Last update: 6th June 2020

In January 2020, the second cohort of Open Dialogue international trainers were officially certified in Finland by professors Jaakko Seikkula and Pekka Holm. Eighteen participants went through a complex training (included theory, supervision and family of origin seminars) of 520 hours and are now eligible to act as responsible trainers and supervisors in education programs for psychotherapists according to Finnish law. For successful completion of the program, the students were required to write up a thesis.

With a consent of their authors, we offer some of those here. Some of them you can download full text, in some you may read the abstract.

Anne Sundelin: Healing elements in open dialogue treatment model – Importance of specific moment´s to drive positive narratives and hope in the context of anxiety

This thesis is about introspective analysis of therapist work aiming to create better understanding of how to integrate Family Therapy theory in practice in Specialized Medical Care system and in individual therapy setting.  This is case study where one (1) client case has been used and selected as meaningful for me personally and professionally. In this retrospective analysis focus is to understand how the way of working is interlinked to theory, to client needs and finally to the requirements of the Care system.

My curiosity and purpose of  this study is to understand how the therapist stays aligned with his interpreted idea and understanding of Open Dialogue and Family Therapy Theory  (here: Open Dialogue) and what does it mean for client and for therapist  in the context of anxiety treatment in psychiatric system.  Methodology in this thesis is phenomenological case study (qualitative). Case study analysis focused on therapist´s reflections documented in patient system as well as regular meeting records and supervision sessions case descriptions and notes.

The clinical and practical scope of this case study is setting limitations here to produce specific and unique results or open new theoretical thinking. These scientific limitations of the work do not however preclude practical benefits. This study narrates a way to collect evidence of change and Open Dialogue elements in one´s own work and integrates this work procedure to the daily clinical practice. Studying the spoken and unspoken storylines can become catalysts for the therapist and this way help to nurture curiosity about the mystery of healing moments in the therapy. Specifically ideas in this case can inspire those of you who work with individuals to establish alternative means to support dialogical position in your daily work.

Ballas and Ferrari: Initial reactions of mental health professionals to the presentation of core elements of Dialogical Approach.

Dialogical approach (DA) questions many of the common assumptions about psychotherapy and mental health interventions. As trainees in this Train the Trainer program we have experienced many doubts ourselves that required careful elaboration and clarification in order to be tamed. Therefore, we had the idea that mental health professionals when first hearing the basic features and principles of Open Dialogue (OD) could both misunderstand certain concepts and react with feelings of resistance and ambivalence towards the idea of adopting a dialogical approach. This is especially relevant within contexts of theoretical presentation of DA, that cannot count on the clarifying effect of practical elements, which would be necessary to understand DA, as any other psychotherapeutic approach. Nonetheless purely theoretical explanation happens to be the first necessary base of its understanding among the wider professional and scientific community. The aim of this project was to create a situation that would allow us to identify common misunderstandings and misperceptions about DA, and the prevalent ideas and prejudices getting in the way of taking an interest in OD. This was done with the idea that knowing these prejudices and common misunderstandings can be fundamental knowledge for OD trainers planning to conduct foundational trainings, but also for DA practitioners trying to explain their way of working to colleagues and other MH professionals. We prepared a 90′ presentation about what OD and dialogical practices are, which was subjected to prof. Seikkula validation for clarity and loyalty to the model. The presentation was then given to two different audiences of colleagues: an Italian one and an American one, and at the end of the presentation professionals in the audiences were asked to answer to a short list of questions aiming to help them point out their doubts and resistances.

The results confirmed that professionals find it hard to keep in mind the distinction between OD and DA, they easily get a superficial understanding of the core elements, so that, at the beginning they often think they “already do it” but then, they imagine that in order to be dialogical they would need to apply every principle in an absolute and acontextual way and soon they dismiss it as impossible, becoming anxious about not being able to follow traditional and power-centered models of therapy. Moreover, it was interesting to see how the reasons given as an obstacle to adopt DA were similar and at the same time different in the two cultural contexts examined.

