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Fourth edition
Edited by
Tom Stockmann
 

The UK Peer-Supported

Open Dialogue

Bulletin

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Read about Open Dialogue around the world in this first anniversary edition

Contents

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Welcome to the fourth POD Bulletin.

To mark our first anniversary, this edition has a series of fascinating contributions from those involved in Open Dialogue projects around the world. We also have the reflections of a UK POD clinician who recently visited Tornio in Finland, the birthplace of Open Dialogue, and a commentary on POD and politics.

Back in the UK there are details of some exciting news, from the final submission of the research funding bid, to the soon-to-be launched 'Dialogue First' service, offering many people across England the choice to be referred to an NHS service based on Open Dialogue principles.

Finally, we look forward to seeing many of you in London on 25th April at the 2nd annual conference on POD. There are a handful of tickets left for those who are still looking for one. For those unable to attend on the day we are planning to live-stream the event online. 

We hope you enjoy the read.
 
Hear from:
  • The first UK staff trained in Peer-supported Open Dialogue
  • Peers working in Peer-supported Open Dialogue teams across the UK
  • The first service users and families receiving Peer-supported Open Dialogue in the UK
Learn about:
  • The first national multi-centre trial in Peer-supported Open Dialogue being planned in the UK
  • The UK’s first NHS service based on some key Open Dialogue principles, open to referrals from across the country
Tickets

Tickets for the day conference are donation based - starting at £1.

 

All proceeds from tickets will go to further our work in Peer-supported Open Dialogue; research, training, and its development in the UK.

POD Project Update

 
Russell Razzaque
Associate Medical Director and Consultant Psychiatrist, NELFT
  
This year POD has managed to get off to a roaring start. In January, we started the second wave of training for clinicians across the country; from Somerset, London, Kent & Nottingham, together with a tranche of trainees from last year working to become mentors this year. All in all there were 90 people in that first module and so Val, Mark and I approached it tolerating more than a little dose of uncertainty. Can such a large group be trained? What will be their starting points? What will be their needs? How far will we be able to take them on the journey towards working dialogically in this time?

Somehow, though, on the first day, all our concerns started to fade away pretty rapidly. People were really engaging, and you could feel an energy building in the room; people came eager to learn. At the end of that module, the reflections from the trainees were so powerful, so passionate, and indeed so accurate in terms of what we were trying to teach them, that we realised that they had truly grasped the essence of POD. We were frankly amazed at how much people had taken on so quickly, and that's when I realised that this truly can work across the NHS. People on this year's training weren't particularly self-selecting, we specified teams from which we needed people from the trial and the Trusts then went away and found them for us. Yet those who came along seemed to take rapidly to this way of working. There is, of course, a lot of training ahead, but it's wonderful to see them off to such a tremendous start.
 
At the same time, I have been working with Prof Steve Pilling, our co-applicants and our panel of top flight academics from UCL, Middlesex University and Kings, on our £2.3million grant application to the NIHR for the evaluation of these teams as part of a multi-centre randomised controlled trial. It has taken us over a year of work, but finally on March 14th we submitted our final bid. We got through Stage 1, and Steve tells me that the odds of getting through this final stage are 60/40 - after all we are competing with every speciality in the healthcare field. So we all need to keep as many digits crossed as we can find.
 
Val and I have been doing workshops across the country as well, and we have a growing number of Trusts who want to send teams to train with us next year. We are negotiating for our course to become a fully accredited University diploma and, so we will have an ongoing training that people from around the country, indeed the world, can join. Mark and I are working on finalising the details and paperwork for this at the moment, and we will also be working with our academic colleagues to find ways in which future Trusts can play a part in the research and evaluation process too. 
 
