Open Dialogue

“We need treatment that respects people’s subjectivity and must meet people as people. This is Open Dialogue’s strength. I believe this is where we enter a field that was reserved for priests in the past” Jaakko Seikkula

Open Dialogue is a humanistic way of meeting clients in deep crisis and has become the world’s most scientifically researched psychiatric wholeness system.

This system of mental health care originated in Western Lapland in the 1980s in order to reduce hospitalizations as well as the excessive need for medications. This approach is not anti-psychiatry, however, medication is used sparingly and only as a last resort.

Jaakko Seikkula, Professor of Psychotherapy at the University of Jyvaskyla, reviewed the methods being used for treatment and set out guiding principles called the Open Dialogue approach, an alternative approach to healing psychosis.

The 7 Principles of Open Dialogue:

Immediate help (within 24 hours) never saying no to a family in crisis asking for help.
Social Network Perspective: as many people as possible are encouraged to be involved: family, friends, co-workers, etc. Everyone’s voice is heard which leads to co-operation. Everyone’s voice is respected as equal.
Flexibility and mobility: integration of all skills of staff are encouraged, so as to fully benefit from staff present, integration of many methods results. The staff team needs to be mobile, going into people’s homes where their own resources are most accessible.
Responsibility: Shared responsibility of everyone involved eg doctors AND family for decision making.
Psychological continuity: integrating various aspects of the system, eg if alcohol seems to be part of the problem, bringing in someone who specializes in this area.
Tolerance of insecurity: in creating a system that increases security, the existing insecurity can be better tolerated.
Dialogism: the staff’s task is to create dialogue in order to understand what has happened. Solutions then grow out of the interactions.

(Jaakko Seikkula – 7 Principles of Open Dialogue)

A 5 year follow up study done in Tornio for first-time psychosis showed the following results:

35% needed neuroleptic medication

81% symptom-free

85% returned to work

A replica study done 10 years later showed the same results and a new diagnosis of schizophrenia decreased from 33 in 100 000 to 2 in 100 000.

Due to the help offered being immediate, people have learned to contact the crisis team early on, resulting in the symptom phase being reduced to 3 weeks.

Seikkula says “the paradoxical difficulty in dialogical practices is that many times it’s so easy, it’s so simple that we don’t believe it. The simple part is that people feel they’ve been heard, nothing more than this, and we’re so busy doing everything else. Perhaps because we’re focused on everything else, leaves them no space to trust their own feelings. The system gives security, so very often, medication isn’t needed.”

He goes on to say “When we change the way we are with our clients in their crisis, instead of focusing on methods and techniques, we enter a process where we trust basic premises in life. Since there is no more important basic premise than the love between family members, then family members can begin to live in love with each other after being separated… If you feel that type of belonging, then you have many new resources for future use.”

Due to the high success rate of the Open Dialogue approach, programs are currently being implemented in the UK and the USA. This respectful approach is proving to be a highly needed alternative to our psychiatric hospitals, where patients often feel over-medicated and unheard in times of crisis and deep despair.

Open Dialogue UK 2016