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

2. 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

3. 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

4. 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

5. 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”

6. 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

7. 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
- Main principles of Open Dialogue as an outcome of the qualitative content analysis (Grounded Theory)

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

9. 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?