How Open Dialogue Started Jaakko Seikkula London 28th of February 2018

Origins of open dialogue Initiated in Finnish Western Lapland since early 1980’s Need-Adapted approach – Yrjö Alanen Integrating systemic family therapy and psychodynamic psychotherapy Treatment meeting as the forum for adapting to the unique needs of every patient and the family

Tornio early 1980’s Interest on family centred approach in the psychiatric hospital Interest on individual psychotherapy for long term schizophrenia patients Traditional procedure for treatment planning after - doctors individual admission interview; - psychologist’s testing and - reading the patient records Closed meeting of staff members

Changing the clinical practice Treatment meetings in the hospital 1984: (1) It is allowed to speak of the patient only if she is present and decide issue related to the family if the family is present; (2) emphasize on team work in admission Admission meetings in the hospital since 1988: First meeting with the family before the decision to admit

Evaluation of own practice – start of research projects 1988 – 1991: The boundary between the hospital and the family 1) difference between first, reoccuring and long term patients in the admission 2) teamwork opens up broader social interest 3) first ideas on the importance of dialogue 4) ” don’t force the family to accept the home treatment instead of hospitalization”

Outcome of the first research project and clinical experiences Need for hospitalization decreased radically – crisis intervention teams and home visits since 1990 Comprehensive community care since 1990

Research project 1994 – 1995 (Jukka Aaltonen) 1994 – 1996: Change of the system from hospital to mobile interventions Data: 3000 patients records, 2 years follow-up - Incidence of schizophrenia 1985 - 1994 - Main principles of Open Dialogue as an outcome of the qualitative content analysis (Grounded Theory)

Main elements of optimal treatment – Open Dialogue IMMEDIATE HELP SOCIAL NETWORK PERSPECTIVE FLEXIBILITY AND MOBILITY RESPONSIBILITY PSYCHOLOGICAL CONTINUITY TOLERANCE OF UNCERTAINTY DIALOGISM

What is Open Dialogue? Guidelines for clinical practice Systematic analysis of the own practice. In Tornio since 1988: Most scientifically studied psychiatric system? Systematic psychotherapy training for the entire staff. In Tornio 1986: Highest educational level of the staff?