Beyond polyphony: Open Dialogue in a Women’s Shelter in Australia as a possibility for supporting violence‐informed practice

Abstract

Open Dialogue is a family/social network‐centered psychotherapeutic approach to responding to people in crisis and distress. In 2017, Open Dialogue network meetings were implemented in an Australian inner‐city shelter for disadvantaged women. The aim of this study was to explore the experience of participating in these meetings from the perspective of service users and Open Dialogue practitioners. Qualitative interviews were completed with thirteen participants (six service users and seven practitioners) and analyzed thematically. The findings suggested that dialogical processes created safety by attending to multiple voices in nonviolent ways that reduced perceived hierarchies. Notions of expertise were renegotiated, which allowed the women to feel heard in significant ways that were different from their previous experiences with other social and healthcare services. Open Dialogue is an approach that can meaningfully attend to some of the power relations within which women live and within which social and health care services are provided.

Development of the peer-supported open dialogue attitude and competence inventory for practitioners: A Delphi study

“…Positive outcomes were still present even after 5 years, where the OD group (n = 42) had a smaller duration of untreated psychosis, reduced medication use, and fewer days in the hospital compared to the control group. The benefits of OD have also been consistently demonstrated in more recent studies across the world, including Finland (Granö et al, 2016;Bergström et al, 2018), United States (Gordon et al, 2016;Rosen and Stoklosa, 2016;Freeman et al, 2019;Gidugu et al, 2021), Denmark (Buus et al, 2019), and Australia (Dawson et al, 2021).…”

“…Indeed, identified by Razzaque and Wood (2015) , POD practitioners themselves argued that implementing POD would be challenging due to (1) major cultural shifts from the medical-based treatment as usual (TAU) to a more person-centered, holistic, relational, and compassionate approach in POD (e.g., relying less on particular diagnosis, set procedures, and medical prescriptions, and putting more emphasis on collaborative decision making, hearing the voices of all present and creating a sense of safety so that all stories can be heard ( Jackson and Thorley, 2021 ) (2) professional changes in current practitioners’ approach to mental health (e.g., surrendering one’s power and positive risk taking; Razzaque and Wood, 2015 ). While many clinicians embrace the possibility of creating a less oppressive medicalised service, challenging existing hierarchies within existing services is not easy ( Tribe et al, 2019 ; Dawson et al, 2021 ). For individual practitioners, POD trainings can be difficult and somewhat uncomfortable as trainees are expected to work as part of a non-hierarchical team, share relevant aspects of their own life histories and display their emotional vulnerability ( Schubert et al, 2021 ), which some of them described as almost a ‘cult-like culture’ ( Florence et al, 2020 ).…”

“…Before joining the POD course, every trainee has different starting points, experiences, and beliefs, so their journey throughout the training would vary individually. While some may find the training to be life-changing and are prepared to practice POD right away ( Dawson et al, 2021 ), others may need more time to gain a better grasp of how to practice POD. Therefore, it is necessary to develop an instrument that assesses the development and competence of trainees before and after training (e.g., how well the trainee has internalized and integrated attitudes, knowledge, values, etc.…”

Implementing Open Dialogue approaches: A scoping review

“…Initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental indeterminate spirit of the approach, might mitigate possible conflicts with existing approaches. We hope that future implementation research will focus more exclusively on the actual processes of adaption and implementation of Open Dialogue approaches in contexts outside the medically dominated mental health services, for example, social services (Dawson et al, 2021), where we believe there is great potential for implementing Open Dialogue approaches.…”

“…Open Dialogue approaches are often presented as more collaborative and less pathologizing than traditional medicalized models (Bellingham et al, 2018; Dawson et al, 2021; Ong et al, 2019). However, it remains uncertain where and how the implementation of these alternative approaches challenge conventional mental health services, and how organizations should prepare for such implementations.…”