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Second edition
Edited by Tom Stockmann

Summer 2015

 
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The UK Peer-Supported
Open Dialogue
Bulletin

“Hurtling Down The Runway While Affixing The Wings”
After success with their glider, the Wright brothers were determined to invent the world's first successful airplane. They finally succeeded on December 17th, 1903.
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Contents

POD Project Update

 

Russell Razzaque
Associate Medical Director and Consultant Psychiatrist, Havering CRT, NELFT

 

“Hurtling Down The Runway While Affixing The Wings”. This was the title of an early chapter in a book by David Plouffe – Obama’s Presidential campaign manager in 2012 – about that historic election. For me it’s a perfect metaphor for where we are with POD right now too.

We have just come out of our third module of training with Mia and Kari (a nurse and psychiatrist from Finland) and their plan from the start was to help us learn about polyphony by living it. They embody it in themselves so deeply that this was intuitive for them, but powerful, and often challenging for us, leading to deep shifts in many of us, in a way that can only enhance our growth and understanding of what it really means to be dialogical. We are all learning to find our own voices – all distinct and strong – as a way of developing a culture that enables us to help others do the same; not just as a technique or intervention, but as a way of being.

Many unanswered questions remain about how we will integrate peers within the teams (not all Trusts have paid peer workers) and how we will fully operationalise the model, but the commitment to each of these things is growing all the time, such that we all have an increasing sense that ways forward will be found in each of these aspects.

While the training and organisational conversations ensue, the wider international Open Dialogue community – almost as if hearing our call – have been finalising fidelity criteria so we can be more certain about when we are working within Open Dialogue and when we are not, and when a service is or is not adhering to its principles organisationally too. This will now help us focus our minds on the next phase of training, both in our teams between modules, and at our next module. We are also committed to continuing to meet and train together after the course, and the fidelity criteria will continue to be our focus then too.

Another parallel track is the research. We are now working hard on our program grant application, which is due to be submitted in October. A first draft for the application is due at the end of August – which we will all review as a research team - so hopefully we should have a clear path to a robust bid by that point. With Prof Tom CraigProf Sonia Johnson and Prof Steve Pilling all taking leading rolls in the panel (with Steve as the Chief Investigator), and the King’s College Clinical Trials Unit as our number crunching partners, it really feels like we’re on a roll.

Finally there are several more Trusts exploring the possibility of joining the trial, and working hard to meet our October deadline. In addition a couple of the four current Trusts involved are also looking to potentially increase their involvement by recruiting an additional team to join the trial.

So there you have it. We’re definitely rolling down the runway, but there’s still a lot of plane to construct as we push forwards together.
 

POD trainers' reflections

 
Mark Hopfenbeck
Assistant Professor, Gjovik University College, Norway

 

In Healing Elements of Therapeutic Conversation: Dialogue as an Embodiment of Love, Jaakko Seikkula and David Trimble write of Open Dialogue that, “The drama of the process lies not in some brilliant intervention by the professional, but in the emotional exchange among network members, including the professionals, who together construct or restore a caring personal community.” The course is based on very much the same principle.
 
The philosophy of the course is that what occurs is more a ‘becoming’ than a ‘training’ which can involve as much unlearning of habitual thoughts and behaviours as learning new skills and insights. Irving Yalom in his The Gift of Therapy describes the therapeutic relationship in terms of being ‘fellow travelers’ – there is no ‘them’ and ‘us’, we are simply ‘fellow humans’ on a common journey, dealing as best we can with the tragedies and sufferings that are inherent to existence. Exemplifying this attitude, one of our students, Mirabai Swingler, has started a campaign based on the idea that ‘there is no them and us, there’s only us’; https://twitter.com/OnlyUsCampaign (also below).
 
As trainers, therapists or colleagues we are first and foremost fellow travellers. In order to re-create and co-construct a ‘caring personal community’ during the course, we facilitate a gradual process of sharing, disclosure and openness about one’s own struggles so that trust can be established and mutually supportive relationships developed. Towards this goal Val has guided the students in family-of-origin exercises and Russell has led the students in developing their own mindfulness practice. In addition the students do a lot of reflective writing between the modules sharing both the personal and professional challenges of becoming a POD practitioner.
 
These challenges are real and often experienced by the students at times as frustrating and even painful. The essence of the training is in many ways aimed at simply providing the support and willingness to meet these challenges and learn from them. Seikkula has written that becoming dialogical is more a way of life than a psychotherapeutic method. This is possibly the greatest challenge, but with it comes the potential for growth, transformation and healing… for all of us.

POD trainees' reflections

 

Lauren Markham
STR Worker, Upminster CRT, NELFT


New vs Old
 

The deeper we are into the training and the project, the more defined the differences are between practising in a dialogical way and in the usual way. Frustrations arise at doing both, as you see how more natural, human and caring Open Dialogue is, there is almost a feeling of guilt at working the usual way.

