Rodney Yates ~ Open Dialogue: Why does the Open Dialogue approach work so well?

Tread softly because you tread on my dreams
W.B. Yeats

Schizophrenia is never being able to trust your senses: we see things which ‘are not there’; we hear what no one else does. We therefore live precariously, with a terrific amount of uncertainty and confusion for long periods of time. This is also an experience particular to individuals.

The Open Dialogue approach gives due recognition to this and seeks to tentatively explore exactly what is happening in the lives of individual clients and to find ways forward which grow out of current predicaments, evolving solutions to expressed difficulties and weighing each tread-fall with care and attention.

This is done through the medium of ongoing exploratory treatment meetings which are convened with all the people connected in the social network of the client in attendance and contributing from their perspectives, with as many meetings as it takes to evolve and become the solution and resolution of the difficulties expressed and experienced, finding a way forward launched from the dialogue taking place. This open and thorough dialogue finds a language to best express the realities of life from client-perspectives, exploring these towards outcomes which everyone present can approve and give consent to.

This is a true and meaningful discernment of what is happening in the life of the client. The care taken in achieving this accuracy is well-rewarded in rendering complex issues accessible to practical solutions and removing scope for mis-understanding and discord later; maybe this process of ascertaing the facts will not have to be visited and revisited again, having uncovered the truth at first onset.

No one jumps to conclusions or imposes stock remedies or solutions, because it is better not to have answers than to apply the wrong ones. When the whole topic is explored with everyone present and conferring, the way forward can become much clearer, with all possibilities explored and only the feasible solutions ruled in. Any sense of compulsion is banished from the proceedings and the approach is sensitive, commensurate and quite beautiful in its simplicity. Why would it not work!

So instead of discounting and disregarding the words of people with schizophrenia, these have taken centre-stage. Open Dialogue practitioners are listening carefully and non-judgmentally to the narratives of people with first-onset schizophrenia in a quest to ascertain appropriate care and treatment – without naming it. Is this a Revolution? What do we all think of this?

Rodney Yates
Open Dialogue Nottingham
December 2013



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4 responses to “Rodney Yates ~ Open Dialogue: Why does the Open Dialogue approach work so well?

  1. A snippet of the main practitioners offering explanations…

  2. It is better not to have answers than to apply the wrong ones – LOVE it.
    I wrote a paper last year or so called “Being Heard: The Magic of the Open Dialogue Approach”. Have been in love with their work ever since I stumbled upon it in my studies. Can’t WAIT to get trained.

    • Great endorsement! I do not know what my psychiatrist thinks narrative psychiatry is. She sits and scribbles, telling everyone what an authority she is on my condition, and she does not even enter into a conversation. No conversations, no narratives – seems conclusive to me.

  3. Some more background… Open Dialogue is rooted in the democratic and humanistic reform of Finnish psychiatry, called “Need-Adapted Treatment,” which was pioneered by Professor Yrjö Alanen, MD. Need-adaptedness means employing all the available methods of psychiatry and mental health work on an as-needed, case-specific basis. The main format of Open Dialogue is the open meeting, which was originally Alanen’s idea. Here is what it means:

    Open Dialogue provides an immediate response within 24-hours of the first contact to the crisis service. In advance of any decisions about hospitalization or therapy, the radically revised treatment meeting brings together the person in acute distress with all other important persons, including other professionals, family members, and anyone else closely involved. Everyone’s voice is heard and respected. Any decisions about medication and hospitalization are made with everyone’s input. The team that comes together at the start remains the permanent team whether a crisis last three weeks or three years. Transparency in Open Dialogue is also a main value. The professionals try to be as open and forthcoming as possible. Their practice of transparency was further shaped by its cross-fertilization with the egalitarian, reflecting process work of the late Tom Andersen, MD and Magnus Hald, MD of Norway. Drawing on the writings of philosopher John Shotter and Tom Andersen, the influential social thinker Lynn Hoffman (2007) describes this approach as a “withness” versus an “aboutness” practice. In other words, Open Dialogue emphasizes “being with” rather than “doing to.”

    If possible, antipsychotic medication is avoided. If not, it is used in as low doses as possible with an understanding of the risks involved. People have the option of tapering off and discontinuing the medication when they start feeling better. The Dutch, randomized-design study (Wunderink et al., 2013), mentioned earlier, makes a strong case for a strategy of discontinuation/tapering off of antipsychotics as fostering better long-term, functional outcomes. This strategy is consistent with the medication protocol of Finnish Open Dialogue (Seikkula, personal communication, 2013), which, in turn, may shed some light on their successes. The current NIMH director Tom Insel, MD has been so persuaded by the Wunderick study that he wrote on his “Director’s Blog” (8/28/13) about rethinking standard, “one-size-fits-all” medication guidelines.

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