Healing elements of therapeutic conversation: dialogue as an embodiment of love

Power, position and social relations: Is the espoused absence of hierarchy in Open Dialogue naïve?

Open Dialogue practitioners aim to reduce social hierarchies by not privileging any one voice in social network conversations, and thus creating space for a polyphony of voices. This sits in contrast to the traditional privileging of those voices credited with more knowledge or power because of social position or professional expertise. Using qualitative interviews, the aim of this current study was to explore Open Dialogue practitioners' descriptions of challenges in implementing Open Dialogue at a women's health clinic in Australia. Findings revealed how attempts to rhetorically flatten hierarchies among practitioners created challenges and a lack of clarity regarding roles and responsibilities. As the practitioners tried to adjust to new ways of working, they reverted to taking up engrained positions and power aligned with more conventional social and professional roles for leading therapy and decision-making. The findings raise questions about equity-oriented ways of working, such as Open Dialogue, where intentions of creating a flattened hierarchy may allow power structures and their effects to be minimised or ignored, rather than actively acknowledged and addressed. Further research is needed to consider the implications that shifting power relations might have on the roles and responsibilities of practitioners in the move to equity-oriented services.

The effectiveness of a dialogical family guidance intervention regarding child treatment response in families with a child with neurodevelopmental disorders

BACKGROUND

Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents` opinions regarding their child`s emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up.

METHOD

Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children`s emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed.

RESULTS

The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up.

CONCLUSIONS

The result does not show any differences between parents` opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention`s effect regarding the child`s mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021).

Training in Open Dialogue and Dialogical Practice: creatively responding as trainers and writers

This paper emerges from a series of conversations about training in Open Dialogue and dialogical practice. In our dialogue, we found ourselves moving away from seeking definitive answers about content (what to include) or process (how to include). We asked, "Why are we asking this question about training at all?" Maybe it is because many helpers and all kinds of professionals all over the world are truly asking, "How do we do, or how do we learn how to do 'open dialogue'?." That question starts with "How to train others in the practice?" We moved toward responding to our own questions-what are we offering as trainers and what are the trainees seeking? We sought to explore what is required for a training space that accommodates the hopes of both trainers and trainees. Words arose during our talking, and we listened to them, let them sink in, and reflected on them. Some words resonated with us as trainers; some linked with observing trainees' experiences (including our own); some showed a glimpse of the relationship between trainer and trainees. These emergent words point to a series of learnings, aspects of the training that we as trainers have come to believe are important. The following paper expands upon these words while also including actual portions of our dialogues and vignettes from training. As such, we illustrate our ongoing learning as trainers of Open Dialogue and dialogical practice as it occurs within the unique nature of each training we provide.

Unraveling complexity in changing mental health care towards person-centered care

Background

Mental health care (MHC) needs to shift towards person-centered care to better meet people's individual needs. Open Dialogue (OD) is well-aligned with this perspective and brings it into practice. This study focuses on exploring the change process within a pilot project involving three MHC teams as they transition to a person-centered OD practice. Our aim is to identify and reflect on the challenges faced by MHC professionals in adopting person-centered care, and shedding light on the underlying complexity of these challenges. By gaining a better understanding of these obstacles, we hope to contribute to the adoption of the person-centered approach in MHC practice.

Methods

Our research employed a qualitative design, involving a total of 14 semi-structured interviews with MHC professionals who were either trained in OD, OD trainees, or MHC professionals without OD training. To analyze the data, we utilized a hybrid approach that combined deductive - and inductive thematic analysis.

Results

We identified four distinctive challenges: (1) understanding and knowledge transfer, (2) (inter)personal process, (3) emotional discomfort, and (4) the need for multi-stakeholder participation and support. In practice, these challenges intersect and the appearance of and relationships between these challenges are not linear or disentangleable.