Finally, we have been gearing up for our exciting conference on April 25th. As we had to turn people away last year despite hiring a 550 seater venue, we decided to hire a 900 seater auditorium this year. And this is filling up too. We will have service users and carers - the first ever to receive POD on the NHS - speaking about their experiences, and this really will be the highlight of the day. We will also hear clinicians talking about their experiences of working this way too, and then we have a wonderful party organised for the evening - for which tickets are currently selling fast. I can say that more than a few of us are looking forward to letting our hair down then, for sure.
 
Lots still to do, of course, but 2016 has indeed got off to a wonderful start.

Introducing the new 'Dialogue First' service


Cathy Thorley
Systemic Family Psychotherapist and Manager of Dialogue First service. 


I remember very clearly being in the audience at the first NELFT Peer-supported Open Dialogue Conference last year. The overwhelming response was “that’s all very well but how can we get it now!” Well we went away and talked about what we could do about that and the result is Dialogue First, a service based on Open Dialogue principles that will be up and running from May 4th this year. I feel very honoured and excited to be managing this service and be working with a great team of people who are passionate about Open Dialogue. It is the first Mental Health Service to be part of a GP's “Choose and book”/e-referral system.

Here’s how it works. People wishing to use our service go along to their GP any time after the 4th May. The GP will be able to find our service on the system and offer you a time when we can get in contact.  We would then arrange to speak on the phone to give the person more information and ask some questions, a kind of getting to know each other time. In order that we can work together, the person would need to not be in crisis, not be under mental health services currently and be able to get to our comfortable rooms close to Harold Wood station, near Romford. If they decided they would like our service, then we would arrange our first meeting and go from there.  As it is an NHS service, there would be no cost to the person or whoever comes from their network.

At the end of last month, Simon Stevens, the CEO of NHS England, came to visit NELFT and I was pleased to be able to talk with him about Peer-supported Open Dialogue and the new Dialogue First Service. I hope there will be many more exciting developments in Open Dialogue to speak about in the coming months. 

For more information on Dialogue First please check out the NELFT Dialogue First website, call 0300 555 1201 extension 54005, or email dialogue.first@nelft.nhs.uk.

We are looking forward to hearing from you.

Training for Trainers in Open Dialogue


Jaakko Seikkula
Professor, Vice Dean of the Faculty of Social Sciences, University of Jyväskylä


Open Dialogue has gained worldwide interest and consequently the need has increased for supporting the new practice with education programmes. The POD training programme is one creative example of the training offered to institutions. In this type of foundation training staff members, as well as service users, have access to a proper introduction to the dialogical practice.

At the same time, the need for longer term training increases. Open Dialogue UK runs an ongoing three year training programme (60 ECTS credits) giving a certificate of Open Dialogue practice. To make this type of training possible in different countries, we need competent trainers. To respond to this need, we will start a two year training for trainers in Open Dialogue. It will take place in Helsinki and start in November 2016. The idea is to invite all of those who already have psychotherapy training and are interested in Open Dialogue practice to participate. More detailed information is provided here

Please feel free to be in contact me if you have more questions.

Jaakko Seikkula

Views from Open Dialogue projects around the world


 

Finland



Working in Keropudas

Anni Haase
Clinical Psychologist, 
Keropudas Hospital, Finland



I have worked at Keropudas polyclinic for three years now. The first thing that was striking to me (positively) was the polyclinic phone that was always answered. An experienced worker takes the phone call every time and peoples' distress is taken seriously. The therapeutic work starts from that very first contact. I now take the emergency phone as a self-evident way of doing things. Yet, I remember how it showed me in the beginning that there is a much wisdom built up behind it. In so many places, people need to do a lot of work to find the right phone number, and the right people, and some of them may give up when they are asked to phone somewhere else. 

People asking for help or just for advice always get an answer. And taken seriously. They don't need to phone all over the town to find help. They are asked to decide together with the worker when they need the first meeting and who should be present. It says a lot about the mentality of the place. 

