Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry

Peter, Sebastian von; Eissing, Katrin; Saliger, Katharina

doi:10.3389/fpsyg.2022.1063747

Cited by 5 publications

(8 citation statements)

References 7 publications

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“…Although attractive, the democratizing and deeply reforming nature of Open Dialogue appeared to evoke insecurities with professionals feeling unprepared to engage with it ( Skourteli et al, 2019 ; Stylianidis, 2019b ; Schubert et al, 2020 ). These initial findings seem consistent with literature highlighting the resistance of mental health professional teams in assimilating Open Dialogue as part of their professional practice (Sondergraard, 2009; Thylstrup, 2009 ; Holmesland et al, 2010 , 2014 ; Seikkula, 2011 ; von Peter et al, 2023 ).…”

Section: Introductionsupporting

confidence: 87%

The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals

Skourteli,

Issari,

Dimou

et al. 2023

Front. Psychol.

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IntroductionThe present study is part of a large-scale original action-research project aiming to assess the introduction and implementation of the Open Dialogue approach within the clinical practice of an established multidisciplinary team in a Day Centre in Athens, Greece. More specifically, it aimed to explore the experiences of professionals within the process of implementation both in relation to their clinical practice and their professional identity.MethodsData collection employed a focus group, which was set up to explore professional reflections of the implementation and research processes since the introduction of the model. Thematic Analysis of transcripts revealed two main themes that correspond to the impact of Open Dialogue on professionals’ clinical practice and on team dynamics, respectively.ResultsProfessionals identify several challenges in implementing OD, such as difficulties in linking theory to practice, containing uncertainty, and addressing cultural barriers to dialogical ways of working. Professionals further reflect on their own internal journey stemming from the implementation of Open Dialogue that has led them to greater openness and growth, personally and as a team.DiscussionThe role of mental health professionals is being acknowledged as being at the frontline of any meaningful psychiatric reform through the assimilation and promotion of humanistic paradigms aiming towards a change of culture in psychiatric care across different contexts. Despite variations in implementation across different contexts, the importance of consolidating and embracing Open Dialogue as a philosophical framework underpinning mental health care is being discussed.

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Section: Introductionsupporting

confidence: 87%

The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals

Skourteli,

Issari,

Dimou

et al. 2023

Front. Psychol.

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“…To pursue this goal, a set of clear and communicable criteria is needed to analyze the extent to which this approach has been delivered and the quality level ( Waters et al, 2021 ). Such a set is also needed for various reasons: first, to allow for communication on this topic among members of the OD community and externally, second to facilitate the transferability and translation of this approach in various contexts, and third to reduce harmful processes with definitional power regarding the “real nature of OD” ( Von Peter et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Implementation of open dialogue in Germany: Efforts, challenges, and obstacles

et al. 2023

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PurposeThe Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany.MethodsThis article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated using a thematic analysis approach.ResultsWhile having to adapt to the fragmented German health care system, OD has been mainly implemented from outpatient service providers and stand-alone services. About half of the teams implemented OD under the conditions of cross-sectoral model contracts and, thus, are considerably limited when it comes to OD implementation. Altogether, OD is not implemented to its full extent in each of the institutions surveyed. Similarly, the expert interviews revealed various challenges that mainly relate to the realization of OD’s structural principles, whereas the implementation of its therapeutic benefits remains less affected. However, these challenges have managed to lead to great commitment by single teams and a certain level of implementation of OD-related concepts.ConclusionOD in Germany can currently only be fully implemented under the cross-sectoral care model contract system that is often temporary, thus significantly hindering its continuous development. Any evaluation of OD’s effectiveness in Germany thus needs to take into account the fragmented nature of the country’s health care system and control for the multiple barriers that impede implementation. Reforms of the German health care system are also urgently needed to create more favorable conditions for the implementation of OD.

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“…However, concepts of heterarchy and “without rank” do not necessarily take account of how perceptions (and realities) of differential statuses within the room are likely to mean than power relations will be enacted, and some voices may potentially be privileged over others. From the perspective of professionals, it may be a challenge to give up positions of “knowing” and “power over” (see Chmnielowska et al, 2022 ; von Peter et al, 2023 ).…”

Section: Conceptual Starting Pointsmentioning

confidence: 99%

Conceptualizing the peer contribution in Open Dialogue practice

Hendy,

Tew,

Carr

2023

Front. Psychol.

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In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer practitioners, co-working as equals alongside workers with professional backgrounds in Network Meetings. The conceptual underpinnings of the peer practitioner role have been drawn from the principles and relational approach of Intentional Peer Support. These have significant similarities with Open Dialogue, in terms of philosophical and theoretical orientations, with a particular focus on what happens in the “between” of a relational encounter. However, there are also significant differences in how practice principles are conceptualized, particularly around areas such as mutuality and self-disclosure. This article offers an analysis of this conceptual territory drawing on the relevant literature. This is then taken forward with the teasing out of specific practice principles that capture the unique contribution that peer practitioners can bring to Open Dialogue practice. These are derived through discussions that took place in an Action Learning Set for peer practitioners who have been involved in delivering Open Dialogue services in mainstream mental health service settings. This was part of a wider research study entitled Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI). The principles address how peer practitioners may be particularly well-placed to offer attunement, validation, connection and mutuality, and self-disclosure – and hence how they may be able to contribute an additional dimension to dialogical practice.

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Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry

Cited by 5 publications

References 7 publications

The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals

The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals

Implementation of open dialogue in Germany: Efforts, challenges, and obstacles

Conceptualizing the peer contribution in Open Dialogue practice

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