Researching Open Dialogue Conversations

I think of the principles of Open Dialogue can fall into two main groups. The first group is about service delivery such as providing immediate help, including the social network, flexibility and mobility, responsibility, and psychological continuity. The second group is more about therapeutic process and includes tolerating uncertainty and dialogism. It is tolerating uncertainty and dialogism that I think distinguishes Open Dialogue from other approaches to seeing families and working with mental health problems.

But while dialogism is a central principle, it is also one of the most difficult to grasp. I think this is because of the different ways that dialogism is conceptualised. (I think that there is also confusion created by Open Dialogue being both a forum for making decisions about treatment as well as a therapeutic approach in itself. But this is a topic for another time.) Cooper, Chak, Cornish, and Gillespie (2013) describe three uses of the word dialogue. First, there is the everyday use that refers to any type of conversation. Second, there is dialogue as a fundamental and inescapable principle of human experience. This relates to the regularly-cited ideas of Bakhtin (1981, 1984, 1986) where dialogue with others is seen as necessary for the development and understanding of the self. In this view we can only know ourselves through interactions with other people. But this view does not specify if any particular types of dialogue promote this understanding of the self. Instead, it seems that any type of interaction with others is enough. Third, dialogue can refer to transformative dialogues. For transformative dialogues, there are particular prescribed ways of conducting conversations that are said to be therapeutic. This is where dialogue becomes a psychotherapeutic approach. It is this concept of dialogue as therapy that I am interested in.

Dialogue as therapy raises a number of questions. For example, if certain types of dialogue are transformative and helpful for people experiencing mental distress, then what characteristics do these dialogues have? What sorts of things can the therapist do to make dialogue more (or less) likely to occur? The writings on dialogical approaches lean toward more abstract descriptions of the therapist’s approach. For example, there is openness and authenticity (Galbusera & Kyselo, 2018), not-knowing (Anderson, 2005; Anderson & Goolishan, 1992), and responsive listening (Olson, Seikkula, & Ziedonis, 2014). Some of the more specific recommendations include repeating the words of the client (Seikkula & Trimble, 2005), giving everyone the opportunity to talk (Haarakangas, Seikkula, Alakare, & Aaltonen, 2007), and using triadic circular questions (Seikkula & Arnkil, 2006). While I found these to be helpful, I wanted to know what specific interactions might underlie these more abstract descriptions. I also wondered if there was something more that happened in dialogical conversations that had not yet been described. These questions led me into wanting to do research.

I knew that I wanted to study dialogical conversations, but I wasn’t really sure how to go about it. I had some discussions with Prof Niels Buus at the University of Sydney, who later became my PhD supervisor. He introduced me to Conversation Analysis (CA) as a way of studying dialogical interactions. I have also had help from Dr Scott Barnes at Macquarie University with the CA side of things. While other types of qualitative research focus on conversational themes or discourses that run through longer periods of interaction, CA analyses the micro details of interactions. These details include the words that people use as well as how they say it (i.e., prosody and intonation). Furthermore, conversation is seen as a vehicle for social action. That is, the things that people say and how they say it, are used to do things. CA thus studies how people use conversational practices to achieve particular social actions. This has been a difficult thing for me to understand. As a therapist I have been used to thinking about what is “behind” peoples’ words, not what their words are doing. By this I mean I have tended to look at the internal motivations of why people say particular things. For example, are their words an indication of “depression” or “psychosis”? Or are they signs of problems in their relationships or unhappiness in their situation in life? CA looks at interaction very differently. The focus is on analysing the interaction and not the psychological motivations. The question is what are people doing and how they are doing it and not why. This has been a difficult thing for me to comprehend and has helped me look at interactions a lot differently. I have come to look at what is observably happening in the interaction rather than what I interpret to be happening.

Some colleagues working in Open Dialogue and their clients have kindly consented to me recording some of their sessions for me to investigate using CA. The results of this research are still in the process of being written up and reviewed, but there are a few things that I would like to mention now. First, issues of authority come up regularly and Open Dialogue therapists use particular conversational devices to mitigate their authority and seek the input of families. Second, we have looked at some of the ways that Open Dialogue therapists summarise prior talk and ask questions to elicit the different views of the family members. Third, we have seen how Open Dialogue therapists catch themselves and each other to correct their talk in the moment in ways that indicate what they consider to be more “dialogical”. I hope to share some more details when they become available.

References

Anderson, H. (2005). Myths about “not-knowing”. Family Process, 44(4), 497-504.

Anderson, H., & Goolishan, H. (1992). The client is the expert: A not-knowing approach to therapy. In S. McNamee & K. J. Gergan (Eds.), Therapy as social construction (pp. 25-39). London: Sage Publications.

Bakhtin, M. M. (1981). The dialogic imagination four essays. Austin: University of Texas Press.

Bakhtin, M. M. (1984). Problems of Dostoevsky’s poetics. Minneapolis: University of Minnesota Press.

Bakhtin, M. M. (1986). Speech genres and other late essays. Austin: University of Texas Press.

Cooper, M., Chak, A., Cornish, F., & Gillespie, A. (2013). Dialogue: Bridging personal, community, and social transformation. Journal of Humanistic Psychology, 53(1), 70-93.

Galbusera, L., & Kyselo, M. (2018). The difference that makes the difference: A conceptual analysis of the open dialogue approach. Psychosis, 10(1), 47-54. doi:10.1080/17522439.2017.1397734

Haarakangas, K., Seikkula, J., Alakare, B., & Aaltonen, J. (2007). Open dialogue: An approach to psychotherapeutic treatment of psychosis in Northern Finland. In H. Anderson & D. R. Gehart (Eds.), Collaborative therapy: Relationships and conversations that make a difference (pp. 221-233). New York: Routledge.

Olson, M., Seikkula, J., & Ziedonis, D. (2014). The key elements of dialogic practice in open dialogue. The University of Massachusetts Medical School. Retrieved from http://umassmed.edu/psychiatry/globalinitiatives/opendialogue/

Seikkula, J., & Arnkil, T. E. (2006). Dialogical meetings in social networks. London: Karnac.

Seikkula, J., & Trimble, D. (2005). Healing elements of therapeutic conversation: Dialogue as an embodiment of love. Family Process, 44(4), 461-475.