Even though most of the staff are qualified family therapists, there is also space to work as an individual therapist (as myself). As people are met with a needs-based approach, there is space for a variety of ways of working. That makes the atmosphere ”breathing”, which is always good! 

In Open Dialogue, there are elements from systemic family therapy, social network perspective and psychodynamic psychotherapy. Personally, my way of working resonates strongly with "remaining present and engaged, attuned to one's own inner dialogue and while many family therapy schools concentrate on specific forms of interviewing, the dialogical therapist focuses more on listening and responding to what has touched them". This comes to the core of psychodynamic way of working to me too.

Challenges: There needs to be continuous openness and a needs-based approach to the processes of healing. It is important to look for all the ways people are trying to solve their emotional/psychological/situational unbalances. It is necessary to hear ”consumers'” experiences and listen to your very own feelings and sense of comfort vs. discomfort. So, many kinds of issues need to be shared transparently with clients, but also with colleagues.
 
Keropudus Hospital
Working in a Dialogical Context

Mia Kurtti
Psychiatric nurse
Master's degree in Health care management
Family therapist and 
psychotherapist

About the work in dialogical context - hmm. It is not easy to capture the core of the work in few lines - but I can try to share some thoughts that I have now, today.

Lately, I have been thinking about frames. Frames that ”hold” us and make it possible to be open, present and tolerate the uncertainty. That requires courage and I, myself, need to feel safe to be able to be present in my everyday work. Since I work in public healthcare, we workers form a system. I don`t like this word, I think it gives a false feeling of something formal, an ”entity” that holds knowledge and wisdom within - even if it is just us, just people who carry these features in our selves and everything that is present in the meetings that gather together professionals, clients, family members, peers. This vulnerability, that comes from the fact that people are humane components, makes constant training and supervision essential. Through that, people (workers) are able to see and experience the dialogical elements. In addition to that it is in my responsibility to keep updating the ethics of my work. Everyday.

For me, the community with whom I work, is my frame. It is extremely important to have superiors who say ”this organisation is committed to Open Dialogical way of working”.

But even this doesn`t guarantee that everybody is heard and seen with their changing and unique needs. Because everything is built up by people. But to be able to acknowledge this and be open and transparent with your colleagues and people whom you are supposed to help, support or just be with. I`m very grateful that we have started to work together with people who have been our clients or have experiences of having care in other parts of Finland. This is a new window I want to keep open and use all the things we can see from there.

This journey is never ending. This journey of being present and yet alert, open but being firm in a safety-creating way.


UK POD clinicians visit Finland

Lisa Monaghan
Clinical psychologist, NELFT

 
Tornio. In February. Land of snow and icicles. Home to the founders of Open Dialogue, those that continue its legacy at Keropudas hospital, the Tornio adolescent outpatients and Kemi adult polyclinic, and for five days the three of us; myself, Cathy and Sara. 

I could talk to you about the experiences we had with the families we saw there, the myths we busted and the skills we learnt. Yes, they were important and amazing experiences but that isn't what hit me the most about this way of working. No, it was the totally all encompassing team community that pervaded every interaction they had with those around them. The trust each person has in the other and the respect this brought which made the whole process smooth and enjoyable. 
A poster on a staff office wall. 
And unlike in the UK, they weren't being sarcastic (we checked).
This calm and welcoming atmosphere is found everywhere here from the clinics to the ward, from the service manager to the cleaners. Everyone is valued and nurtured, staff have a healthy and hearty lunch provided, as well as open and bright staff rooms, where their accomplishments and growth as a team and individuals are displayed and celebrated; a place they choose to come to be together. From here, all things are considered and dealt with dialogically, with an ease that only with willing, time and experience can we hope to accomplish.

So whilst we did not find the northern lights, what we did find was something much rarer, in the NHS anyway; a sense of family and being connected at work like you are at home, an alien concept to most of us in the UK and the NHS. Now we truly understand the OD ideals of embodying its principles and see that we cannot do this alone. To succeed, to change and sustain that growth we must all be fully in it together. To maintain this understanding and way of being in a culture that prioritises the individual, while at the same time undermining it, will be the challenge, everything else will come together as we do. 

