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Einboden R, Dawson L, McCloughen A, Buus N. Power, position and social relations: Is the espoused absence of hierarchy in Open Dialogue naïve? Health (London) 2024:13634593241249101. [PMID: 38676316 DOI: 10.1177/13634593241249101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
- Rochelle Einboden
- University of Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Canada
- The University of Sydney, Australia
| | - Lisa Dawson
- Sydney Children's Hospital Network, Australia
| | | | - Niels Buus
- Aarhus University, Denmark
- Monash University, Australia
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2
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Ong B, Barnes S, Buus N. A conversation analysis of therapist repeats in open dialogue network meetings. FAMILY PROCESS 2023. [PMID: 36717155 DOI: 10.1111/famp.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Ben Ong
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Scott Barnes
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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3
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Beckmeyer JJ, T Russell L. Family Structure Diversity and Youth Health Care Access and Interactions With Health Care Providers. JOURNAL OF FAMILY NURSING 2022; 28:308-320. [PMID: 36173123 DOI: 10.1177/10748407221124133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Using data from the 2019 National Survey of Children's Health, we evaluated family structure differences in youth health care access and experiences. We found youth living with their married biological/adoptive parents generally had greater health care access than youth living in structurally diverse families. Differences, however, varied based on which aspect of health care access was examined and the specific types of structurally diverse families youth were living in. Youth living in single-father and other relative-headed families showed the most consistent differences in health care access from youth living with their married biological/adoptive parents. In terms of health care experiences, youth living in several structurally diverse families were more likely to have had time alone with health care providers. Furthermore, there were differences in family-centered care, but the effect size and magnitude of the differences were small.
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4
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Russell LT, Ganong L, Beckmeyer JJ. Understanding and Serving All Families: Introduction to the Special Issue on Supporting Structurally Diverse Families. JOURNAL OF FAMILY NURSING 2022; 28:299-307. [PMID: 36221247 DOI: 10.1177/10748407221131118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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5
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Waters E, Ong B, Mikes-Liu K, McCloughen A, Rosen A, Mayers S, Sidis A, Dawson L, Buus N. Open Dialogue, need-adapted mental health care, and implementation fidelity: A discussion paper. Int J Ment Health Nurs 2021; 30:811-816. [PMID: 33848029 DOI: 10.1111/inm.12866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Open Dialogue is a need-adapted approach to mental health care that was originally developed in Finland. Like other need-adapted approaches, Open Dialogue aims to meet consumer's needs and promote collaborative person-centred dialogue to support recovery. Need-adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need-adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need-adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need-adapted mental health care to ensure they deliver these interventions as intended and in an evidence-based fashion.
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Affiliation(s)
- Edward Waters
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Benjamin Ong
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Child and Youth Mental Health Service, Penrith, New South Wales, Australia
| | - Kristof Mikes-Liu
- Faculty of Medicine and Health, Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Mental Health Service, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Andrea McCloughen
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alan Rosen
- Illawarra Institute for Mental Health (iiMH), University of Wollongong, Wollongong, New South Wales, Australia.,Brain & Mind Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - Steven Mayers
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Anna Sidis
- Northfields Clinic, School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lisa Dawson
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Niels Buus
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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6
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Stokkebekk J, Iversen A, Hollekim R, Ness O. "The troublesome other and I": Parallel stories of separated parents in prolonged conflicts. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:52-68. [PMID: 33421170 DOI: 10.1111/jmft.12474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/28/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
This qualitative study aims to explore how noncohabiting parenting couples in prolonged conflict construct the other parent and themselves. Ten parents from five parent couples were interviewed. A dyadic analytical design was used, where parent's stories of conflict were analyzed in parallel with their co-parent. Drawing on positioning theory, self-identity as parents emerged as implicit counter positions in storylines, which construct the co-parent as "the troublesome other." Two typologies of conflicted storylines were prominent in the findings: storylines of violations of trust, positioning the co-parents in relation to traumatic events in the past and, storylines of who is bad, positioning the co-parent as either a disloyal co-parent or a dysfunctional parent. The findings indicate that prolonged conflicts made it impossible to find available positions for cooperation. We argue that family therapists should aid each household toward promoting child and family resilience rather than continued efforts to solve chronic conflicts.
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Affiliation(s)
- Jan Stokkebekk
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Anette Iversen
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Ragnhild Hollekim
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway
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De Haene L, Rousseau C, Kevers R, Deruddere N, Rober P. Stories of trauma in family therapy with refugees: Supporting safe relational spaces of narration and silence. Clin Child Psychol Psychiatry 2018; 23:258-278. [PMID: 29566556 DOI: 10.1177/1359104518756717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With the sharp increase of refugees' arrival and resettlement in western communities, adequate mental health care forms a pivotal dimension in host societies' responses to those individuals and communities seeking protection within their borders. Here, clinical literature shows a growing interest in the development of family therapy approaches with refugees, in which therapeutic practice engages with the pivotal role of refugee family dynamics in posttrauma reconstruction and adaptation in resettlement and aims at supporting posttrauma reconstruction through strengthening capacities to restore safety, meaning and connectedness within family relationships. In this article, we focus on the narrative restoration of meaning as central mode of posttrauma reparation and explore its specific dynamics and relational complexities in the context of therapeutic practice with refugee families. Hereto, we integrate theoretical and clinical scholarly work on trauma narration and its intersection with empirical findings on trauma communication in refugee families. Furthermore, we develop case reflections to illustrate different processes of engaging with trauma narration in refugee family therapy. This analysis develops an understanding of the multivoiced ways in which refugee families engage with traumatic suffering through different modes of expression that may entail both narration and silence and explores how family therapeutic practices can engage and mobilize voices of narration and silence as relational stories of restoration.