Conclusion

Upon careful consideration of these interdependent challenges, it became evident that embedding a person-centered approach like OD brings about systemic change, leading to an unfamiliar situation X. The research findings indicated that understanding and conveying the concept of person-centered care in practical settings poses significant challenges. The field of knowledge management helps to capture the complexity of understanding and transferring this knowledge. The change process necessitates an (inter)personal process and elicits emotional discomfort, as person-centered OD practice confronts a deeply entrenched paradigm in MHC. Achieving a shared understanding of person-centered care requires dedicated time and attention, while introducing this approach prompts broader discussions on underlying values and human rights in MHC. Current implementation efforts may underestimate or overlook these underlying values, but initiating an open dialogue can serve as an initial step in addressing the complexities.

Experiences of dialogue in advance care planning educational programs

BACKGROUND

Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown.

OBJECTIVE

To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life.

RESEARCH DESIGN

This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT

A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews.

ETHICAL CONSIDERATIONS

This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099).

FINDINGS

Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values.

CONCLUSIONS

The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

The contribution of anthropology to the study of Open Dialogue: ethnographic research methods and opportunities

When Open Dialogue diversifies internationally as an approach to mental healthcare, so too do the research methodologies used to describe, explain and evaluate this alternative to existing psychiatric services. This article considers the contribution of anthropology and its core method of ethnography among these approaches. It reviews the methodological opportunities in mental health research opened up by anthropology, and specifically the detailed knowledge about clinical processes and institutional contexts. Such knowledge is important in order to generalize innovations in practice by identifying contextual factors necessary to implementation that are unknowable in advance. The article explains the ethnographic mode of investigation, exploring this in more detail with an account of the method of one anthropological study under way in the UK focused on Peer-Supported Open Dialogue (POD) in the National Health Service (NHS). It sets out the objectives, design and scope of this research study, the varied roles of researchers, the sites of field research and the specific interaction between ethnography and Open Dialogue. This study is original in its design, context, conduct and the kind of data produced, and presents both opportunities and challenges. These are explained in order to raise issues of method that are of wider relevance to Open Dialogue research and anthropology.

Say what you want, I’m not listening!

We present a conversational social robot behaviour design that draws from psychotherapy research to support individual self-reflection and wellbeing, without requiring the robot to parse or otherwise understand what the user is saying. This simplicity focused approached enabled us to intersect the well-being aims with privacy and simplicity, while achieving high robustness. We implemented a fully autonomous and standalone (not network enabled) prototype and conducted a proof-of-concept study as an initial step to test the feasibility of our behaviour design: whether people would successfully engage with our simple behaviour and could interact meaningfully with it. We deployed our robot unsupervised for 48 h into the homes of 14 participants. All participants engaged with self-reflection with the robot without reporting any interaction challenges or technical issues. This supports the feasibility of our specific behaviour design, as well as the general viability of our non-parsing simplicity approach to conversation, which we believe to be an exciting avenue for further exploration. Our results thus pave the way for further exploring how conversational behaviour designs like ours may support people living with loneliness.

Play and liberty: A brief incursion into some ideological currents in the history of systems-oriented family therapy

We reflect on family therapy and its history from two points of view, as an entity that becomes understood with the help of a twofold concept of a game, and a twofold concept of liberty. Systemic family therapy has always been comprehended with the help of game theory. Its development becomes more properly understood if we keep in mind that game itself is a dualistic concept entailing both a cultural and a logico-mathematical interpretation of a game. We show how cultural ethos has molded the ways how game metaphor have been implemented to systemic thinking. In the same manner we show how Isaiah Berlin's idea of two incompatible concepts of liberty helps to contextualize family therapy in a way that its connections to sociopolitical theories of liberty become obvious. We believe that we have been able to demonstrate, how this twofold recontextualisation enriches the understanding of the ideological history of the family therapy. We claim that our reflections imply that family therapy is essentially a dualistic endeavor, that in the amid of it is a rift that cannot become repaired but only contemplated, that integrity of family therapy requires that we preserve both conflictual views, and don't try to simplify situation by abandoning one or the other. As a result, our article intends to develop further and deepen the idea that is originally presnted in the article "Strategy and intervention or non-intervention: A matter of theory" by Harold Goolishian and Harlene Anderson.

