Not ‘Just a Talking Head’: Experiences of Australian Public Mental Health Clinicians Implementing a Dialogical Family Therapy Approach for Young People with Severe Mental Health Concerns

Abstract

The evidence for efficacy of family‐based approaches for psychological problems is extensive, although model‐specific effects have not been established. However, implementation of family therapy approaches in tertiary mental health settings has been challenging due to factors such as negative staff attitudes and difficulties engaging families. Open Dialogue is an emerging network‐based therapy that has a focus on genuine collaboration, flexibility, authenticity, and openness. This study describes the experiences and perspectives of clinicians, service users and families, following training in Open Dialogue, within a child and adolescent mental health service, and an adolescent inpatient unit in public mental health services. A total of 16 participants (11 clinicians and five service users and family members) took part in semi‐structured interviews regarding their experiences with Open Dialogue. Interpretative phenomenological analysis was used to analyse interview transcripts. Four major themes were identified from interviews with clinicians: valuing responses from families, learning from families and privileging their expertise, hesitation about doing family therapy, and engaging with authenticity and flexibility. Three themes emerged from family interviews: hesitation about doing family therapy, valuing collaboration and openness, and opening space for more talk. These themes are relevant to challenges of family therapy in public mental health settings and future directions for implementation.

Implementing Open Dialogue approaches: A scoping review

“…In Dawson et al’s (2021) description of a network meeting, a young person at the center of concern had some trepidation before and during the meeting, but she and her family found it meaningful to share their concerns about each other. In the study by Sidis et al (2020), young clients expressed being nervous before and after meetings but being able to say what they wanted to say. Staff members’ reflections were appreciated as they shared their thinking about the situation (Sidis et al, 2020).…”

“…The studies of staff members’ experiences noted that Open Dialogue approaches had given staff members more opportunities for responding authentically, and for assisting clients and families/social networks. Sidis et al (2020) found that working with Open Dialogue was very much aligned with staff members’ personal values. They valued being more authentic in their approach and the privileging of the families’ perspectives.…”

“…In the study by Sidis et al (2020), young clients expressed being nervous before and after meetings but being able to say what they wanted to say. Staff members’ reflections were appreciated as they shared their thinking about the situation (Sidis et al, 2020).…”

“…In the study by Sidis et al (2020), young clients expressed being nervous before and after meetings but being able to say what they wanted to say. Staff members' reflections were appreciated as they shared their thinking about the situation (Sidis et al, 2020). Tribe et al (2019) reported a number of challenges experienced by clients who struggled with unusual practices of reflection and non-directive meetings.…”

Beyond polyphony: Open Dialogue in a Women’s Shelter in Australia as a possibility for supporting violence‐informed practice

“…Over the last two decades Open Dialogue has been implemented in healthcare services across Scandinavia (Buus et al, 2017), and has been adapted in Australia, the United Kingdom, Italy, Germany, and the United States of America. The approach has gradually been extended to mental health services for people with issues other than psychosis, such as young people in psychiatric crisis (Buus et al, 2019) or young people diagnosed with eating disorders or mood disorders (Sidis et al, 2020). Extending into community services, this study explored the experiences of Open Dialogue network meetings following their implementation in an Australian women’s shelter.…”