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Affiliation(s)
- Lucia De Haene
- 1 Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven, Belgium
| | - Cécile Rousseau
- 2 Division of Social & Transcultural Psychiatry, McGill University, Canada
| | - Ruth Kevers
- 1 Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven, Belgium
| | - Nele Deruddere
- 1 Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven, Belgium
| | - Peter Rober
- 3 Faculty of Medicine and University Hospital Leuven, University of Leuven, Belgium
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8
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Minas M, Anglin J, Ribeiro MT. Building reciprocity: the dialectic processes of creating a grounded theory and the emergence of a theoretical framework. QUALITATIVE RESEARCH IN PSYCHOLOGY 2017. [DOI: 10.1080/14780887.2017.1392669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maria Minas
- University of Lisbon, Faculty of Psychology, Lisbon, Portugal
| | - James Anglin
- University of Victoria, School of Child and Youth Care, Victoria, Canada
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9
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Rober P. Addressing the Person of the Therapist in Supervision: The Therapist's Inner Conversation Method. FAMILY PROCESS 2017; 56:487-500. [PMID: 27157200 DOI: 10.1111/famp.12220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this study a method of retrospective case supervision is presented aimed at helping the supervisee to become a better self-supervisor. The method pays special attention to the therapist's self-reflection and has the therapist's inner conversation as a central concept. The starting point of the method is an assignment in which the supervisee reflects on a case using a tape-assisted recall procedure. The method helps trainees to develop experiential expertise to become more flexible and effective therapists. A case example of one training group of novice family therapists illustrates the use of the method.
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Affiliation(s)
- Peter Rober
- Context, UPC K.U. Leuven, Leuven, Belgium
- Department of Neurosciences, Institute for Family and Sexuality Studies, University of Leuven, Leuven, Belgium
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Wyverkens E, Van Parys H, Buysse A. Experiences of Family Relationships Among Donor-Conceived Families: A Meta-Ethnography. QUALITATIVE HEALTH RESEARCH 2015; 25:1223-1240. [PMID: 25316692 DOI: 10.1177/1049732314554096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this qualitative evidence synthesis, we explore how family relationships are experienced by parents who used gamete donation to conceive. We systematically searched four databases (PubMed, Web of Science, PsycINFO, and ProQuest) for literature related to this topic and retrieved 25 studies. Through the analysis of the qualitative studies, a comprehensive synthesis and framework was constructed. Following the meta-ethnography approach of Noblit and Hare, four main themes were identified: (a) balancing the importance of genetic and social ties, (b) normalizing and legitimizing the family, (c) building strong family ties, and (d) minimizing the role of the donor. Underlying these four main themes, a sense of being "different" and "similar" at the same time was apparent. Findings are discussed in terms of their implications for studying and counseling donor-conceived families.
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11
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Kotzé E, Hulme T, Geldenhuys T, Weingarten K. In the wake of violence: enacting and witnessing hope among people. FAMILY PROCESS 2013; 52:355-367. [PMID: 24033235 DOI: 10.1111/famp.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the territory of violence and despair, hope is rare. Recent work on hope has shifted attention from hope as a feeling to hope as a practice that people can do together. This case report of a family exposed to domestic violence highlights the role played by a South African police officer in the mother's actions to separate from the context of violence. As a witness to the violence, the police officer acted from an ethic of justice and an ethic of compassion. Outsider witnessing of a counseling session resulted in the recruiting of a community of acknowledgement for the mother, the police officer, and an Assistant Commissioner of Police. Listening carefully and doing hope together gave rise to alliances against practices of violence. As a step of accountability, the authors used reflexive practices to question their responses and to avoid colonizing practices.
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Affiliation(s)
- Elmarie Kotzé
- Department of Human Development and Counselling, University of Waikato, Hamilton, New Zealand
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12
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De Haene L, Rober P, Adriaenssens P, Verschueren K. Voices of dialogue and directivity in family therapy with refugees: evolving ideas about dialogical refugee care. FAMILY PROCESS 2012; 51:391-404. [PMID: 22984976 DOI: 10.1111/j.1545-5300.2012.01404.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees' suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.
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Affiliation(s)
- Lucia De Haene
- Education, Culture and Society, KU Leuven, Leuven, Belgium.
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Hernandez-Wolfe P, McDowell T. Speaking of privilege: family therapy educators' journeys toward awareness and compassionate action. FAMILY PROCESS 2012; 51:163-178. [PMID: 22690858 DOI: 10.1111/j.1545-5300.2012.01394.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study explores how family therapy educators from privileged social locations understand issues of privilege and the process by which they integrate their personal and professional journeys to create and model equity in family therapy training and professional development. These educators developed awareness about issues of privilege and oppression and owned their privilege. Increased awareness involved personal struggles with guilt and managing internalized voices of prejudice that are constantly reinforced in society. These educators adopted a stance of action and accountability for equity. We hypothesize that the process leading to owning one's privilege involves the ability to be compassionate for others' suffering and one's own limitations.
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