We found this saying while we were there and it is what stays with me as I continue my journey with Open Dialogue so I will end with it while looking to our future together:
 
"By sticking to the road
You become its slave. 
The only way forward
Is to wade into the virgin snowdrift"
- Bron Ossiulh

Ireland


Dr Iseult Twamley
Open Dialogue Project,
Cork/Kerry CHO,
HSE South Ireland




“I met my Mother in a session today...”

This was said by one of our Open Dialogue staff last month.  The person in question wasn’t actually her Mother, but it felt the same to the staff member. This has really stayed with me, as an example of the places Open Dialogue can take us… and that for all of us in the room, we embark on a conscious journey of change when we meet. 

That journey of change is very apparent to me, as I write this on the 4 year anniversary of our first training here in Ireland, with Mia Kurtti and Birgitta Alkare. That 5 days was transformational for our service. I have been reading over transcripts of focus groups we conducted with staff before the training, and transcripts of the regular focus groups we then held over the next 3 years of the pilot project. We have a long history of recovery initiatives and service user/carer engagement  - indeed that is how we came to commit to Open Dialogue. Even so, it is marked how the language and values have shifted, from concerns about “what families may throw at us” and jokes about how “We might end up needing Open Dialogue!” to a real engagement with transparency, a commitment to service user and support network inclusion … and a genuine acknowledgement of how much we as staff and a service needed to change. 

It has been a difficult journey. In our first 3 year pilot we struggled to get referrals. The 23 families we worked with were fulsome in their praise: “We spoke more and we learnt more in the 4 or 5 sessions we had, than I ever had in (the service) before”.  Still, concerns were raised about suitability for Open Dialogue…or waiting till the crisis was over (yes, yes, I know..!) Staff who had been so excited about the approach (“Open Dialogue gave me permission to practise how I want to work”) became demoralised and some lost confidence in whether we were “doing it right”. When Mary Olson came to give us training in 2014, we got much needed encouragement, as she told us how dialogical we had become. I guess no one told us change would be this hard.

So what kept us going? A genuine commitment to the values, from high and low within the service (our management support has been unflagging). An articulate and passionate service user/support voice that told us this is what they wanted, and more of it please. Staff, passionate about the privilege and delicacy of the work we do, with the courage to change their practice, to risk the real relationships, to chance not knowing, to dare to “be with”.

So, where now? Since September we have met 46 families in our multidisciplinary Open Dialogue “clinic” and we will be accompanying them though their mental health journey from start to finish. Three of us are on the 3 year Open Dialogue UK training – two of us training as trainers, as we are planning a one year training in Open Dialogue in 2018. We are hoping to recruit 2 peer support workers to work on our project starting in the summer (this will be part of the first pilot of paid peer support workers in Ireland, so we are really excited about it). We are having our first conference in Ireland on September 13th in Cork (do please come) and we are delighted that Russell will be attending to present all your good work. We have a very soft spot for the POD programme, as we nearly joined you all but didn’t get funding in time, so it was great to say hello in this article - feel free to get in touch, or come visit.

Italy


Open Dialogue in Italy:
From project to programme

Raffaella Pocobello, ISTC-CNR, Giuseppe Salamina, Chiara Rossi and Claudia Alonzi, Local Health Unit of Turin - ASL TO 1



In this contribution we will briefly present the development of the Italian experience with the Open Dialogue approach and share some of the first lessons learned.

The Italian context

Italy was the first country to close psychiatric hospitals, with the mental health reform in 1978, replacing it with radically different networks of community services. Franco Basaglia, who led this transformation, was strongly convinced that the new mental health services have to put great emphasis on citizenship rights of people with mental health problems and democracy, instead of some technical approaches which inevitably lead to their dehumanisation. 

