What is Open Dialogue?

Introduction

Open Dialogue is an alternative approach for treating psychosis as well as other mental health disorders developed in the 1980s in Finland by Yrjö Alanen and his collaborators.

Background

Open dialogue interventions are currently being trialed in several other countries including Australia, Austria, Denmark, Germany, Italy, Norway, Poland, the United Kingdom, and the United States.

Key principles of the open dialogue method include: the participation of friends and family, responding to the client’s utterances (which may seem nonsensical in the case of pyschosis), trying to make meaning of what a client has to say, and “tolerating uncertainty”.

Theoretical Basis

In a paper illustrating the Open dialogue method Seikkula, Alakar and Aaltonen postulate that “from the social constructionist point of view, psychosis can be seen as one way of dealing with terrifying experience in one’s life that do not have language other than the one of hallucinations and delusions” and that “psychotic reactions should be seen [as] attempts to make sense of one’s experiences that are so heavy that they have made it impossible to construct a rational spoken narrative” arguing that people may talk about such experiences in metaphor.

They offer a model that “psychotic reactions greatly resemble traumatic experiences” with experiences of victimisation “not being stored in the part of the memory system that promotes sense-making”. Postulating that “an open dialogue, without any pre-planned themes or forms seems to be important in enabling the construction of a new language in which to express difficult events in one’s life.”

This understanding differs radically from common psychiatric models of psychosis that view it as being caused by a biological process in the brain, such as the dopamine hypothesis of schizophrenia.

Effectiveness

A systematic review of academic publications on the topic in 2018 concluded that: “most studies were highly biased and of low quality” and that “further studies are needed in a real-world setting to explore how and why [open dialogue] works.”