openly as a part of this process. Immediate response Kent, UK: Borgmann. Cooke, A. (2014) (ed.) Understanding Psychosis Th ese are the basic guiding principles of In a crisis, it is vital to act immediately and Schizophrenia. British Psychological Society, the open-dialogue approach that originated and not to wait for the client with psychosis Division of Clinical Psychology. bps.org.uk in the Western part of Finnish Lapland. Its to become more coherent before a family Laws, K., Langford, A. & Huda, S. (2014) Understanding Pychosis and Schizophrenia: A development started in the early 1980s and meeting. It is preferable that the fi rst Critique. www.thementalelf.net the open dialogue system has been going response be initiated within 24 hours, Penn, P. (1999) Metaphors in regions of on now for about 30 years. as this can prevent hospitalisation. Th e unlikeness. Human Systems, 10: 3-10. Speck, R.V. & Attneave, C.L. (1973) Family In Finland, psychotherapeutic practice meeting is organised regardless of who fi rst Networks. New York: Pantheon. has long been part of public health- contacted the response unit. In addition, a care. Especially important has been the 24-hour crisis-service ought to be set up. development and research undertaken Everyone, including the client, in Turku by Yrjö Alanen and his team participates in the very fi rst meetings since the1960s. Starting with individual during the most intense psychotic period. psychodynamic psychotherapy, the Turku Th e clients usually seem to be experiencing team integrated family perspectives into something that has been unappreciated their treatments in the late 1970s and called or unacknowledged by the rest of the the approach need-adapted treatment family. Although the clients’ comments (Alanen, 1997) in order to emphasise that may sound incomprehensible in the every treatment process is unique and fi rst meetings, aft er a while, it becomes should be adapted to the varying needs of apparent they are actually speaking of each client. real incidents in their lives. Oft en, these incidents include some terrifying issues, Open dialogues in organising a threat or theme that they have not been psychiatric practice able to articulate before the crisis. Th is From its very beginning, the open- is also the case in other forms of diffi cult dialogue system has been based on behaviour. In extreme anger, depression or rigorous evaluation of both the dialogical anxiety, the client is speaking of previously Open dialogues with clients with mental health problems and their families processes in meetings with the clients and unspoken themes. In this way, the main their families, and of the outcomes in crises person in the crisis, the client, reaches for (Aaltonen et al., 2011; Haarakangas, 1997; something that had not been touched by 2 Context 138, April 2015 ents with mental health problems others in their surroundings. Th e aim of the who should be invited to meetings. It can specifi c language and their way of living. treatment becomes the expression of these be done, for instance, by asking the person During the fi rst ten to twelve days of a experiences that previously had no words, who made contact in the crisis: crisis, the need is quite diff erent compared especially those that had not developed a 1. Who is concerned about the situation or with the need three weeks later. For shared language. who has been involved? instance, during the most acute phase, it is During the fi rst couple of days of a crisis, 2. Who could be of help and is able to oft en advisable to meet every day, which it seems possible to speak of things that participate in the fi rst meeting? is no longer necessary once the situation are diffi cult to discuss later. In the fi rst 3. Who would be the best person to invite has stabilised. In that later period, families days, hallucinations may be handled and them, the one who contacted the services generally know how frequently they should refl ected upon, but they easily fade away, or the treatment team? be meeting. and the opportunity to deal with them may By doing it this way, the participation of Th e best place for the meeting, if the family not reappear until aft er several months of those closest to the client is suggested as approves, might be the client’s home. Home individual therapy. It is as if the window for part of an everyday conversation, which meetings seem to prevent unnecessary these extreme experiences only stays open decreases any possible suspicion about the hospitalisations, since the family’s own for the fi rst few days. If the team manages invitation. Also, the one who has made resources are more accessible in that sett ing to create a safe enough atmosphere by contact with the services can decide who (Keränen, 1992). In traditional psychiatry, responding rapidly and listening carefully is or isn’t present. If the proposal for a families can easily refuse to participate in to all the themes the clients bring up, then joint meeting is made offi cially, by asking, treatment. However, the need-adapted important themes may fi nd a space where for instance, “Will you allow us to contact approach, with its emphasis on taking into they can be handled and the prognosis your family and invite them to a meeting?”, account the uniqueness of each treatment improves. problems may arise in engaging both the process, has been more successful in clients and those close to them. engaging with families. Including the social network Another factor in identifying the Th e clients, their relatives, and other key relevant participants is to fi nd out whether Responsibility Open dialogues with clients with mental health problems and their families members of their social network are always the clients have contacted any other Organising a crisis service in a catchment invited to the fi rst meetings to mobilise professionals, either in connection with area is diffi cult if all the professionals support for the client and the family. Other the current situation or previously. If the involved are not committ ed to providing key members may be representatives of other professionals cannot att end the fi rst an immediate response. A good rule other authorities such as state employment meetings, a joint meeting can be arranged of thumb is to follow the principle that and insurance agencies, vocational- later. whoever is contacted takes responsibility rehabilitation services, fellow workers or Th e people in the client’s social network for organising the fi rst meeting and the supervisor at the client’s workplace, as can be included in many ways. If they inviting the team. Th e person contacting well as neighbours or friends. cannot be present, the client can be asked the professional could be, for example, Social networks can be seen as relevant if they want to invite others who could the client, a family member, or a referring in helping defi ne the problem. A problem possibly help. Some member of the network practitioner. Th is means it is no longer is one that has been defi ned as such in can be given the task of contacting them possible to respond to a request for help by the language of either those closest to the aft er the meeting and relaying the absent saying, “Th is has nothing to do with us, please client or by the client him or her self.
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