Transformation of professional identity: an exploration of psychologists and psychiatrists implementing Open Dialogue

Abstract

This study explored how psychologists and psychiatrists working in Australian youth mental health services constructed their professional identity, and whether and how implementing Open Dialogue transformed this. Nine clinicians (psychologists, clinical psychologists and psychiatrists) were interviewed after completing Open Dialogue training. Interviews were subjected to discourse analysis. First, two general pre‐existing discursive professional identity positions were constructed: (i) psychiatrists rhetorically distancing themselves from the medical model as ‘fixers’ of mental illness; and (ii) psychologists and psychiatrists rhetorically embracing their personal identity. Second, participants’ responses about implementing Open Dialogue revealed opportunities and discomforts, including: (i) dialogical approaches offering psychiatrists an alternative identity to ‘fixers’; and (ii) dialogical approaches generating discomfort at the risk of exposing participants’ own vulnerability. Participants’ professional identities comprised contrasting positions. Practitioner points Clinicians’ professional identities comprised contrasting positions Clinicians constructed their professional identities by othering themselves from perceived dominant professional paradigms Clinicians incorporated dialogical approaches into existing clinical work after being exposed to Open Dialogue Clinicians identified Open Dialogue as offering opportunities to construct alternative professional identities Clinicians appeared uncomfortable with dialogical approaches in situations of high risk within risk‐averse settings

Downgrading Deontic Authority in Open Dialogue Reflection Proposals: A Conversation Analysis

“…Various approaches to family therapy have emphasized therapist expertize with mechanistic perspectives on family problems and the therapist as an external agent intervening in the family system (Flaskas, 2010). However, clinicians working in Open Dialogue construct their identities through distancing themselves from the traditional roles as “experts” or “fixers” of mental health problems and promote a willingness to be vulnerable in front of clients (Schubert, Rhodes, & Buus, 2020). Writings on Open Dialogue and dialogical approaches similarly recommend that therapists take a position of “not‐knowing” (Anderson & Goolishan, 1992), following the lead of the client (Seikkula, 2011), and tolerating doubt and uncertainty (Seikkula & Arnkil, 2006).…”

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach

“…It is obvious that this use of a non-psychiatric language, the promotion of dialogue and the associated (dialogic) attitude have profound implications for the role of those working in OD, including an impact on professional identity. This is especially true for psychiatrists who need to consider what kind of expertise, what competencies and what bodies of knowledge are needed for good implementation of a network meeting, topics that are the subject of recurrent discussion in the OD community ( Holmesland et al, 2010 ; Borchers, 2014 ; Valtanen, 2019 ; Schubert et al, 2021 ). What is clear, however, is that the central expertise lies not in the transmission of knowledge by mental health workers but in their capacity to promote dialogue and the equal exchange of perspectives ( Seikkula et al, 2001 ; Olson et al, 2014 ).…”

Open Dialogue Approach: Exploring and Describing Participants' Experiences in an Open Dialogue Training Program

“…What these countries have in common is empowering all users in processes making research and clinical performance relevant, particularly individuals in need of health care services (Crowe et al, 2015). However, OD's practical implementation has only been inves-tigated to a limited degree (Buus et al, 2017;Schubert et al, 2020). According to Buus et al (2017), studies focusing on implementation imply that the approach often generates resistance from practitioners, whose positions were challenged in different ways.…”

“…According to Buus et al (2017), studies focusing on implementation imply that the approach often generates resistance from practitioners, whose positions were challenged in different ways. A study from Australia sheds light on how psychologists and psychiatrists working with young people construct their professional identities through othering themselves from dominant professional paradigms or discourses (Schubert et al, 2020).…”

“…They recommend studies examining specifi c models and frameworks, which can advise support and stronger evidence base for communication skills training in psychiatry. There are some studies describing professionals' experiences with the implementation process of OD (Aaltonen et al, 2011, Bergström et al, 2017Buus et al, 2017;Florence et al, 2020;Hopper et al, 2020;Schubert et al, 2020;Seikkula et al, 2006;Seikkula et al, 2011;Ulland et al, 2013), but as far as we know, no studies have described participants' experiences with an OD training program. Therefore, the current article aims to explore and describe participants' experiences in an OD training program.…”