Psychosis seminars (trialogue)

1. Introduction

Version followed: the Hamburg Psychoseseminar model as its originators describe it (Bock, Buck and Esterer, Stimmenreich; Bock and Priebe 2005; Bock's 2017 trialogue lecture; the AG der Psychoseseminare "Blue Brochure"), with practical variants from the East London pilot (Kaselionyte et al. 2016), the Irish Trialogue network (Mac Gabhann and Dunne 2021) and current German-language seminars (Berlin-Tempelhof, Heidelberg, Basel).

What it is. A psychosis seminar (Psychoseseminar) is a regular, open, public discussion forum where three groups meet as equals: people with lived experience of psychosis, their relatives (family and friends), and mental health professionals and trainees. Interested members of the public and students also attend. The pattern is called the trialogue (Trialog). It is not a therapy and not a treatment. No one is a patient in the room, and no one holds clinical responsibility for anyone else. Bock and Priebe stress that meetings are dialogues, not teaching sessions, and offer no medical treatment [source: Bock and Priebe 2005]. The forum sits closest to mutual aid and peer support. A clinician does not "deliver" it. A clinician takes part as one of three equal parties, may help found or co-organise a seminar, refers clients and relatives to one, and carries trialogic principles back into everyday practice. This guide is written for those roles.

Origins (verify before quoting). The model began in Hamburg. It was started by Dorothea Buck, a psychiatric survivor and writer, and the psychologist Thomas Bock, with the journalist Ingeborg Esterer named as a co-founder in one account [source: Kaselionyte et al. 2016]. Bock and Buck's own account is as follows. Buck attended an ordinary social-psychiatry seminar in which students interviewed therapists about psychotic content, and she offered to be interviewed herself. The comparison was so revealing that the next semester the seminar was opened to everyone. About 80 people came, in roughly equal thirds. In their words, a seminar "übereinander" (about each other) became a conversation "miteinander" (with each other) [source: Stimmenreich, pp. 14–15]. [uncertain] The dates and numbers differ between sources. Some accounts give 1989. Bock and Priebe (2005) and Kaselionyte et al. (2016) give the first seminar as Hamburg 1990. Mac Gabhann and Dunne (2021) and the Basel seminar's flyer say "late 1980s". Bock and Priebe report more than 100 people at the first meeting, while Stimmenreich reports about 80. An academic year of 1989/90 would fit all of these, but no source states it. The movement grew quickly after the 1994 World Congress in Hamburg [source: Stimmenreich]. About 130–150 seminars now run in Germany, Austria and Switzerland [source: Bock and Priebe 2005; Blue Brochure]. Vienna started a "Trialog" in 1994, and offshoots exist in Poland, Turkey, Ireland, the UK and elsewhere [source: Mac Gabhann and Dunne 2021; Kaselionyte et al. 2016].

How change is thought to happen. Change is meant to come through equal dialogue, not through intervention. Each group is treated as expert in its own experience. The groups meet on neutral ground, without treatment roles or family ties. They work towards a shared language, and in doing so they break down mutual prejudice and enlarge each person's picture of psychosis [source: Stimmenreich, pp. 10–11; Bock 2017]. Bock describes paradoxical effects: change becomes possible because it is not the aim, and understanding comes more easily at a distance from one's own family or clinic. Bock's slogans for what each group gains are:

• for people with experience, "therapy without intent";
• for relatives, "family therapy without the family";
• for professionals, "triple supervision without payment";
• for students, "timely unsettling" [source: Bock 2017; Stimmenreich, p. 13].

The model rests on an anthropological view of psychosis set out in the Blue Brochure. Psychoses are "zutiefst menschlich" (deeply human). Each psychosis is unique. Everyone carries the potential for psychosis, and a thin-skinned sensitivity lowers the threshold. Crises often follow life transitions [source: Blue Brochure]. The philosophical sources the authors name are Habermas's "domination-free discourse" and Jaspers's existential understanding [source: Stimmenreich, p. 11; Bock 2017].

2. Framework

The seminar does not have treatment phases. Its structure has two levels: how a seminar is set up and run in cycles, and how an individual client moves through it. The second level is mostly [synthesis].

2a. Seminar level (published structure)

Current variants show the range:

• Berlin-Tempelhof: sessions every four weeks of about 90 minutes with a break, rotating moderation, no registration and no duty to attend regularly.
• Heidelberg: fortnightly 2-hour sessions; anyone may speak or stay silent; the forum also covers depression, anxiety and compulsions.
• Basel: monthly 2-hour sessions with a maximum of 20 participants, moderated by a core group; a modest course fee is charged, and attending the whole cycle is recommended.
• East London NHS pilot: seven meetings over three months in a town hall, with 25 attendees and a core of about 10, at a total cost under GBP 1,500.

[source: Berlin-Tempelhof flyer 2026; Heidelberg flyer 2026; Basel flyer 2020/21; Kaselionyte et al. 2016]

2b. Client level (clinician's frame) [synthesis]

1. Assessment of fit and referral. Usually one conversation inside ongoing treatment.
2. First attendance. The client may come alone or with a peer, and is free to listen only.
3. Regular attendance. The client joins over one cycle or drops in occasionally.
4. Integration. Insights from the seminar are brought back into therapy or family work.
5. Optional active roles. Some clients later join the core group, co-moderate, or move into wider trialogic and peer roles such as anti-stigma school projects or peer counselling (EX-IN). The sources describe these roles but give no criteria for moving into them [source: Bock 2017; Bock 2010].

