PdPP: About the Association

In the early 1980s Finland developed a needs-based model of treatment across its Mental Healthcare System. This was in response to a worsening situation with acute psychosis. 

The project was built on the recognition of needs of each individual, of involving family members and of early intervention. Later in 1983 the Western Lapland University and Psychiatric Hospital developed an approach to first case psychosis treatment within the needs-based framework, with minimal or no medical intervention and a structured dialogical methodology. It was called the Open Dialogue Approach.

The response consists of a social group being involved in the treatment of one of its members, with two practitioners facilitating the group. With the introduction of ambulatory crisis support in 1990, most of the psychotherapy treatment was held in the family or individual's home. This treatment resulted in a 40% reduction of hospitalisation. 

Other results of this approach, in a five year follow-up have shown that 80% of the participants were able to return to work or studies, with only 33% of participants having used neuroleptic medication. A ten year follow-up study showed that these outcomes had remained high (Seikkula & Alakare 2004; Seikkula et al. 2011a). 

  The Open Dialogue method helps bring people of a troubled social group, back to a social connection where they have a voice; using a specific dialogical method which allows a participant's needs to be heard, responded to, and reflected upon. This leads to a more informed support group growing around the affected member; leading to realizations that can start to form an environment more conducive to a recovery that people can become pro-actively engaged in. 

The dialogical process was developed over many years in Scandinavia. It was influenced by Systemic Family Therapy and Psychodynamic Therapy, together with dialogical philosophies of Mihail Bahktin and Valentin Voloshinov, "in which the participants in dialogue become co-creators of a shared reality." (Seikkula et al, 2009)

The importance of language in communication, understanding and wellbeing, is rarely considered. Mikhail Bakhtin has said that the worst thing that can happen to a person, is to not be responded to.

Mikhail Bakhtin and Valentin Voloshinov created the idea of dialogism for describing a specific type of communication and interaction in which the participants in dialogue become co-creators of the shared reality. In family therapy their ideas were transformed into psychotherapeutic dialogue by the Open Dialogue team. (Seikkula et al., 2006, p216). Mikhail Bakhtin believes that "crises are between people", so people need to be involved in the recovery.

Constructing words and establishing symbolic communication is a voice-making, identity-making, agentic activity occurring jointly “between people”. The crisis becomes the opportunity to make and remake the fabric of stories, identities, and relationships that construct the self and a social world. (Seikkula J, Olson M.E., 2003)

In many countries it seems that this integrated support and understanding is only at the level of systematic connections that can be contrary in their functioning, rather than developing a collaborative understanding in the best interests of people in difficulty.

Open Dialogue is unique in that it is a “communal practice organized in social networks.” It is embedded in the larger transformation of public psychiatric sources in Finland, that were associated with a reform called “Needs-adapted Treatment” (Seikkula J, Olson M.E., 2003). In England, Peer-supported Open Dialogue trainings are funded by the National Health Service.