Giorgos Polymerou: Reflective dialogues of therapists in a couple’s therapy session: A thematic analysis of a couple’s experience about the reflecting team process

Theory about reflecting team process and inner dialogues that take place during this process is examined in this thesis project. There is also a report about the existing research related to client’s perceptions about the reflecting team process. Then it follows a thematic analysis of a couple’s experience concerning the reflective dialogues of two therapists who were using this reflecting team process. The feeling of getting understood, the tendency of the couple to intervene or take a distance during the process and the openness of the process were the main themes that emerged during the analysis of the results.

Hanna Lampi: When words are not enough. Playfulness in family therapy with children.

As a Family psychotherapist, I work mainly with families that have children under the age of 13, and in most cases, the child in the family is the identified patient, thus bringing the whole family to therapy. It can be challenging to create open dialogue within the family using only verbal dialogue. Even with older children talking can be considered as more of a cognitive tool and with younger children or children with difficulties in language skills, learning, attention, etc. can have a hard time following discussions and participating fully. 

This thesis is my attempt to bridge skills in Theraplay with Open Dialogue and hopefully give ideas to other therapists working with families with children. What could we, as family therapists, do to facilitate connectedness and open dialogue through playfulness and activities enabled by Theraplay?

Janne Kurki: What Is Needed for the Ethical Practice? A Case Study of an Adolescent Psychiatry In-Door Patient Ward

In my thesis, I approach open dialogue from the point of view of embodied values of everyday treatment. This is, on the one hand, what happened in one in-door patient ward in Helsinki from-August 2018 to December 2018 from the point of view of patients and staff members, but, on the other hand, more general reflection what is needed for open dialogue to take place in anorganization not very open to dialogue nor to open dialogue. In other words, what could open dialogue practically mean in the context foreign to open dialogue.Thus, I try to find my way from special facts to general phenomena. The special facts are thequestionnaires fulfilled by the 34 patients and staff members. The main conclusion I make of all this is that even if as new-borns we are all ready and even eager for interaction, open dialogue is hardlyan inborn capability; instead, it is a result of painstaking cultivation, studying and inquiring. This means that embodying values we claim to be ours is not easy, on the contrary: embodying values ispossible only through on-going reflection and doubt, something we hardly have enough time in our everyday practice. Another conclusion I make of the answers is that the context matters both as something that limitsand something that makes open dialogue possible. The urban working environment with hierarchical institutions (like hospitals, policlinics, child welfare etc.) and hierarchical decision processes form a huge obstacle for open dialogue. Patience and passion are needed to overcomethose obstacles. The third conclusion I make of the answers of my patients is the sensitiveness of helpless people. The more fragile you are, the more extreme are your experiences. Thus, in crisis, a little is a lot. You have to mind your words and deeds, when you are helping helpless people.

Pavel Nepustil: „Another kind of connection“: Recovery coaches as co-therapists in dialogical meetings

I initiated an action research project within my private psychotherapy practice, in collaboration with a group of recovery coaching trainees. The main idea of the project was to involve the trainees, people with their own experience of addiction and recovery, into dialogical meetings with couples and families as my co-therapists. In the cyclical process of action research we switched between action phases (meetings with clients) and reflection phases (research team meetings only). Clients of the sessions were not involved directly in the research process but the sessions were recorded and they were asked to offer feedback afterwards. As a result, Open Dialogue model with its reflecting conversations between consultants and emphasis on present moment was found to be suitable model for involving „lived expertise“ as a natural part of the meeting. The clients and trainees were emphasising „another kind of connection“ achieved through the experience with similiar issues and the process also moved the „identified client“ from the central focus of the session. Organisation of the future meetings was elaborated and suggested as the practical outcome of the research.

Suimei Morikawa: My awareness after listening to teammates’ voice

During Open Dialogue(OD) Trainers’ Training Program terms(2018-2020), I thought that talking with my teammate is the most important things for me so far. This research plan has been made to see what changes would take place when I listen to my teammates’ thoughts in a dialogical manner.A theme has been selected for the dialogues as below:“What do you think is desirable, or what do you want to do, to realize the implementation of OD(Open dialogue) in Japan, or to exercise OD in your own workplace?” through dialogues with my 8 teammates. I realized several important things that I had not realized before talking with my teammate. I realized how I neglected dialogues with teammates till now. My dialogues with other teammates continue.