How clinicians can support posttraumatic growth following psychosis: a perspective piece

Psychosis is often a traumatic experience that can lead to significant suffering. However, people may also experience posttraumatic growth following psychosis. Posttraumatic growth refers to the positive changes that people experience following a struggle with an adversarial event and has been shown to occur in at least five domains, including a greater appreciation for life; improved relationships with others; greater personal strengths; new life possibilities and spiritual/existential growth. Studies have shown that mental health services can play a key role in facilitating posttraumatic growth. However, there are no recommendations that clinicians can follow to best support posttraumatic growth following psychosis specifically. Without guidance, clinicians risk invalidating people's experiences of, or providing improper support for, posttraumatic growth. To address this knowledge gap, we reflect on current research and clinical guidelines to recommend ways that clinicians can support posttraumatic growth following psychosis.

A conversation analysis of therapist repeats in open dialogue network meetings

Writings on Open Dialogue approaches to working with families experiencing mental distress emphasize the importance of the therapist repeating the family's words back to them verbatim. Repeats are theorized to display the therapist's listening and to encourage elaboration without imposing the therapist's own interpretations or conclusions on the family. These recommendations have not been subjected to rigorous interactional investigation. In this study, we used conversation analysis to analyze 160 examples of therapists repeating the prior talk of the family from 14 h of video-recorded Open Dialogue sessions. We found that these repeats had similar functions to those previously described in conversation analysis research such as initiating repair, marking receipt, and requesting elaboration as well as examples of therapist repeats occurring in overlap with the talk of the client. Open Dialogue writings thus present an oversimplified account of how repeats are utilized in clinical Open Dialogue sessions. Consistent with dialogical writings, repeats can elicit elaboration with limited input from the therapist, however repeats reflect selectivity and function to direct and guide the conversation to some extent. So, while therapist authority can be mitigated by repeating clients' words, when a therapist chooses to employ a repeat actively shapes the direction of the interaction.

Co-therapy in Open Dialogue: Transforming therapists' self in a shared space

The present study aimed to explore co-therapists' relationship and how therapists' individual presence influences this relationship in Open Dialogue. Although co-therapy is key in Open Dialogue network meetings, the processes of that relationship remain largely understudied. The study applied thematic analysis to semi-structured interviews with 20 Open Dialogue trained therapists working in public and private sectors internationally. The results indicate that therapists are present in a meeting with their experiencing and professional self. Specific co-therapy processes allow co-therapists to attune to one another verbally and physically, creating a shared space that promotes new common understandings, shared responsibility and ultimately a transformation of each therapist's self and practice. Trust between co-therapists seems to be a prerequisite for co-therapy to flourish. Results of the present study reveal a dynamic influence of co-therapy practice, in which co-therapy promotes a more dialogical personality and allows the therapists' own transformation, which in turn enables common understandings and sharing of responsibility. Considering the growing interest in dialogical approaches and Open Dialogue trainings, trainers, supervisors, and practitioners need to be aware of and attend to the dynamics of co-therapy relationship in order to care for themselves, their team and ultimately the networks they collaborate with.

Introducing Peer-supported Open Dialogue in changing mental health care

The need to transform mental health care toward person-centered, recovery-based, and network-oriented care is recognized worldwide. Open Dialogue (OD) is seen as a hopeful approach in the context of this transformation and is introduced in countries around the globe. Five Dutch mental health care organizations spread over the Netherlands introduced the Peer-supported Open Dialogue (POD) approach, which adds an explicit role of peer-support workers to the OD approach. It appeared that (P)OD-trained professionals face issues in introducing the (P)OD approach in existing MHC settings. One of the reasons, which is the focus of this study, may be that they encounter difficulties in explaining to non-(P)OD-trained professionals what (P)OD entails. The main objective of this study is to provide guidance to and contribute to making (P)OD better understandable for non-(P)OD-trained professionals. In this study, we used a qualitative design and conducted 23 semi-structured interviews with POD-trained professionals with various backgrounds, to cultivate a rich understanding of which aspects could contribute to a better understanding of POD for non-POD-trained professionals. We used a hybrid approach to analyze the data, meaning that the technique of both inductive and deductive thematic analyses has been applied. From these analyses, six aspects emerged that could give guidance to and contribute to making (P)OD more understandable for non-(P)OD-trained professionals: (1) Experiencing (P)OD by attending treatment network sessions, (2) a coherent and profound narrative about (P)OD, (3) adjusting terminology to better fit the context, such as the two terms "principles" and "responsibility" in this study, (4) the order in which (P)OD elements are introduced in the narrative, (5) bringing the elements "presence," "reflecting," and "expertise by experience" more to the foreground, and (6) conceptualizing the main elements in a "talking paper." A better understanding of (P)OD might be one of the building blocks for improving (P)OD adoption in existing MHC practices, which are on their way toward person-centered, recovery-based, and network-oriented care.

