What Does it Mean to Work ‘Dialogically’ in Open Dialogue and Family Therapy? A Narrative Review

Abstract

The Open Dialogue approach has gained increasing international interest outside of its origins in Finland. However, the central principle of promoting dialogue can be a difficult concept to teach and apply. In addition, there is a wide range of authors and articles about Open Dialogue and dialogical approaches creating a potentially overwhelming number of sources for clinicians to consider. In this narrative review, we describe and synthesise the wide range of writings on how dialogue may be promoted in family therapy. This article covers the various uses of the term ‘dialogue,’ the dialogical mindset of the therapist, recommendations on how to respond to clients during meetings, the involvement of the therapist’s ‘self’ in meetings, and the use of reflecting teams. We present a concise list of recommendations to aid clinicians and to promote further discussion about dialogical practices.

Some Ontological and Epistemological Consequences of the Development of Online Family Therapy and What This Could Mean for Practice

“…Ong and Buus (2021) distil the transformative account of dialogism into five therapeutic commitments that describe attitudes and practices that are both prescribed (positive account) and proscribed (negative account) in a dialogical approach, as summarised in Table 1 1 .…”

“…1 1 We rely here on Ong and Buus (2021) as an effective summary of Seikkula and Bertrando's contributions to dialogical theory. However, we think that Ong and Buus fail to draw an important distinction between Seikkula and Bertrando's positions in relation to the use of specific questioning techniques when they state that, ‘when repeating the client's words the conversation can feel stuck and circle over the same area.…”

“…Our core proposal is that moving family therapy online catalyses an (already ongoing) move from a more monological orientation (where speaking is privileged) to a more dialogical orientation (where listening is privileged). We offer a definition of what it means to work dialogically derived from Jakko Seikkula's writing and informed by Ong and Buus's (2021) review. We argue that the Milan team's work of their middle period, as described in Hypothesising- Circularity-Neutrality (1980), represents a paradigmatically monological approach to therapy.…”

“…What Do We Mean by Dialogue? As Ong and Buus (2021) point out, 'dialogism' has both descriptive/ontological uses (how things are), and prescriptive/transformative uses (how things ought to be). Often both are at work in a single piece of writing, as is the case here.…”

“…Both Bakhtin's literary research and research on mother-baby interaction have contributed to this ontological account. Ong and Buus (2021) point out, however, that the ontological use of dialogism allows 'that any form of interaction, even those that are monological, conflictual, or abusive, can provide a person with information on their relationship with others, which in turn can inform their views of themselves ' (p. 248).…”