Open Dialogue Treatment (90% Decline in Schizophrenia!)

"All of us could have psychotic problems. It's an answer to a very difficult life situation. It's in a way, a kind of metaphorical way to speak of things that beforehand did not have anywhere they could be spoken of."
-- Jaakko Seikkula


This is the land of open dialogue where for more than twenty years, they've been documenting their results which are the best in the western world, to the extent that schizophrenia is now disappearing from their region.

They're down to 2 cases per 100,000. A 90% decline in schizophrenia! And why? Because their first-episode cases are not becoming chronic.

- Robert Whitaker, author of Anatomy of an Epidemic

Video Trailer: http://www.youtube.com/watch?v=aBjIvnRFja4

Jaakko Seikkula, Ph.D. is a professor at the Institute of Social Medicine at the University of Tromso in Norway and senior assistant at the Department of Psychology in the University of Jyvskyl in Finland. Between 1981-1998, he worked as a clinical psychologist at the Keropudas hospital in Finland where he and colleagues developed a highly successful approach for working with psychosis known as Open Dialogue Treatment (OPT).

Among those who went through the OPT program, incidence of schizophrenia declined substantially, with 85% of the patients returning to active employment and 80% without any psychotic symptoms after five years. All this took place in a research project wherein only about one third of clients received neuroleptic medication.

Source: http://spiritualrecoveries.blogspot.com ... hange.html

Dan Fisher's Presentations on Recovery

In April-May, 2006, I gave a series of talks in Sweden, Netherlands, and Denmark. I talked but I also entered into dialogue with “users” (their name for consumer/survivors), families, and providers. This tour filled me with new understanding, which I want to share with you all. We entered into dialogues of mutuality across cultures and languages. ...

I now feel the core of recovery is as follows. Throughout our life we each pursue our development to become the unique person we deeply are. We develop this sense of ourselves through deepening emotional connections with important persons in our life. These connections provide us the light to see and feel our values and emotions. The better we know ourselves, the better we can self-direct our life based on our dreams and goals.

When we experience various traumas causing us loss of control over our lives, we suffer extremes of emotional distress. If we are unable to share these emotions with others, we develop distortions in our thinking and feeling which interfere with our expected life role. We are then at risk of being labeled mentally ill, unless we can share these extremes of anger and sadness and transform them into passion. This passion can empower us to continue our journey of self-discovery.

Through this process we learn to believe in ourselves and to accept our deepest self. To transform disturbing emotions into passion, we need to share with authentic, genuine people. These genuine people are capable of connecting with us at our heart level. Heart-felt conversations with genuine people are based on caring, trust, respect, hope, and love. These conversations empower us because they help us to believe in ourselves. In these conversations we are able to be fully present in the moment with each other enabling us both to more deeply be. The “Heart is a lonely hunter” forever seeking nourishment through love.

People in Europe resonated with this message, just as they had in Japan. The hunger seems to be universal. The need to hear a hopeful message is widespread. They resonated when I told them of the young man in Canada who shared with me that he heard voices when his heart no longer spoke to him. In a similar vane, members of the Voice Hearers Network in the Netherlands reported that telling your life story in your words to others is crucial step in relieving the distressing aspects of hearing voices.

Users in Denmark told with great enthusiasm of a Finnish model for preventing first episodes of psychosis from leading to mental illness. In remote, rural areas of Finland, far from hospitals and academic psychiatry, professionals have empirically learned how to prevent schizophrenia from developing. When a member of the community (usually a young adult) goes into a state of severe emotional distress and their reality becomes distorted, a team of professionals convene several meetings with the significant members of the person’s social network. The person in distress is always present at such meetings.

Open dialogue, in down to earth language, is used to frame each person’s understanding of what has been happening within the network to lead the person in distress to respond in such a fashion. They use some of the ideas for a reflecting team developed by Tom Anderson in Norway. Such meetings allow the person in distress to remain in his or her home without hospitalization, and to require little medication. Apparently, the break in the conversations, which had caused acute distress, is repaired. This allows the young person to resume connection with the people and conversations necessary to orient him/her to reality.

