Open Dialogue

Domain V · Systemic, relational, group & community · Jaakko Seikkula · 1980 · Tornio, Western Lapland, Finland

What it is

Open Dialogue (OD) is two things at once. It is a way of organising a psychiatric service around network meetings that start at the first crisis. It is also a form of therapeutic conversation, known as dialogic practice. It is not a manualised therapy with fixed session content: the Key Elements…

Format

• Version followed: the Finnish (Western Lapland) Open Dialogue as described by Jaakko Seikkula: the seven principles (Seikkula 2021; Seikkula et al. 2003/2006), with the in-session practice taken from Key Elements of Dialogic Practice in Open Dialogue: Fidelity Criteria, Version 1.1, 2 Sept 2014…

Who practises it, and how they are trained or regulated

• Fidelity, training and use of the name.
• Fidelity tools: the Key Elements criteria (2014). Companion tools are an Open Dialogue Therapy Adherence Fidelity Scale, the "10 Organizational Criteria" (Ziedonis & Olson 2015) and a rating manual (Ziedonis, Small & Larkin 2018). The Key Elements document is meant for supervision, training, research and self-reflection. No scoring method is described.
• Training: Tornio ran a 3-year programme that met Finnish requirements for psychotherapist licensing. Most sites now train whole teams for about one year. The Institute for Dialogic Practice (USA) runs a 3-year International Certification of four 5-day blocks a year: theory, clinical supervision and family-of-origin work. In the UK, Open Dialogue UK runs a 3-year practitioner training. NELFT with London South Bank…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Overwhelm. Moderate the pace rather than pushing for expression (see Section 5).
• Added services pulling the person out of the network frame. Check that continuity holds.
• Some trainees experience the training as disorganised. Expect this, and keep a learning journal.
• The team changing between meetings because of rotas. Protect continuity. It is a core principle, not a luxury.
• Swapping their words for diagnostic terms. Use their language in your own talk with colleagues in the room as well.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.