Even if still forming the guidelines for many mental health services, Basaglia’s principles have been challenged in the last decade by the promises of bio-medical disease models, with emphasis on the pharmacological treatments, especially when dealing with acute crisis. This reductionist model becomes increasingly dominant, despite users, professionals and family members experiencing it as inadequate in everyday life, and requesting for more recovery oriented practices. 

The Project

This is the context in which our OD adventure started, in the autumn of 2014, when the Local Health Unit of Turin was impressed by the OD principles, as well as the results obtained in Western Lapland, and was strongly determined to implement this approach in Italy. The proposal was enthusiastically accepted by eight mental health departments (MHD) and the National Research Council. Some months later, a two-year project was financed by Ministry of Health to evaluate the transferability of the Finnish Open Dialogue (OD) approach into the Italian mental health system. 

The project started in February 2015. The MHDs enrolled throughout the country cover a population of 4 million inhabitants in Turin, Savona, Trieste, Modena, Rome and Catania. A total of 80 professionals with different background (psychiatrists, nurses, psychotherapists and social workers) have been selected to be trained and to be part of dedicated OD teams in each MHD. 

At present, OD training is ongoing and it is delivered by a pool of Finnish trainers, including Jaakko Seikkula. The training comprises 20 days over 1 year, and will end in October 2016. OD teams have begun clinical work, started the supervision of the first cases and tested organisational changes to adapt their services to OD approach. 

With respect to the research, the first phase is still ongoing. It implies participatory observation, evaluation of the impact of the training on trainees, OD adherence of their clinical interventions, fidelity and transferability.

A second phase will start as soon as the teams are ready to practise OD according to fidelity scales, and will consist of a feasibility study for the outcomes evaluation. 

Then, a third phase - requiring additional funding that we are applying for - will evaluate the effectiveness of OD, comparing it with the treatment as usual. In order to have more robust research, with comparable data to that to be collected in the UK, collaboration has been established between the respective research groups. 

The programme

From the very start of the project, it was clear for us that this was only the beginning of a process, requiring time and dedication. Participating in the supervision of family sessions, we realized that OD is not merely a technique but a powerful and compassionate attitude to relate with people experiencing mental suffering and their families. It implies taking people seriously, the careful listening to all the voices, the sharing of powers and the facilitation of decision making processes. To us it seems to respect - and is the much needed relaunch of - Basaglia’s legacy. But it still requires some fundamental cultural, personal and organisational changes.

Meanwhile, it has been decided that more people need to be trained to make OD sustainable and available for more mental health services.  Moreover, during this year we had the invaluable opportunity to come in contact and to learn from experiences in other countries of the OD-implementation process. This exchange is vital for the challenges ahead. 

For all these reasons, we have decided to conceive the Italian Open Dialogue experience as a programme to be developed, rather than as a project with a deadline.
Franco Basaglia

Massachusetts, USA


Open Dialogue in Massachusetts:  
A Brief History

Mary Olson, PhD, Ross Ellenhorn, PhD,  Chris Gordon, MD, and Amy Morgan, LICSW

 

Over the past fifteen years, Open Dialogue has emerged in Massachusetts in different places as a result of a confluence of influences and factors. There now exists an interconnected network of research, training, and clinical initiatives that includes the Open Dialogue Research Project at the University of Massachusetts Medical School in Worcester, MA, the Institute for Dialogic Practice in the Pioneer Valley, Advocates, Inc., a non-profit provider of mental health services in Framingham, MA and Prakash Ellenhorn, a private PACT team in Boston, MA. 
 
In 2001, I (MO) was a Fulbright professor in the Department of Psychology at the University of Jyvaskyla when I first visited Keropudas Hospital and began to study Open Dialogue. When I returned from Finland in 2002, I began working on generating a US research project with Jaakko Seikkula, PhD, whom I met in Finland. We found a group of like-minded researchers and practitioners at the University of Massachusetts Medical School. In 2002, Seikkula began biannual visits to Massachusetts to further the UMMS academic and scientific partnership.