The recurrence rate is very low, most likely because such an approach strengthens the person’s connections with their network, rather than rupturing such connections as frequently happens in hospitalization. This approach is similar to the community healing ceremonies utilized in developing countries. The recovery rate in developing countries is much higher than in industrialized countries.

Read more here: https://ssl4.westserver.net/power2u/art ... urope.html

In the Open Dialogue approach, when a person or family in distress seeks help from the mental health system, a team of colleagues are mobilized to meet with the family and concerned members of the family’s network as promptly as possible within 24 hours, usually at the family’s chosen familiar location. The team remains assigned to the case throughout the treatment process, whether it lasts for months or for years.

No conversations or decisions about the case are conducted outside the presence of the network. Evaluation of the current problem, treatment planning, and decisions are all made in open meetings that include the patient, his or her social relations, and all relevant authorities. Specific services (e.g., individual psychotherapy, vocational rehabilitation, psychopharmacology, and so on) may be integrated into treatment over the course of time, but the core of the treatment process is the ongoing conversation in treatment meetings among members of the team and network.

... The drama of the process lies not in some brilliant intervention by the professional, but in the emotional exchange among network members, including the professionals, who together construct or restore a caring personal community...

CASE ILLUSTRATION: FROM FLASHBACKS TO LOVE
This single meeting ... embodies much of what we seek to explore in the dialogical treatment process. The network meeting was organized for Ingrid, a resident in a sheltered psychiatric residence. Her difficulties had emerged 9 years ago in reaction to an assault that she and her boyfriend had suffered on the street when three men, friends of Ingrid’s brother, had tried to rob Ingrid’s boyfriend. Ingrid had been injured when she tried to defend her boyfriend. She began to experience flashbacks of the assault and sought psychiatric treatment.

Quite soon after the assault, she disconnected from both father and mother, who had earlier divorced. Nothing seemed to help. The flashbacks, in the form of painful nightly dreams, came to invalidate her entire life. Ingrid was a pleasant woman, and everyone eagerly wanted to help her. Two contact nurses were responsible for her treatment and rehabilitation, working in collaboration with other social and health-care professionals.

Early in her career as psychiatric patient, Ingrid’s treatment team had tried to organize family meetings, which turned out to be unsuccessful because of the strong emotions involved. After many years of treatment, the team arranged a network meeting to plan for Ingrid’s treatment and future. The meeting, included Ingrid, her current boyfriend (not the one assaulted), her mother and father, her social worker, the two contact nurses, and her doctor. Although invited to the meeting, her brother did not appear.

The consultant asked the team members about their ideas for the meeting. They said that they wanted to reconnect the family relationships and discuss the future. The consultant offered open-ended questions to Ingrid and her family, wondering how they wanted to use the meeting time. Ingrid said that she was very tense and wanted to hear from her parents. They in turn said that they wanted to hear about Ingrid’s current life. Her boyfriend accused Ingrid’s parents of failing to support her rehabilitation by not being in any contact with her. The meeting was tense; Ingrid and her parents avoided looking directly at each other.

Ingrid’s mother began to talk about the assault, coming to tears as she spoke of feeling guilt about the event. She said that when she spoke with Ingrid’s brother, he blamed Ingrid’s boyfriend for what had happened. The consultant moved carefully to ensure that everyone had opportunity to express his or her concerns, aiming to move neither toward conclusions nor toward treatment planning decisions. One of the contact nurses burst into tears as she described her difficulties trying to help Ingrid without any remarkable success. The mood of the meeting became progressively sadder. Ingrid’s mother spoke of pining for the daughter she had loved so much when she was a child.

After the reflective dialogue, the consultant asked the family members if they wanted to comment on what they had heard. Ingrid’s mother had been listening to the team’s conversation in tears. Her father spoke of being moved by the dialogue and was especially touched by their affirmation of the family despite his own feeling that he had not done enough to reconnect. Ingrid’s mother said that she loved her daughter very much.

From my perspective as the consultant, I had been tracking verbal and gestural signs of emotional expression throughout the meeting, my own feelings resonating to the feelings in the room. I was moved by Ingrid’s mother’s expression of love and by the signs that the others in the room were deeply touched by her words. Ingrid and her mother took each other’s hand.