Open Dialogue: A case study on the influence of sharing or withholding reflections during a network meeting

In Open Dialogue, sharing of reflections by professionals constitutes an important contribution to promoting a polyphonic dialogue between participants. In the inner dialogue, past and future influence the present moment. In this study, we explore the influence of sharing or withholding reflections by professionals on the interplay between inner and outer dialogue. A case study was used with a multi-perspective methodology, which combined video recordings of a network meeting and interviews by using video-stimulated recall with the clients separately, and social workers together afterward. We found that the sharing of reflections by professionals stimulates the inner dialogue and creates an opening for sharing these in the outer dialogue. In addition, we observed that when reflections are withheld, the client's inner dialogue still continues, but their inner dialogue was not shared in the outer dialogue.

“Always opening and never closing”: How dialogical therapists understand and create reflective conversations in network meetings

Tom Andersen’s reflecting team process, which allowed families to witness and respond to the talk of professionals during therapy sessions, has been described as revolutionary in the field of family therapy. Reflecting teams are prominent in a number of family therapy approaches, more recently in narrative and dialogical therapies. This way of working is considered more a philosophy than a technique, and has been received positively by both therapists and service users. This paper describes how dialogical therapists conceptualise the reflective process, how they work to engage families in reflective dialogues and how this supports change. We conducted semi-structured, reflective interviews with 12 dialogical therapists with between 2 and 20 years of experience. Interpretative Phenomenological analysis of transcribed interviews identified varying conceptualisations of the reflecting process and descriptions of therapist actions that support reflective talk among network members. We adopted a dialogical approach to interpretation of this data. In this sense, we did not aim to condense accounts into consensus but instead to describe variations and new ways of understanding dialogical reflecting team practices. Four themes were identified: Lived experience as expertise; Listening to the self and hearing others; Relational responsiveness and fostering connection; and Opening space for something new. We applied these themes to psychotherapy process literature both within family therapy literature and more broadly to understand more about how reflecting teams promote helpful and healing conversations in practice.

COVID Couple Therapy: Telehealth and Somatic Action Techniques

In March of 2020, during the global COVID-19 pandemic, therapists quickly transitioned to telehealth platforms to provide their services. Teletherapy, while subject to some constraints, presents unique opportunities to work creatively with couples, particularly during these uncertain times. This paper offers a case study of work with a couple using systemic, developmental attachment, dialogical, and somatic trauma theories. Action techniques, including doubling, ideal futures creation, and a foam roller trust exercise are employed to facilitate change processes as couples face the chaos and unknowns of the pandemic and the difficulties that have become triggered between them. These exercises help to open perspective, increase awareness, and lower resistance to change. Couples are able to physically enact and metabolise alternative realities while discharging excess energies in familiar surroundings.

Do we all speak the same language? A critical systemic functional discourse analysis of psychiatric hospital brochures

BACKGROUND

Over the last decades, treatment of patients with mental health diseases has shifted from longer-term in-hospital diagnosis and treatment to brief crisis diagnostic and/or treatment stays in hospital wards combined with ambulatory care preventing relapse and promoting patient-centered recovery. To guarantee a shared understanding of the nature of the care provided, it is important that hospital brochures and ambulatory care information are aligned, both in the way in which they define and understand recovery and regarding how they approach the empowerment and activation of the patient.