In 2010, after several unsuccessful funding attempts, we finally received support from the Foundation of Excellence in Mental Health Care (FEMHC).  The Foundation had been formed in the wake of the publication of Robert Whitaker’s “Anatomy of an Epidemic” in 2010, with the aim of supporting psychiatric reform. Since then, we have received ongoing funding from the Foundation for our project, “Preparing the Open Dialogue Approach for Implementation in the U.S”, which has been co-led by Douglas Ziedonis, MD, UMMS Chairman of Psychiatry, along with Jaakko and myself. Daniel Fisher, MD, a leader in the psychiatric survivor movement, has also been key consultant. We have spent the first phase developing the research materials that are the requisite scientific steps prior to undertaking a clinical study, which we will be starting this coming year. 
 
In addition, in 2009, Bob Whitaker introduced Chris Gordon, MD to Jaakko and me at a conference in New York City. Gordon, a psychiatrist who had been interviewed for Whitaker’s book, has been an early pioneer of recovery-oriented practices as medical director at Advocates in Framingham, MA. Chris learned about Open Dialogue from Whitaker’s research and became interested in training a team in this approach. Chris’s colleague, Brenda Miele Soares, LICSW obtained support from the Department of Mental Health for Open Dialogue training. This provided the needed impetus to launch the training program in Open Dialogue and Dialogic Practice, which I had been contemplating for several years. So, in 2011, I founded, together with Jaakko, the Institute for Dialogic Practice in Haydenville, MA, joined by European faculty, psychologist Peter Rober, PhD from Belgium and Markku Sutela, MS and Birgitta Alakare, MD from Keropudas Hospital.
 
In the first year, we had 28 participants from all over the US. Chris and Brenda enrolled a team of 15 practitioners in our first year, including clinical leader Amy Morgan, LICSW. Chris also had received funding from FEMHC to train this team as part of a new, experimental study structured with provisions for outcome research and evaluation both for acute care and long-term service users. In subsequent years, Advocates has continued to send people for training. Chris, Brenda, and Amy, have begun to present the impressive outcomes of their program evaluation of Open Dialogue at international conferences, showing that this way of working can be implemented successfully in a public setting in Massachusetts.
 
Finally, another outstanding initiative has come from Ross Ellenhorn, PhD, who also attended the first year of the program.  He leads a private PACT team in the Boston area and after he himself obtained the training, began sending other members of his highly talented group. In this way, his agency, Prakash Ellenhorn, has become another important site for dialogical practices.  I have developed an ongoing relationship with this group and have heard many positive reports from both practitioners and families. As an example, I received a very moving letter from a family seen by Ross’s team, writing to thank me for teaching the open dialogue approach.
 
It has taken these many years to achieve tangible progress in the form of these various endeavors. Yet, what I keep hearing from families, at Advocates, at Prakash Ellenhorn, and at the Institute for Dialogic Practice is that this approach really works, fostering a context for genuine healing and transformation.

Poland


Aleksandra Lisinska-Jarza
Psychologist,
Children and Youth Psychiatric Inpatient Ward, Gromkowski State Hospital, Wroclaw  
Polish Institute of Open Dialogue Foundation


Experiences gained during the last years paint a picture of the way that Open Dialogue has been introduced in Poland. The new approach in the field of Polish psychiatry sometimes resembles a stone thrown to a steady water, which creates wider and wider circles, brings up new energy, new possibilities and adds some disturbances, heats the temperature of a public debate on deinstitutionalisation in Poland and stands as a trial for the state of polish mental health service. During the last 3 years, since the first basic OD training started, the movement seems to grow stronger, at – taking into account systemic resistance - an incredible pace. 