Yuichi Oi: Relationship between workplace social capital and sense of coherence: As an explore the potential of Open Dialogue to promote organizational health in Japan

A cross-sectional survey was conducted in Tsukuba city, Japan. From the multiple regression analysis with 5,578 full-time employee’s data, we found the positive relationship between workplace social capital and sense of coherence. In consideration of the relevance of open dialogue, social capital and sense of coherence, the concept of open dialogue seemed to have a potential to contribute the health of organization.

Jimmy Ciliberto: The co-construction of the tolerance of uncertainty in Open Dialogue-oriented meetings

Open Dialogue can be seen as something that is contemporarily a dialogical practice, a service delivery system and a world view (SIRTS, 2016). These three levels are inevitably connected, imbricated, and represent the complexity of dialogicity, in its apparent simplicity. In fact, although they are characterized by “concrete” actions that can be defined and taught, they are mainly “made up” of wider premises that ask the professional to embody a humanistic and democratic stance towards human beings’ sufferings. As far as family therapy is concerned, change is no more the main aim of the therapy, which instead becomes the living experience of polyphony, both vertical and horizontal (Bachtin, M., 2002), and of tolerance of uncertainty. This last principle is as crucial as hard as complex, and it has been defined as the “counterpart of any assessment tool”, the capacity not to give an immediate answer to the client, without therefore having a preliminary definition of the problems, in order to foster a transformative dialogue among the participants to the meeting (Seikkula, J., Olson, M. E., 2003; Olson, M., E., Seikkula, J., Ziedonis, D., 2014). At the same time, tolerance of uncertainty is deeply intertwined with questions related to other aspects, such dialogism, polyphony, safety and so on, so new questions inevitably arise: how can clients tolerate their own uncertainty? How can professionals deal with their own one, and contemporarily help their clients? How can professionals and clients work together, to co-construct this process?

The general aim of the present thesis has been therefore to explore and increase the knowledges about the principle concerning the tolerance of uncertainty, which means to highlight the elements that can foster this process. More specifically, this project intended to:

1. Define an operationalization of the construct, through interviews to four internationally recognized OD practitioners, systemic-dialogic family therapists, trainers and supervisors.

2. Verify the experience of tolerance of uncertainty, as operationalized through the previous step, in the treatment process of three families, who have been followed by a dialogic oriented mental health service, in Northern Italy. As far as the first aim is concerned, seven dimensions have been extrapolated:

1. Knowing of not knowing everything

2. Feeling safe in your own way

3. Being heard

4. Working in teams

5. Availability, continuity, flexibility

6. Reflections

7. Being transparent

Looking at the key elements that have emerged from the thematic analysis, we have divided these seven dimensions into two subgroups, one more related to the experience of the tolerance of uncertainty (feeling safe in your own way, being heard and knowing of not knowing), and the other more connected to the practices that can help professionals and clients stay in this experience (being transparent, working in teams, availability-continuity-flexibility, reflections).

As far as tolerance of uncertainty is concerned, four elements emerged as particularly important, in the experience of the three families and their teams: being heard, reflecting, being available, and working in team, which are also four of the dimensions that the interviewed Open Dialogue practitioners highlighted.

We have been able to observe a coherence, that highlights two main areas that particularly supported clients and professionals tolerating uncertainty together, to whom we could refer as “not being alone” and “creating space for polyphony”. As clients were not called to deal with their sufferings by themselves, without their network, as professionals were not alone in the hard task of helping families in their process of healing. Not being alone means giving space, not only to every person, but also to every voice harboring in each person. So being together by itself was necessary but not sufficient to foster dialogicity and tolerance of uncertainty, and it seems that the capacity of creating enough space for vertical and horizontal polyphony was crucial. These elements result furthermore coherent with what emerged from the interviews to the four colleagues, who explicitly referred to the importance of working in team, of encouraging the fact that every voice wants to be heard, of fostering polyphony, and how less options are available if you are alone. All people involved in these groups, clients and professionals, embodied the safe experience that “nothing exists out of the relation” (Cecchin, G., 2004), and tolerated uncertainty together, arriving

to a point where uncertainty itself stopped being scary and unbearable and turned, instead, into an

opportunity to raise new evolutionary questions.

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