AIM AND RESEARCH QUESTIONS

The overall aim of the study was to shed light on whether (1) hospital brochures used in crisis intervention centres in Flanders reflect the tenets of recovery-oriented and empowering care, and (2) the encoded messages are reflective of patients and their needs.

METHODS

A systemic functional critical discourse analytic framework was used to analyze a small corpus of hospital brochures.

RESULTS

Our findings suggest that the answers to both research questions are negative.

CONCLUSION

This small-scale qualitative study on the under-researched population of psychiatric patients admitted to crisis intervention wards highlights the complexities involved in imparting well-aligned psychiatric care messages to the patients, their home caregivers, the medical community and the general public.

"I've Lived that Thing that We do with Families": Understanding the Experiences of Practitioners' Undertaking a Three-Year Open Dialogue UK Training Programme

Open dialogue is a systemically-based approach to mental healthcare, originating from Finland. Growing numbers of practitioners are being trained internationally, but little is known about the impact of such trainings within a UK setting. This study used interpretative phenomenological analysis of focus group data to explore the experiences of thirteen individuals undertaking a three-year UK open dialogue training. Four themes emerged: (1) a powerful experiential process; (2) personal therapeutic change; (3) deeper and more open relationships and (4) altered relationships to power in working practice. The findings suggest that open dialogue trainees experience greater depth in relationships with both clients and colleagues as a result of training, even participants who already had therapeutic training backgrounds. The findings also contribute to Transformational Learning literature regarding how experiential, non-hierarchical, dialogical teaching methods may enhance learning on therapeutic programmes and, therefore, lead to positive changes within clinical practice.

"You helped me out of that darkness" Children as dialogical partners in the collaborative post-family therapy research interview

Applying Dialogical Methods for Investigations of Happening of Change (DIHC), this study investigated how children who had been diagnosed with an oppositional defiant or conduct disorder participated in a collaborative post-therapy research interview and talked about their experiences of family therapy. The results showed that the children participated as dialogical partners talking in genuine, emotional, and reflective ways. Encountered as full-membership partners, the children also co-constructed meanings for their sensitive experiences. However, their verbal initiatives and responses appeared in very brief moments and could easily have been missed. The collaborative post-therapy interview offered a safe forum for co-reflection by participants on what they had found useful or difficult in the family therapy process. In this interview setting, the family first listens to reflection by the therapists on the therapy process and their thoughts on some of the family's related sensitive issues. The results indicate that when therapists present themselves as not-knowing, receptive and accountable, therapists may facilitate reflection for all family members, including children.

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach

In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD's internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.

Integrating eHealth within a Transforming Mental Healthcare Setting: A Qualitative Study into Values, Challenges, and Prerequisites

Mental health care is shifting towards more person-centered and community-based health care. Although integrating eHealth within a transforming healthcare setting may help accomplishing the shift, research studying this is lacking. This study aims to improve our understanding of the value of eHealth within a transforming mental healthcare setting and to define the challenges and prerequisites for implementing eHealth in particular within this transforming context. In this article, we present the results of 29 interviews with clients, social network members, and professionals of an ambulatory team in transition within a Dutch mental health care institute. The main finding is that eHealth can support a transforming practice shifting towards more recovery-oriented, person-centered, and community-based service in which shared-decision making is self-evident. The main challenge revealed is how to deal with clients' voices, when professionals see the value of eHealth but clients do not want to start using eHealth. The shift towards client-centered and network-oriented care models and towards blended care models are both high-impact changes in themselves. Acknowledging the complexity of combining these high-impact changes might be the first step towards creating blended client-centered and network-oriented care. Future research should examine whether and how these substantial shifts could be mutually supportive.

Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

Dialogical Family Guidance (dfg)-Development and implementation of an intervention for families with a child with neurodevelopmental disorders

Aim

To describe the development and implementation of a Dialogical Family Guidance (DFG) intervention, aimed at families with a child with neurodevelopmental disorders (NDD).

Design

The DFG components are presented and the content of a DFG training course. Professionals' experiences after the DFG training were evaluated.

Methods

Dialogical Family Guidance development phases and implementation process are examined. The Revised Standards for Quality Improvement Reporting Excellence checklist (SQUIRE 2.0) was used to provide a framework for reporting new knowledge.