The words 'person centred' are thrown around a lot and many services claim to have a person centred approach; I have never truly known the meaning of those words until starting Open Dialogue. The way the network choose when to meet, who to have at the meeting, what to talk about, places them firmly at the centre of everything. Decisions are made collectively and everybody gets to have their say; whether in agreement or not all voices are heard. I have learnt what listening really is: sitting there and truly hearing what someone is saying without making assumptions or judgments - such as simply passing things off as symptoms or part of an illness.

One of the more difficult things as a practitioner is to not jump in and offer solutions. My current role (as a support worker) is practical and I am expected to 'do'. To sit there, listen and not have to offer a solution is difficult, but again it helps the network come to a collective decision.

It is a different way of working which at first was difficult to take in, but the longer we work like this the more I can see how families have grabbed this and seen this as a great opportunity and something they enjoy and find useful. Since dipping my toe into the Open Dialogue water I want to fully submerge myself and work this way all the time. It’s difficult balancing myself with one foot in the water and one routed on the treatment-as-usual shore but I need to tolerate the uncertainty and see where this journey leads. 

POD in VIVO

 

Tom Stockmann
Psychiatry Speciality Trainee, NELFT


Since starting POD training, I have joined a number of families and fellow clinicians in attending network meetings, a mutual process of adventure and learning.
 
In a POD network meeting, you are sat in a room with a family and fellow clinicians, conversing. However, it is much more than that. You are trying to listen, watch and feel, mindfully. You are working to avoid a focus on an agenda of your own, to not guide the discussion. Because of this, you do not know what will arise next, you merely observe what does occur. The result is that each meeting tends to be an unpredictable journey, of myriad words, thoughts, feelings and sensations. These may be pleasurable, fun, humorous, loving. They may also be distressing, disturbing or anxiety provoking, reactions that we are all learning to allow to be present, not avoiding, rejecting or 'solving' via an 'expert' intervention.
 
Everyone in the room lives a personal journey, based on the complexities of their own life, mind and soul, but at the same time it is shared, as you tune into others' experiences, via the dialogue. An image that arises is of each person's journey - their understanding, language, and experience - as a sound wave. Within a network meeting there are many of these waves, oscillating in the same space at their own frequencies and wavelengths - a polyphony.


 
Polyphony?


Through the meetings, a common rhythm is gradually achieved, as all the voices present, whilst retaining their own wavelengths, find a common language with which to understand and begin to change the situation.
 
This transformative process is heralded by occasional wonderful 'moments of aliveness' in the meetings, when you feel positive change, the attunement of previously isolated 'others'. These moments vary according to the situation - perhaps someone feeling able to tell their spouse the extent of their suffering for the first time, the brief eye contact of the long distant teenage son, or the expression of familial love and compassion previously buried beneath conflict and misunderstanding. 
 
A transformative moment may emerge following a reflective discussion between the clinicians, in which the clinicians openly discuss their impressions of what has been said up to that point, focusing on any associated personal resonance, conjured images, or sensations. It can be a powerful and meaningful time for everyone when the family are touched by the clinicians' observations. Sometimes, it may lead to a person realising that they can lower their well-worn shield, and safely speak authentically to clinicians, and moreover, be heard.
 
Our meetings continue until they reach a natural end, sometimes lasting for three hours. We have all been struck by how the time passes without fatigue. The next session is arranged at the end of each meeting, ideally at a time and place suggested by the family. Occasionally, a new crisis has arisen during the course of our meetings. In response, rather than taking usual actions, such as a crisis team referral, we have together increased the frequency of meetings. In concert, everyone involved has shared the heightened anxiety and distress, and seen an improvement in the situation eventually follow.
 
Feedback from families involved in POD has been overwhelmingly positive so far. Working within this model is hugely rewarding for clinicians too. Of course, the two are not independent, as a recent article by a mental health nurse, on the difficulty in maintaining compassion at work, makes clear. After all, there is Only Us

Commentary

Amanda Francis
Specialist Support Worker, Kent and Medway NHS and Social Care Partnership Trust


Reflecting on 
Reforming the culture of healthcare: the case for intelligent kindness, 
by Penelope Campling 
(British Journal of Psychiatry Bulletin, 2015)

This editorial is a comprehensive, thoughtful and incisive overview on the philosophy and practice of healthcare at its most basic level. It discusses the need to instil values of intelligent kindness in healthcare, and the mechanical hierarchical systems and business models that hinder this.

The author supports her case by tracing a pathway from Menzies Lyth’s study of nursing in the 1950s to the Francis Report, highlighting the cultural morals and principles inherent in the NHS from its formation: “When there was a strong motivation to create a better future based on the idea of the common good – a concept that may be out of fashion but is still enshrined in the NHS constitution.”

Campling explores the perspectives of contemporary writers and philosophers. Paul Ricoeur, Onora O’Neill and Michael Sandel are amongst those referenced, as is the striking appeal made by Tony Judt before his death that "we rediscover a language around which we can be motivated collectively, whether on the issue of justice, inequality, cruelty or unethical behaviour – a language that will bind us together.”

Such visions are compared with the “corrupting forces”“an active promotion of a competitive market economy, on the basis of a commodified view of need, skills and service… the process of industrialising healthcare… the framework and currency of specification, regulation and performance management…[and] the inexorable rise of consumerism and the promotion of ‘patient choice’”. Campling warns that “these processes have taken hold without proper debate and understanding of the unintended consequences for the system as a whole”.