Nowadays in Poland, there is growing interest and awareness of the necessity of starting a process of deinstitutionalisation. We are at the very beginning, there are still big hospitals and traditional structures of the system with significant influence from the biological approach. The Open Dialogue Approach (ODA) plays a major role in the process of moving towards community, need-adapted psychiatry - it serves us as an inspiration, indication and a practical tool in a process of changing our minds and our laws. 

The first basic training in Poland started in 2013, and soon was followed by another seven trainings in 6 cities. These actions created a breeding ground for further actions and practice. Altogether, there are now over 175 trained people – mostly among professionals of mental health field – psychologists, psychiatrists, nurses, but also social workers and people with experience of psychological crisis. Another group – 25 staff members from Koszalin Psychiatric Hospital - are ready to start their own training in March 2016. 

With such fundamentals – ongoing courses and people ready to work with a dialogicity in their minds, we could think about implementing Open Dialogue into practice. Though ‘OD islands’ on a map of Poland seem to create a growing web of good practices, one has to keep in mind the big differences between each place. Discrepancies between places concerns, for example, types of financing. In Poland, neither the National Health Fund (NHF), nor insurance companies pay for treatment shaped around OD. It is mostly a mash of private, charity or short-term EU or departmental project funds. Needless to say, such a situation challenges professionals to search for sources of financing that could give their work basic sense of stability.

Also, institutions involved in OD movement vary – from psychiatric hospitals and psychiatric inwards in general hospitals, through daily care units, community help-care centres, family support centres, and social welfare centres. In such a wide range of institutions there are professionals pioneering OD, searching for their own way of implementing their ideas, creating their own projects and dealing with institution-specific obstacles – such as hierarchical structure, housing condition limitations, colleagues' or CEOs’ scepticism.

Nevertheless, the good practices pay back, with growing work and personal satisfaction and promising outcomes. An example of such a promising initiative is the implementation of OD in the Children and Youth Psychiatric Inpatient Ward of the State General Hospital in Wroclaw.
Altogether, during the last year we organised network meetings using the ODA for more than 100 of the patients during their hospitalisation. Due to the limited number of personnel working on the ward and trained in OD, it is not possible to guarantee an access to regular network meetings during the hospitalization for all of the patients. Nevertheless, about 60% of our patients do have such a chance. These meetings are meant to be open for everyone involved in everyday life of the child or a teenager. And so – the staff members on the ward have already hosted educators, physicians, court officers, teachers, priests, family assistants, and neighbours.

More than 300 network meetings have been organised within the aftercare mobile team project financed from charity donation. The team consist of three people working with the OD approach on the ward – a psychologist or a psychiatrist, a nurse and a person with experience of psychological crisis. The same team accompanies one patient during their stay on the ward and after the discharge. The first meeting with the patient and his social network is organised within the first week of hospitalisation. When there is no longer a need to be on the ward – the same team meets with the family at their home, or if that is not possible – in a special room in the hospital. Such a pattern of work is demanding in terms of adopting a new way of thinking about being both with the patient and the rest of the personnel. It turns out that on the in-patient ward, among multi-professional staff – doctors, psychologists, nurses, physiotherapists, occupational therapists – it is a long-lasting and challenging process.

Undoubtedly, it would be easier to implement certain procedures, structured tools or schematic patterns of behaviour. However, it would not change a deep understanding or emotional attitude towards 'The Other' – meaning – it would not have a lot to do with Open Dialogue. The staff are still at the beginning of their journey, slowly but steadily trying to embrace more and more of what the ODA can offer them.

Perhaps this is our polish-specific way of implementing OD. With, so far, not much support from high officials and the NHF, bottom-up change in institutions is our chance. This is what we have learnt so far - to invite professionals to a new way of thinking and being with the patient, sow a seed and let them decide how to grow it, with a belief, that circles on the water around OD are wide enough to embrace far-reaching targets and high hopes.