Results

The DFG training course seemed to increase possibilities of a more independent role as a nurse to deliver the DFG family intervention. The project showed that the use of dialogue can be difficult for some professionals. Analysis of the questionnaire completed after DFG training reported a high level of satisfaction. DFG training offered a new approach to deliver knowledge and understanding to families using dialogue, including tailored psychoeducation and emotional and practical guidance.

Dialogue and Dominance in Couple Therapy for Depression: Exploring Therapists' Responses in Creating Collaborative Moments

Previous investigations have found specific communication patterns in couples dealing with depression, specifically when depression concurs with conjugal conflicts. The presence of these patterns can reflect couples' difficulties in engaging in collaborative communication during their sessions, posing a real challenge for therapists. This exploratory study uses a dialogical approach to examine issues of dominance and type of dialogue in two couples who differed in terms of their levels of dyadic adjustment. The therapists' reactions were explored in order to detect the kinds of responses that were most effective at engendering a collaborative attitude in therapy sessions. The method used to analyze the dialogue was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the degree of quantitative and semantic dominance displayed by a different member of the couple in each case was illustrative of their relational dynamics, while in both cases interactional dominance was exercised by the therapists. Results on dialogue revealed that dialogic dialogue might help to coconstruct new shared meanings of depression. The findings indicated that certain responses by therapists as part of the dialogue could be useful in bringing about a reduction in hostility between the members of a couple, provided that the responses are maintained over the course of the session. Some research and clinical implications that emerge from the results are discussed.

Nothing matters: the significance of the unidentifiable, the superficial and nonsense

Purpose: The aim of this study is to explore the ways in which “small things” may be of importance for people with mental health difficulties.

Method: Empirical material from three different studies was reanalysed through a phenomenological, dialogical, approach.

Results: We discovered some paradoxical aspects of small things: i.e., they could be about “something” that was difficult or even impossible to identify. The unidentifiable could be about bodily, sensual experiences that are superficial (i.e., belonging to the surface). The interaction with others highlighted as significant could be about doing something fun, talking nonsense or kidding around, and hence not at all about making sense of something—a kind of important nonsense. We summarize these aspects in three themes: the importance of the unidentifiable, the superficial and nonsense. These aspects can be regarded as small things—even “nothings”—that make it possible “to stay in the world”.

Conclusion: We elaborate on the findings in relation to the following: Gumbrecht’s critique of the prevailing hermeneutic world-view with its idea that “interpretation is humankind’s exclusive way of relating to the world”, Ingold’s idea that social life is lived in relations of “interfacility” and hence a turn to surfaces is needed for a “restoration of social life”, and Biesta’s idea of existence as “coming into the world in the presence of others”.

[Open Dialogue and the Challenges for its Implementation - an analysis based on a review of the literature]

METHOD

The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the literature on the Open Dialogue Method, this article sought to identify the principles and contributions for deinstitutionalization.The PubMed (365), PsycInfo (134), Lilacs (no articles found) databases and 2 books were consulted. Thirty-four publications that fulfilled the requirements of this review were selected. The search was conducted in October 2015. The key words used were: open dialogue, crisis, first psychotic episode, schizophrenia, family therapy, need-adapted approach.

RESULTS

There were 3 reviews, 5 theoretical studies, 21 qualitative studies and 5 quantitative studies. Two of them were written in Italian, one in French and thirty-one in English. The authors were from Norway, the United States, Finland, Australia, the United Kingdom, Belgium, Canada and Poland. The publications were grouped for purposes of analysis into the following categories: Open Dialogue concepts and principles; Open Dialogue contributions; Challenges for Open Dialogue implementation in other countries, realities and contexts.

Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study

Background: The need for psychological therapies for psychosis has become apparent since long-term antipsychotic drug treatment has a range of adverse side effects, with moderate therapeutic effects at best. Aims: To investigate whether the psychotherapeutic approach, dialogue therapy (DT) is associated with improvements of symptoms and functioning beyond standard psychiatric treatment (ST) in both schizophrenia and other psychosis. Methods: A retrospective case-control design, comparing 54 patients with different psychoses who received DT with 54 patients in a control group receiving ST was carried out. The groups were matched on diagnosis, age, sex, and treatment start. Outcome measures were Global assessment of functioning (GAF) scores, medications at follow up, and hospital stays after completed outpatient treatment. Results: Mean time in treatment from inclusion to follow-up was 3 years and 5 months. At follow-up, GAF functioning (GAF-F) and GAF symptom (GAF-S) scores both were significantly higher in the DT group than the ST group. Effect sizes (Cohen's d) were large; 1.8 for GAF-S and 2.1 for GAF-F. At follow-up, the use of psychoactive drugs was significantly reduced despite a shorter time in psychotherapy in the DT group compared to the ST group. Days of hospitalizations after end of treatment in the study period were significantly reduced in both groups compared to the period before start of treatment. Conclusions: The findings from this exploratory study are consistent with the possibility that dialogue therapy may lead to improvements in symptoms and functioning compared to standard treatment in psychosis.

A License to Be Crazy

The author’s multivoiced perspectives as mother, holistic practitioner, therapist, and social justice activist will address and question some of her and others’ assumptions, beliefs, mistakes, and social constructions around madness. Rather than coming to a conclusive “answer” to the question “What is psychosis if it is not what the bio medical model of psychiatry says it is,” the author cautiously offers her gleanings and queries. These few bare questionable and questioning bones rattle to tell more of their story.

An introduction to peer-supported open dialogue in mental healthcare

Peer-supported open dialogue is a variant of the ‘open dialogue’ approach that is currently practised in Finland and is being trialled in several countries around the world. The core principle of the approach is the provision of care at the social network level, by staff who have been trained in family, systems and related approaches. These staff include peer workers, who will help to enhance the democratic nature of the meetings around which care is centred, as well as enabling such meetings to occur where networks are fragmented or lacking. Certain organisational and practice features and underlying themes are key to the approach. Crucially, open dialogue is also a system of service provision. Staff trained in peer-supported open dialogue from six National Health Service (NHS) trusts will launch pilot teams in 2016, as part of an intended national multicentre randomised controlled trial.

Family Group Conferencing as a Catalyst for Recovery and Ownership in Mental Health

BACKGROUND

Recovery is a journey not only of personal change but also of social reengagement. It underlines the essence of social environments that are supportive to the recovery of people with ongoing mental health issues. The process of recovery also affects other actors, and likewise these actors exert their influence on the recovery of their family member or friend.

OBJECTIVE

Since 2009, we have been studying whether the decision-making model called family group conferencing (FGC) helps mental health clients increase their self-reliance. The essence of FGC is that individuals who experience problems have the opportunity to develop a plan together with people from their social network. Clients in mental health have to deal with different forms of disempowerment, especially when they are threatened with compulsory measures. It is an aim to help them regain ownership over their problems as well as over the potential solutions.

METHOD

From 2011 to 2013, we evaluated 41 family group conferences that were organized for clients in a public mental health care setting in the north of the Netherlands. Each conference was analyzed in a qualitative case study framework.

RESULTS

This article highlights two case portraits. It gives insight into how ownership was restored and what this meant regarding clients' recovery process.

CONCLUSION

FGC seems a promising tool to shift the attention from disorders and inabilities to capacities and the rediscovery of social resources.

Family Group Conferencing-Its Added Value in Mental Health Care

Worldwide, there is a growing emphasis on reducing coercion and involving social networks in the care of mental health clients. Nurses should encourage their clients to regain control over their lives, preferably with less coercion and with help from their social network. During four years, a Dutch evaluation study was deployed to determine the applicability of mobilising help from social networks of people with psychiatric problems. Specifically the potential of Family Group Conferencing was examined. In this discursive article the question, 'what Family Group Conferencing adds to the existing methods that aim to reduce coercion in mental health care and promote inclusion' is addressed.