In a follow-up 1 year later, Ingrid remembered the meeting well. She said that it was one of the most powerful experiences of her life. She did not have a single flashback for 4 months following the meeting. Although the dreams of the assault occasionally recurred thereafter, she had managed to start vocational school with team support. She was no longer in a relationship with her boyfriend but was in contact with her mother and had visited with her father and his new family. She had met with her brother on one of her visits with her mother. They had had a couple of family meetings with the team as well.

THE SHARED EXPERIENCE OF EMOTION
Committed to responding as fully embodied persons, team members are acutely aware of their own emotions resonating with expressions of emotion in the room. Responding to odd or frightening psychotic speech in the same manner as any other comment offers a ‘‘normalizing discourse,’’ making distressing psychotic utterances intelligible as understandable reactions to an extreme life situation in which the patient and her nearest are living. ... In the case illustration, it was important that the emotions of the family members connected to the ‘‘not-yet-spoken’’ experience of Ingrid’s assault were expressed openly in the meetings in the presence of the most important people in Ingrid’s life...

The most difficult and traumatic memories are stored in nonverbal bodily memory. Creating words for these emotions is a fundamentally important activity. For the words to be found, the feelings have to be endured.

Employing the power of human relationships to hold powerful emotions, network members are encouraged to sustain intense painful emotions of sadness, helplessness, and hopelessness. A dialogical process is a necessary condition for making this possible. To support dialogical process, team members attend to how feelings are expressed by the many voices of the body: tears in the eye, constriction in the throat, changes in posture, and facial expression. Team members are sensitive to how the body may be so emotionally strained while speaking of extremely difficult issues as to inhibit speaking further, and they respond compassionately to draw forth words at such moments. The experiences that had been stored in the body’s memory as symptoms are ‘‘vaporized’’ into words.

... Before the meeting, network members may have been struggling with unbearably painful situations and have had difficulty talking with each other about their problems. Thus, they have estranged themselves from each other when they most need each other’s support.

In the meeting, network members find it possible to live through the severity and hopelessness of the crisis even as they feel their solidarity as family and intimate personal community. These two powerful and distinct emotional currents run through the meeting, amplifying each other recursively. Painful emotions stimulate strong feelings of sharing and belonging together. These feelings of solidarity in turn make it possible to go more deeply into painful feelings, thus engendering stronger feelings of solidarity, and so on. Indeed, it appears that the shift out of rigid and constricted monological discourse into dialogue occurs as if by itself when painful emotions are not treated as dangerous, but instead allowed to flow freely in the room.

Observing and reflecting on his experience participating in scores of network meetings, the first author began to recognize an emotional process that, when it emerged in a treatment meeting, signaled a shift out of monologic into dialogic discourse and predicted that the meeting would be helpful and productive. Participants’ language and bodily gestures would begin to express strong emotions that, in the everyday language used in meetings, could best be described as an experience of love.

As in the meeting with Ingrid and her social network, this was not romantic, but rather another kind of loving feeling found in families absorbing mutual feelings of affection, empathy, concern, nurturance, safety, security, and deep emotional connection. Once the feelings became widely shared throughout the meeting, the experience of relational healing became palpable...


Read more: Healing Elements of Therapeutic Conversation: Dialogue as an Embodiment of Love[PDF File]

... a very good resource and collection of links for any who are looking for more information on the Open Dialogue approach, either as a form of treatment for themselves or a loved one.

The Open Dialogue method has the best reported outcomes for any method of assisting those who are beginning to show “psychotic symptoms.” Rather than relying primarily on medications, it aims to facilitate dialog throughout a person’s close social network. You can find out a lot about it just by clicking on the links below.