Campling calls for "intelligent kindness", which she describes thus: 
“not a soft sentimental feeling of action that is beside the point in managing and delivering healthcare. It is a binding, creative and problem-solving force that focuses the imagination and goodwill. It inspires and directs the attention and efforts of people and organisations towards building relationships with patients, recognising their needs and treating them well.”

Campling raises the idea that lack of empathy, or even outright cruelty, are sub-conscious defence mechanisms, a way to deal with and detach from the suffering witnessed whilst caring. As a result, the ability to reconnect "intelligently" with kindness and compassion, would create a culture that would benefit all, at all levels of professional healthcare from front-line to executive staff.

Reference:
http://pb.rcpsych.org/content/pbrcpsych/39/1/1.full.pdf 

Only Us Campaign:


Mirabai Swingler 
Spiritual Care Lead/Chaplaincy Team Lead, NELFT

 
The Only Us Campaign was launched during the second module of the NELFT Peer Supported Open Dialogue training, and from that little acorn in the form of a smiley teary badge it appears a rather large tree may be about to grow. 

Already, despite having no funding, no committee and no website the campaign has over 1000 twitter followers of the @OnlyUsCampaign account, enthusiasts have been invited to speak at various mental health events, and there are some exciting projects brewing in time for World Mental Health Day on October 10th 2015, the theme of which is Dignity

This theme fits perfectly with the message of Only Us; that it is the conceptualisation of mental health as something which divides humanity into ‘them’ (usually the ‘ill’, the other) and ‘us’ (the ‘well’) that leads to the negative consequences of separation, division and othering, such as stigma, abuse, scapegoating and the silencing of the disempowered voices.  In point of fact we are all on a continuum of mental health; we all need to take care of ourselves and be supported if we are to avoid significant distress and breakdown.  When we don’t admit this, but instead try to keep up the appearance of being invincible, like the smiley face without the tear on our badges, we create even more stress on top of the distress we are already feeling, and are also closed to receiving the help we might need. 

This is particularly true whilst there is still a stigma around mental health, and the campaign has been especially popular with healthcare and mental health professionals who may have lived experience or are struggling with the dilemma of whether to disclose a mental health issue to their employer, mindful that this experience is potentially an advantage in their work but not yet seen to be the case. 

It has been helpful in the past, in order to open people’s eyes to the prevalence of mental health issues, to cite the statistic of 1 in 4 of us having lived experience of ‘mental illness’.  But in reality, it’s more like 4 in 4, and there is no them and us, Only Us.  So perhaps the next stage in the eradication of mental health stigma is making the meaningful statement of ‘coming out’ as a fully-rounded and vulnerable human being by wearing an Only Us badge and talking about it. With friends, family, colleagues and clients… and being open to the dialogue it provokes.

The Only Us campaign on Twitter: 
https://twitter.com/OnlyUsCampaign

Badges can be ordered here: 
http://www.buttonbadges.co.uk/smiley_teary_badges.html

Events and networking


Council for Evidence Based Psychiatry Conference: More harm than good: confronting the psychiatric medication epidemic
London, September 18th, 2015

Third International Conference on Dialogical Practices 
Kristiansand, Norway, September 23rd - 25th, 2015.

ISPS - Re-imagining mental health nursing into the 21st century 
London, September 24th, 2015. 

Ethnic Health Initiative conference: Family therapy across cultures. London, September 21st, 2015.Royal College of Psychiatrists Faculty of General Adult Psychiatry Conference. London, October 8th-9th, 2015.


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

The Dragon Café:
"Mental Fight Club’s latest creative project: a relaxing café and imaginative space, open to all, located opposite Borough tube station. (Map). Open every Monday, midday to 8.30 pm."

Publications


Carl Rogers and the Person Centred Approach
BBC Radio 4 - 'Mind Changers'
 
"Claudia Hammond presents the history of psychology series which examines the work of the people who have changed our understanding of the human mind. This week she explores Carl Rogers' revolutionary approach to psychotherapy, led by the client and not the therapist. His influence can be seen throughout the field today."
 
Psychiatry Reconsidered
by Hugh Middleton

"This book provides an account of mental health difficulties and how they are generally addressed in conventional medical circles, alongside critical reviews of the assumptions underpinning them."

Peer-supported Open Dialogue
Jane Hetherington (POD Trainee) writes on POD in the Psychotherapist

Developing Open Dialogue
Val Jackson's website has a host of useful information about Open Dialogue in the UK and beyond

“For the word (and consequently for the human being) there is nothing more terrible than a lack of response” – Mikhail Bakhtin

Social Media Bite

The 2015 Peer Supported Open Dialogue Conference in London -
Highlights video no. 2
Peer Supported Open Dialogue Conference 2015 UK 2
By Green Lane Films 
If the video doesn't appear above, please click here
If you have any thoughts about, or feedback on, the content of this bulletin, please email us at podbulletin@gmail.com. We want to stimulate discussion and really value your views. 
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