Recently I taped a conversation between my 4 colleagues who are attending the Open Dialogue training with me in Helsinki and with whom I completed the first British Peer Supported Open Dialogue training run by NELFT and the ensuing mentor training.

Recently I taped a conversation between my 4 colleagues who are attending the Open Dialogue training with me in Helsinki and with whom I completed the first British Peer Supported Open Dialogue training run by NELFT and the ensuing mentor training. We discussed amongst ourselves the difficulties we had experienced as psychological practitioners and women in our various roles within our trusts. We wondered why it had been so much more difficult for us to progress with Open Dialogue than we had originally thought it would be. We wondered about the nature of Open Dialogue as an intervention and as an organisational issue and why there have been so many bars to its greater uptake. We also were curious as to why Open Dialogue was not universally accepted as the treatment model in the whole of Finland. What is it about the model that has prevented greater uptake?

As practitioners we have spent considerable time and energy studying Open Dialogue both in the UK and in Finland. To us the advantages of the model seem obvious and a kinder more compassionate way of being with a patient and their family than treatment as usual as currently offered in the UK. When we are asked by practitioners about Open Dialogue principles fellow clinicians state “that is what we do anyway”. Unfortunately that is not true, in mental health the emphasis is still on the medical model, with medication being often the initial response. The psychiatrist is considered the lead practitioner and revered as the principal source of wisdom in relation to treatment. The very nature of psychiatric training will lead in the majority of instances to medication being the first treatment option with psychological input a secondary consideration. There are increasingly a number of psychiatrists who are psychotherapeutically trained but the presumption that a psychiatrist offers a therapeutic intervention is generally wrong. I mention this because many members of the general public would not understand the difference between a psychiatrist, psychologist and psychotherapist and presume psychiatrists offer talking therapy. In Open Dialogue training the psychiatrists who have trained form part of a team involved in the network meetings and medicine is not necessarily initially offered. This has been one of the considerations that has caused problems with some psychiatrists who are wary of not being able to prescribe which is of necessity their speciality and where their expertise lies. In addition reflective practice groups for psychiatrists often disappear as part of the economies Trusts have been forced to make and there are few opportunities to explore practice and process or a place to reflect on treatment options..

It is not just the psychiatrist who is wedded to the medical model the expertise of the CPN (psychiatric nurse) and their training is of necessity medical model as opposed to therapeutically focused. CPN’s are taught about diagnosis, medication and mental health terminology. They are not taught about psychological interventions or given the support in clinical supervision or reflective practice groups that working in mental health services requires, it is not part of the training to think therapeutically. More enlightened services did in the past often offer supervision groups which were psychotherapeutically led. The severe cuts to services we have experienced in recent years has meant that this type of support for practitioners disappears and absenteeism rises as a result of practitioners experiencing the psychological distress with no outlet in which to process the experience. Open Dialogue offers extensive and ongoing reflection and supervision which is why practitioners enjoy working in the service and remain engaged with low levels of stress related absenteeism..

Author Bio: Jane Hetherington, Principal Psychotherapist at KMPT and an employee at Early Intervention Services in Kent, has completed Open Dialogue course and will be a part of the new Open Dialogue service. She is trained as an integrative psychotherapist and has experience working in primary care, substance misuse, and psychosis services. Here, she writes about a few psychotherapeutic theories.