Diálogo Aberto: a experiência finlandesa e suas contribuições

RESUMO O Diálogo Aberto é um método desenvolvido na década de 1980, na Finlândia, para o enfrentamento da crise psicótica. Este artigo é um ensaio teórico que tem como objetivo apresentar o Diálogo Aberto em seus princípios e enquanto prática de saúde mental desinstitucionalizante, enfatizando seu potencial terapêutico, seus resultados e suas contribuições para outros países. Conclui-se que, para a implementação do Diálogo Aberto em outros contextos, é necessária uma mudança organizativa na estruturação dos serviços e uma substantiva mudança cultural no interior da equipe e da comunidade.

Signing on for dirty work: Taking stock of a public psychiatry project from the inside

As applied anthropologists used to working at arm's length from public psychiatry, we step out of the daily grind to take stock of the challenges of taking on ethnography entrained-harnessed to the implementation of a new program. These include the loss of critical distance, the struggles to negotiate locally viable forms of authority and relevance, the necessity of sustaining a Janus-faced relation with principal players, the urgency of seeing time-sensitive information converted into corrective feedback, and the undeniable attraction of being part of "committed work" with game-changing potential. In so doing, we rework the terms of witnessing and revive an old alternative: that documentary dirty work be reclaimed as a variant of public anthropology, one that transforms the work of application from mere afterthought to integral part of the original inquiry.

Creating a Space for Acknowledgment and Generativity in Reflective Group Supervision

Small group supervision is a powerful venue for generative conversations because of the multiplicity of perspectives available and the potential for an appreciative audience to a practitioner's work. At the same time, the well-intentioned reflections by a few practitioners in a room can inadvertently duplicate normative discourses that circulate in the wider culture and the profession. This article explores the use of narrative practices for benefiting from the advantages of group supervision while mindful of the vulnerability that comes with sharing one's work among colleagues. The reflective group supervision processes described were modified from the work of Tom Andersen and Michael White to provide a venue that encourages the creative multiplicity of group conversation while discouraging unhelpful discourses which constrain generative conversation.

Anorexia nervosa: A fresh perspective

Anorexia nervosa is currently presented as a pathologised, psycho-medical feminine phenomenon through aetiological rationalisations and theories. Research results indicate that there have been no improvements in treatment outcomes for anorexia for over 50 years, except, possibly, with forms of family therapy for adolescents. This situation can be seen as critical and calls for alternative ways of understanding anorexia, and consequent different approaches to psychotherapy for persons in relationship with anorexia. This article critically explores these issues, and suggests that such circumstances offer opportunities for alternative post-structuralist approaches for informing different understandings of and working with anorexia in collaborative relational arrangements where the voices of persons in relationship with anorexia are honoured and heard.

"To be taken seriously" : women's reflections on how migration and resettlement experiences influence their healthcare needs during childbearing in Sweden

OBJECTIVE

To use an intersectional approach to analyze women's reflections on how their migration and resettlement experiences to Sweden influenced their health and healthcare needs during childbearing.

METHODS

Focus-group discussions, pair interviews and individual interviews were conducted in southern Sweden between 2006 and 2009, with 25 women originating from 17 different countries with heterogeneous backgrounds that had experienced childbirth in Sweden. Qualitative content analysis was used with an intersectional approach, taking into consideration intersections of ethnicity, socio-economic status (SES) and gender.

FINDINGS

The hardships of migration, resettlement, and constraints in the daily life made the women feel overstrained, tense, and disembodied. Being treated as a stranger and ignored or rejected in healthcare encounters was devaluing and discriminating. The women stressed that they felt stronger and had fewer complications during pregnancy and labor when they were "taken seriously" and felt that they had a confident, caring relationship with caregivers/midwives. This, therefore, enabled the women to boost their sense of self, and to recognize their capabilities, as well as their "embodied knowledge".

CONCLUSION

Caregivers/midwives should be aware of the hardships the women face. Hardships stem from experiences of migration and resettlement as well as from structural constraints such as the "triple jeopardy" of ethnicity, SES and gender, which increase women's needs of support in childbearing. Such awareness is necessary when promoting health and reducing the unnecessary suffering and victimization of women, their children, and their families. It is a matter of patient safety and equity.