- “Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies” Psychotherapy Research, March 2006; 16(2): 214_/228 http://psychrights.org/research/Dige...pyresearch.pdf

- “Healing Elements of Therapeutic Conversation: Dialogue as an Embodiment of Love” Fam Proc 44:461–475, 2005 http://taos.publishpath.com/Websites...uticConver.pdf

- “Open Dialogue Approach: Treatment Principles and Preliminary Results of a Two- year Follow-up on First Episode Schizophrenia” Ethical and Human Sciences and Services, 2003, 5(3), 163-182. http://psychrights.org/research/Dige...upehss0204.pdf

- “Open Dialogue in Psychosis II: A Comparison of Good and Poor Outcome Cases” Journal of Constructivist Psychology, 14:267-284, 2001 http://psychrights.org/research/Dige...nstrudial2.pdf

- “The Open Dialog Approach to Acute Psychosis: It’s Poetics and Micropolitics” Family Process, Vol 42, No 3, 2003 http://www.theicarusproject.net/file...onSeikkula.pdf

- “Inner and outer voices in the present moment of family and network therapy” Journal of Family Therapy (2008) 30: 478–491 http://www.theicarusproject.net/file...ogSeikkula.pdf

- “Open Dialogues with Good And Poor Outcomes For Psychotic Crises: Examples From Families With Violence” Journal of Marital and Family Therapy July 2002 Vol 28 No 3 263-274 http://taos.publishpath.com/Websites...orOutcomes.pdf

- Family and Network Therapy Training for a System of Care: “A Pedagogy of Hope:” [In Lightburn, A. & Sessions, P. (Editors). (in press). The handbook of community-based clinical practice. New York: Oxford University Press.] http://www.theicarusproject.net/file...culumOlson.pdf

- Book chapter on Scandinavia/Finland approach to psychosis: http://www.theicarusproject.net/file...hernSweden.pdf

- “A TWO YEAR FOLLOW-UP ON OPEN DIALOGUE TREATMENT IN FIRST EPISODE PSYCHOSIS: NEED FOR HOSPITALIZATION AND NEUROLEPTIC MEDICATION DECREASES” Published in Social and Clinical Psychiatry. 2000, 10(2), 20-29. http://www.talkingcure.com/docs/jaak...kula_paper.rtf

- “Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process of Bakhtin, Voloshinov, and Vygotsk” http://spiritualrecoveries.blogspot....is-change.html

- Madness Radio: Open Dialog Alternative, interview with Mary Olson http://www.madnessradio.net/madness-...on-open-dialog

- Mary Olson on VoiceAmerica http://www.voiceamerica.com/voiceame...aspx?aid=44519

- A PowerPoint: http://www.health.bcu.ac.uk/ccmh/2008update/JS.pdf


Source: http://recoveryfromschizophrenia.org/20 ... n-the-web/

Additional commentary from the maker of the documentary that opened this discussion thread...

My Reflections on the Finnish Open Dialogue Project
Daniel Mackler

In June of 2010, I visited Western Lapland in Finland for two weeks. My goal was to make a documentary film on the Open Dialogue project. Although the film is now complete, and I feel it tells their story fairly well, there remains a lot that I left out — things I somehow, for one reason or another, couldn’t capture on camera.

I want to share a few of those missing things here. I first want to share my impressions of arriving at the Keropudas Hospital in Tornio, Finland, which is the nerve center for Finnish Open Dialogue. It all began there, almost thirty years ago. I actually stayed on the hospital grounds for my two weeks in northern Finland, so I had a lot of time to spend wandering around the hospital, talking with patients, and just watching how life unfolded on a day-to-day basis, and in the evenings too. Because of the Finnish confidentiality rules, however, I was not allowed to film patients — which was very disappointing and frustrating for me — but the administrators did let me talk with whomever I wanted, ask whatever questions I wished, walk freely inside the hospital without a pass or escort, and even visit their locked ward whenever I wanted, which I did often. Oddly, no one seemed to mind what I did there, or where I went — they really let me go free. I also sat in on many Open Dialogue therapy sessions, which, again unfortunately, I couldn’t film, but I did come away with impressions. Many...