Commentary


The POD Practitioner: Conversational Partner and Sociopolitical Activist 

Mark Hopfenbeck
Assistant Professor, Norwegian University of Science and Technology



"We are dealing with the interface between society and the family. One might speak of dealing with the surrounds of families. My clinical work over the years has convinced me that the organization of social structures and society plays a larger role in the alienation of a person from himself and others than most clinicians are willing to accept at the moment."
-   Ross Speck (1967) Psychotherapy of the Social Network of a Schizophrenic Family

Ross Speck was one of the founders of social network therapy and his work was an early source for inspiration for the development of Open Dialogue. As the above quote indicates, he based his work on a social model emphasising the importance of structural inequalities and injustices for the development of mental distress.

Maybe that is one of the reasons the POD training attracts so many wonderful students who seem to have one thing in common, the desire for change; change in the way they work, change in who they are as persons and professionals, as well as change in the world around them. Most of them have also begun to realise that these various aspects are connected and that change in one can only be fully achieved with corresponding changes in the others. Much of the POD training is focused on reflecting over these connections and collaboratively finding ways to create such change.

Therefore, it seems like a good fit that early in the training the students are asked to read Monk and Gehart’s (2003) Sociopolitical Activist or Conversational Partner? Distinguishing the Position of the Therapist in the Narrative and Collaborative Therapies. The article states that narrative therapists aim to liberate people from society’s “normalizing practices that constrain and undermine people’s efforts to lead a life of their own design” (p. 20), while “collaborative practitioners invite multiple, contradictory voices into the therapeutic conversations, which allows participants to generate and explore new perspectives and meanings together” (p. 21). In the POD training we try to combine these two, as we see them, complimentary perspectives based on the belief that an open dialogue which includes the multiple voices of a person’s extended social network can in itself be liberating. 

In a recent opinion piece in the New York Times entitled Why Therapists Should Talk Politics Richard Broulillette writes, “My sense is that … many therapists, because they have been trained not to discuss political issues in the consulting room, are part of the problem, implicitly reinforcing false assumptions about personal responsibility, isolation and the social status quo.” In POD there is an explicit willingness to discuss whatever issues are considered important by the persons involved. Very often these issues will include ‘Austerity Ailments’ based on experiences of discrimination, exclusion and marginalisation. Just as systems theory taught us that we cannot not communicate, so it is that a therapeutic approach cannot not be political. As POD practitioners we should not only ‘talk politics’, but we should also practise politics.

In order to sustain the spread of Peer-supported Open Dialogue, we need POD practitioners who are both collaborative conversational partners and sociopolitical activist-entrepreneurs who can mobilise resources for social change, promote system transformation and contribute to the creation of a more equal, inclusive and cohesive society. 

“Fighting for the rights of people deemed mad, 
who have already suffered more than enough, 
is the last great civil rights movement.”
-    Dillon, et al. 2013: 315

Events and networking


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Love is Dialogical: The Open Dialogue UK International Conference and Training by Kermit Cole, Mad In America

Upcoming

**Open Dialogue Nottingham day event - With focus on the Parachute NYC project. Nottingham, May 23rd, 2016**


Critical Psychiatry Network Annual Conference - Critical thinking about ‘race’ and culture in the psy disciplines. Leicester, April 11th, 2016.
 
Joint ISPS UK/BPS Conference - Re-Visioning Mental Health through Co-production. London, May 10th, 2016.

International conference on Mental Health and cultural diversity - Exploring transformative practice and service models. Leicester, June 22nd-24th, 2016.

ISPS UK Residential conference - Therapeutic relationships: Challenges for mental health services and those who use them. Exeter, September 7th-8th, 2016.

Royal College of Psychiatrists Open Dialogue Network 

The General Adult Faculty of the RCPsych has established an Open Dialogue network. Psychiatrists who wish to join, or find out more information, can obtain the administrator contact details by emailing the Bulletin.

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