Academic journal article The International Journal of Narrative Therapy and Community Work

Narrative and Open Dialogue: Strangers in the Night or Easy Bedfellows?

Academic journal article The International Journal of Narrative Therapy and Community Work

Narrative and Open Dialogue: Strangers in the Night or Easy Bedfellows?

Article excerpt

EARly inTERVEnTiOn in psycHOsis

There are now early inter vention in psychosis ser vices throughout England working with 14 to 34 year olds who are having psychotic experiences for the first time. Although the teams take an inclusive approach to the family, ver y few teams employ family therapists and the majority use a behavioural approach (Fadden, James and Pinfold, 2012), although systemic approaches and integrated models of family inter vention are gaining acceptance (Burbach and Stanbridge, 2006).

I (Val Jackson) first heard Jaakko Seikkula describe the Open Dialogue approach in 2003 when he presented a seminar in Yorkshire. For the last ten years, I have been working in an early inter vention in psychosis ser vice enthusiastically applying Open Dialogue principles whenever possible. I first described a narrative approach to family inter vention in psychosis in 2007 (Jackson and Elks, 2007; Jackson and Gupta, 2010) and frequently seek to combine these two approaches in my work with families. Over the years, I have shared many conversations with narrative therapist, Hugh Fox, about the similarities and differences of the two approaches. Which brings us to the question that this paper explores: Are open dialogue and narrative approaches capable of integration? Before considering this, let us first introduce both approaches.

WHAT is OpEn diAlOgUE?

Jaakko Seikkula and colleagues developed the Open Dialogue approach (Seikkula 2003, 2006) in Western Lapland in the early 1980s influenced by Tom Andersen's collaborative approach which listens closely to and responds to the spoken word. Open Dialogue is a network approach that has two impor tant elements that contribute to its success:

(i) A consistent response

First and foremost, it is a way of organising ser vices so that individuals and families who are experiencing a mental health crisis receive a consistent response, one that focuses on a contextual and psychological understanding of the problem, with less emphasis on medical intervention. It is impor tant to emphasise that this is a whole service approach in Tornio, Western Lapland, standard care for all mental health crises, and is not dependent on a diagnosis.

The client, their family, friends and impor tant people in their lives come together with a consistent group of professionals, with all decisions being made in network meetings. Network meetings are arranged within 24 hours of the crisis, to which all who are concerned or involved are invited, including other agencies (e.g. addiction ser vices, probation etc). These meetings can be arranged daily for the first two weeks until a sense of safety is achieved and thereafter as required. Clients are not referred between 'specialist' teams during their contact with the integrated ser vice. The network meetings do not replace other therapies but coordinate them in a consistent approach. If other therapies are recommended, either individual or family approaches, then the lead therapist will become a member of the network team. The same team meets with the network throughout the life of the problem.

(ii) Shared dialogue/shared histor y

Secondly, the professional team of two or three therapists (95% of whom have family therapy training) work closely with the client and their network, developing a dialogue and a shared histor y in order to create a language for experiences that have previously had no words to describe them. Individuals having psychotic experiences frequently tell us there is nothing wrong and are reluctant to par ticipate in more formal therapy. In these situations, it is particularly impor tant to linger, to listen and tolerate uncer tainty. The client's network is very important to the development of this dialogue.

A reflecting process is an integral par t of this process. During network meetings the team members share their reflections at regular intervals. This process was largely influenced by Tom Andersen's (1987) reflecting team approach but the reflections are also used for the professionals to share their concerns. …

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