... A second key thing I learned about Keropudas Hospital, which, like most mental hospitals, is placed on the far outskirts of town (in their case, on the edge of the forest), is that it’s a rather large hospital that is relatively unused. There are one or more whole wards that are unused. I remember visiting one. It looked like an average, spacious hospital unit, but it was silent — and empty. It was dusty. Nothing was happening there. And the reason: they no longer have patients for them. They’ve developed such an effective system of helping people get well from psychosis, and get permanently out of the psychiatric system, that they no longer need so many beds. (No wonder they have some of the lowest per capita spending for psychosis anywhere in Finland — at least that’s what I’ve heard. When people get fully well, and are able to get off all their psychiatric drugs, they save the system a lot of money.)

Also, much of the work they do helping people with psychosis, most of it, in fact, has nothing to do with the hospital itself. In most cases they don’t prefer that people in crisis come to the hospital, and they don’t even do much therapy in the outpatient clinic that is located at the hospital. In fact, their hospital outpatient clinic has only one therapy room — one therapy room to serve a population of around 70,000 people!

Granted, the Open Dialogue clinicians do have an outpatient therapy clinic in each of their catchment area’s two largest towns (Tornio and Kemi), but they even prefer to avoid using these clinics for therapy, if at all possible. Their best preference is to meet in people’s homes. The therapists, usually a team of two or three trained family therapists, travel to the homes of the people in crisis. The clinicians made a point of telling me repeatedly that they saw no value in having people come to the hospital for therapy, because of the stigma. They felt that if they could help people get better at home, in their natural environment, then it was all for the good. Also, the clinicians told me repeatedly that they learned far more from people by seeing them in their homes than they could ever learn by seeing them in such an artificial place as a hospital or clinic. ...

What I heard from the Finnish people seeking help was that they felt the Open Dialogue system was fair — and honest. They also told me repeatedly that it felt “normal” to them. They used those words repeatedly. Interestingly, most of them seemed to have no idea that psychiatry was commonly hated and mistrusted in many other parts of the world, and even in parts of their own country. In fact, when I explained this to them many were genuinely surprised, as it contradicted their experience. This led them to tell me other things they liked best about their system. And they liked many things.

They liked the openness and frankness of the therapists. They liked it that above all else their own voices were heard and valued. They liked it that they had a key say in the decision about whether or not psychiatric drugs might be of benefit to them or not. They liked it that they had alternative options to drugs presented to them. They liked it that when they were in crisis they could invite their family and friends and other important people from their lives into therapy meetings — if they wished.

They also liked it that the therapists worked in teams, right in session — because they liked listening to what the therapists had to say to each other, in the middle of session. They told me that they felt they deserved to know what the therapists were thinking! And doesn’t it make logical sense?

They also told me that they liked it that their therapists met with them immediately in their crises, and didn’t put them off for months on endless, bureaucratic waiting lists. They liked it that therapists gave them the choice of meeting in their own homes or in clinics. They liked it that hospitalization was only used in cases of dire safety issues, and that hospitalizations were generally quite short. And they also liked it that visitors like me were so interested in what was going on with Open Dialogue — and were also interested in their lives. Many of them wanted to know what I myself thought of their lives, their situations, and of their therapy too. And, because it was Open Dialogue, and because I felt safe there, I shared my opinion. And they valued it. And it even felt therapeutic — which felt good to me. ...

Read the full interview here: Open Dialogue Treatment: http://bipolarblast.wordpress.com/2011/ ... ndialogue/

This is amazing...more people should know about this...we should demand for this to be used more frequently!!! If I could go to that hospital in finland, I would!!

I agree babybowrain. I think we need to begin demanding these kind of very successful treatment programs for ourselves and our loved ones. Change will not come without us asking for it. A very good argument can be made that over the long-term, if we can produce recovery for people this is what truly helps them. Helping people get back to their own lives is also most cost-effective..

I hope you will share what you have learned about Open Dialogue Treatment with others, family, friends, peers and key figures in medicine and government.

~ Namaste

Yes spiritual, I have already shared it with a few friends who are suffering as well as family, and a depersonalization board. No one seems to care much though, people don't seem to understand at all....I heard this sort of therpay goes under the form of "dialogical therapy" or something like that, and I looked that up and gestalt therapy is dialogical too, so I thought that maybe we could benefit from gestalt therapy?
Also I found this institute in america: http://www.opendialogueapproach.com/
nothing in canada though
family does not seem to care so much, my suffering seem to be to them "no big deal"...as if I've always been sick.

