Open dialogue and reflectiv processes

In 1988, we moved to Vesterålen, and started the Vesterålen District Psychiatric Centre (VDPC) together with some of our colleagues.

In 1990, the VDPC received an offer to complete a two-year program in family and professional networks with professor Tom Andersen (1936 – 2007). He worked at the University in Nord-Norway and had the role of both tutoring and guiding the program. Tom Andersen came to the psychiatric centre for at least 1 and a half work days per month for 2 years. The days were focused on teaching and clinical work with families. It was an exciting journey for the 5 employees working for the VDPC at that time.

Tom Andersen’s idea was that interactions between family members and the quality of their dialogue was a solution to mental illness. He would wonder about the words an individual used to describe the situation and the problem. He wondered if they could use different words to shape a certain perspective on the problem. Tom Andersen thought it was important that each member of the family have a chance for input on what was important for them while the others listened attentively. Other questions he raised included whether it was possible to come to a mutual understanding in the family where everyone can grow and develop from the situation, could the family find healthy ways to communicate when new problems arise, and could they at the same time work together to support each other to find innovative ways to communicate and relate to each other.

In this way, the therapist did not decide what one should talk about or what should be in focus; this is different from traditional treatment where it is the "therapists who treat" and "families who are treated".

At the end of the 1980s, Professor Jaakko Seikkula and colleagues at the Keropudas hospital in Torneå (Northern-Finland) also developed new ways of meeting a patient in a mental crisis. All patients or family who contacted the clinic received an offer from the staff to come home to the family or the family could come to the hospital within 24 hours. As their way of working developed, the entire staff went through a family therapy education in what they called Open Dialogue. In family conversations, each family member had the opportunity to express their understanding and perspectives on the member with the mental crisis. The therapists were actively engaged in trying to understand the content of the psychosis. All “voices” were just as important, and all “voices were heard”. In this way, all the family members were actively included in an equal manner. There were always two therapists present at each session. One therapist would lead the conversations while the other(s) would actively listen and reflect on the words used in the dialogue. These reflections were important to give back to the family after the conversation. The reflection could then be used to give a distinct perspective on the situation. By the end of the session, they strived to arrive at a conclusion that everybody could agree on about how to move forward. In addition, there was a strong focus on using minimal medicine as treatment for a brief period.

They have had astounding results with this approach and Open Dialogue is now introduced worldwide to people experiencing some form of crisis.

Tom Andersen and Jaakko Seikkula were close colleagues with a similar approach to psychiatry. In the middle of the 90s, Jaakko Seikkula was hired part-time at the University of North-Norway. Due to his relocation, he worked at the VDPC several days a year. We became very inspired by his work with families and networks after observing his teaching method.

In 1996, Tom Andersen and Jaakko Seikkula established the “International Meeting for the Treatment of Psychosis”. The meeting occurs five days each year where professionals from multiple countries gather to exchange experiences within clinical work, research, and ethical problems. Two times (in 1998 and 2010) we have hosted the meeting in Stokmarknes.

We have been active participants in this network since its creation. During the past five years we have guided groups in OD via skype in both Norway and the United States. We have also run several training programs on OD in the United States, in Norway and in Czech. Republic.

We ended our work at Vesterålen DPS in 2015-16. With our GOOD DIALOGUE-clinic we wish to continue the development of Open Dialogue in clinical work.