Some thoughts on an open dialogue workshop that I attended today in Liverpool, interestingly almost precisely one year on from the last workshop I attended, so I thought an interesting opportunity to see how thinking within the process has developed and how my own thoughts have crystallised over the intervening year.
Throughout the first session of the workshop I found myself holding onto a vague sense of anxiety and discomfort. At first I wondered if this related to some confusion I was feeling with regard to the concept of open dialogue. However I also realised that, ironically for a meeting on the role of dialogue, much of the language used was quite hostile, and moral, in its implication and attitude towards ‘current practice’ that was repeatedly presented as ‘biological’ psychiatry. Interestingly then I found myself feeling forced into the representative role of psychiatrist, and I think this contributed to my anxiety and discomfort.
As in last year’s workshop I was left uncertain as to the claim being made by proponents of open dialogue. The principles of dialogic practice were reviewed, and each was situated within a framework of previous theory and practice. Some claims were made for efficacy, with statements such as ‘how much more evidence is needed?’ However again quickly reviewing papers that I identified through a google scholar search I was left confused by the sampling and statistical methods employed.
So far as I could see however the speakers made no novel theoretical claims with regard to possible models of effect, relying instead on historical theory to justify their approach. But many of the principles, as I said I a previous reflection, seem to simply be self-evident claims of good practice, why then re-label these practices as new ‘open dialogue’.
I am therefore unclear in my mind – is open dialogue claiming to be a model of therapy, or simply a model of good clinical practice. Perhaps these two are not fully distinct, but I feel there is a potential tension in this confusion, particularly in considering the role of open dialogue alongside other therapy and practice models.
I am left wondering though – if open dialogue makes no novel claims of its own what does it bring that has not been previously proposed?
Throughout much of the workshop open dialogue was positioned in opisition to ‘biological psychiatry’, yet I fear there was something of a straw man being constructed here, as few of even the most biologically hard nosed of my colleagues would subscribe to some of the ideas being voiced. Yet practice clearly needs to change as at present account of personal voice and experience is woefully inadequate.
Yet change to take greater account of individual voice and experience has been called for for quite sometime, that it has not been fully adapted speaks to me of resistance to change in attitude towards conceptualisation of mental distress that I think reaches beyond mental health care to a more general social process.
Will open dialogue be a force for change? If it leads to some of the changes in emphasis that it proposes it will certainly be welcome, and it is also heartening to see so many enthusiastic people in one place calling for change. Perhaps this will be heeded, but I do think that some caution is warranted, much as I personally hope for change.