Thank you for sharing that link, babybowrain. I've known about the Open Dialogue Approach for several years now but it's beginning to get much more attention for a number of reasons:

- People want programs that are effective
- People want approaches that are respectful of who they are as a person and what their life experience has been
- Medications do not work for all people and they can be horrendously expensive
- There are some justifiable criticisms of medications and the manner in which they are marketed and used off-label
- We know there are risks associated with medications, ranging from mild to very severe
- We know that recovery is a viable option for many, many people

All of these factors have made those in the West more receptive to the programs like Open Dialogue. It's encouraging to know it's making a slow inroad in the West. I am a fan of it for all of the above reasons but my personal experience and passion is more closely aligned with Jungian approaches, such as that offered through Diabasis. I do have a blog with a number of collected articles that may be helpful. Should you wish to look at it, you can find it here: http://jungianschizophrenia.blogspot.com/

family does not seem to care so much, my suffering seem to be to them "no big deal"...as if I've always been sick.

There is some standard advice I often share with people who are reaching for their own recovery. Part of that advice includes acknowleding that families are often vital to recovery but because they are so close to us, they may not be the best forms of support. My own experience has been that the best forms of support come from peers. Meantime, here's a copy of that standard advice...

I've often shared the following with individuals who are in a recovery phase of their experience but it's worth emphasizing that caregivers often benefit from developing their own support teams and toolboxes. Forgive me if you've read it before -- it's a cut and paste.

==========================================================================================

Support Teams are comprised of people you find helpful and should include: Professionals; Family and Friends; Peers, and; Mentors. Each member of your team can address unique needs.

Professionals provide medical and psychotherapeutic care and may include psychiatrists, psychologists, counselors, social workers, therapists, general practioners, nurses, nutritionists, massage therapists, etc.

- Family and Friends provide connection, meaning, purpose and are often in a unique position to provide vital feedback. For example, if you are taking a new medication your family will be very much aware if it is working for you. Or if you are beginning to slip into a depressive, manic or psychotic episode, they may well become aware of it before you do.

- Peers are especially important because, in my experience, they can often provide the best forms of emotional support and understanding -- they have been there; they have walked in your shoes; they know what it's like. Many people look to their family and friends to offer peer support but these people may lack the insight that shared experience can offer. They can also be so intimately involved and deeply impacted by your experience that they lack the ability to provide impartial support and may, in fact, require their own support team. The latter will be especially true for those who are in a position of primary caretaker.

- Mentors serve in a unique capacity because these are the people who inspire you to reach for your best. Mentors can be drawn from any other area of your support team (i.e. a family member can be a mentor) but more likely, they will be drawn from the larger world around you. It's not necessary that any chosen mentors also carry a diagnosis of any kind of mental illness; rather, they simply need to have been another human being who faced some enormous challenges and either overcame them or turned them to his/her advantage. If your support team does not have at least a few mentors on it, your team is lacking. One point worth emphasizing is that Mentors must be self-chosen. It's also worth noting that they needn't be alive; some of my mentors have included Helen Keller, Viktor Frankl and my own mother -- all of whom are dead.

Support Toolboxes are made up of things you (and members of your Support Team) recognize as beneficial and helpful. Support toolboxes can be quite unique because what we find helpful on an individual basis may vary considerably. They may include things such as education, exercise, medication, meditation, music, nutritional therapies, spiritual practices, personal journalling, etc. The most effective treatment is always going to be the one that works for that particular individual.

A strong Support Team and a well-equipped Support Toolbox greatly increases the odds that if you're floundering in any capacity, you'll be able to find the person or thing that is most going to help take you forward. So, choose your team wisely and outfit your toolbox with care.

Maybe there are some things there that you could apply to your own experience babybowrain. As for therapeutic approaches... the unfortunate truth is that, for now at least, we may need to create those programs for ourselves. That increases the challenges but we can take our time and learn slow. Every step forward is a step forward.

~ Namaste