The forum is open-ended. There is no dose and no point of "completion".

3. Guiding principles

• Equal standing (Augenhöhe). Users, relatives and professionals meet "with equal entitlements and without any formal responsibilities" [source: Bock and Priebe 2005, quoted in Kaselionyte et al. 2016]. In practice: drop your professional role at the door. You speak as one participant, not as an authority who sums up.
• Everyone is an expert in their own experience. Experts by training sit alongside experts by experience and by close observation [source: Stimmenreich, p. 10; Bock and Priebe 2005]. In practice: ask people what they know from their own experience. Do not correct them with what the textbook says.
• Mutual learning, not psychoeducation. Bock contrasts the seminar with psychoeducation, which he describes as one-sided, defined by doctors and aimed at compliance. He puts "empowerment before compliance" [source: Bock 2017]. In practice: do not give mini-lectures. Bring questions, and let your own assumptions be unsettled.
• Neutral ground. Meetings happen away from clinics and from user or family organisations, after office hours [source: Bock and Priebe 2005; Stimmenreich, p. 10]. In practice: do not hold it on a ward. If no other room is possible, name the problem openly.
• Subjectivity and meaning. The focus is on personal stories and on the subjective sense of experiences, not on standard programmes [source: Stimmenreich, pp. 11, 16; Bock 2010]. In practice: invite people to say what an experience meant to them, not only what it was.
• Shared language. Participants work to get past jargon and to build a common language [source: Bock and Priebe 2005; Bock 2017]. In practice: when you use a technical term, translate it, or ask how others would name the same thing.
• Modest professionals and skilled moderation. Bock names these among the conditions a seminar needs, together with a public venue, a joint invitation, a set time frame and a manageable group size [source: Bock 2017]. In practice: speak less than your share, and protect space for the quieter groups.
• Joint ownership. Topics are jointly agreed, the chair often rotates across the three groups, and the invitation is issued together [source: Bock and Priebe 2005; Bock 2017]. In practice: never let one group, especially the clinic, own the agenda.
• Voluntariness and openness. Anyone may attend regularly or occasionally, and may speak or stay silent. Registration is usually not required [source: Heidelberg flyer; Berlin-Tempelhof flyer; Mac Gabhann and Dunne 2021]. In practice: never make attendance a treatment condition or record it as compliance.
• Fair rules of exchange. These are: let others finish, listen, take others seriously, and accept views and experiences that differ from your own. Anonymity is an option, and people speak without being interrupted [source: Heidelberg flyer; Mac Gabhann and Dunne 2021]. In practice: state these rules at every session.
• Responsibility limited to emergencies. Professionals present carry responsibility only for acute medical needs [source: Bock and Priebe 2005]. In practice: you are not anyone's therapist in the room. You step in only for an emergency.
• Complement, not substitute. The seminar adds to conventional services and does not replace them [source: Bock and Priebe 2005]. In practice: present it to clients as an addition to treatment, never as an alternative to it.
• Respect for Eigensinn (self-will). Bock reads a struggle for autonomy as a resource and a good prognostic sign, while unconditional obedience is the more worrying sign [source: Bock 2010]. In practice: treat a person's disagreement with treatment as something to discuss, not as non-compliance.

4. Intervention inventory

The seminar has no therapeutic techniques in the usual sense. The procedures below come in three groups:

• A. Procedures for founding and running a seminar, which a clinician may help with as one of the three parties.
• B. Procedures for the clinician who refers to a seminar or takes part in one.
• C. The trialogic practices the originators carry from the seminar into treatment, plus related trialogic formats.

Where the sources give only a principle, the step-by-step detail is marked [synthesis]. The Hamburg health authority publishes a founding guide ("Leitfaden Gründung Psychose-Seminar / Trialog-Forum"), but its content is [uncertain]. Bock, Buck and Esterer's guide Arbeitshilfe 10 (2000) is cited in the Blue Brochure but its content is [uncertain].

A. Founding and running a seminar

A1. Form a trialogic organising group and issue a joint invitation

• Purpose / when: At the founding stage, so that no single group owns the seminar. Bock lists a "joint invitation" among the necessary conditions [source: Bock 2017].
• Steps:
  1. Recruit at least one person from each of the three groups to plan the seminar. Possible sources are local user and relative self-help groups, the local self-help office and interested clinicians. Current seminars are run by such mixed teams. Berlin-Tempelhof was set up by a clinic, outpatient providers, people with experience and relatives together. Heidelberg's seminar was started by a working group representing users and relatives and is supported by the university clinic and the city [source: Berlin-Tempelhof flyer; Heidelberg flyer].
  2. Agree the purpose in one sentence: equal dialogue and mutual learning, not treatment.
  3. Sign the invitation in the names of all three groups and give a contact address [synthesis, based on the "joint invitation" condition].
  4. Involve users and carers in design, delivery and evaluation from the start. The East London pilot names its failure to do this as a limitation [source: Kaselionyte et al. 2016].
• Example language (illustrative): "We are people who have lived through psychosis, family members and people who work in psychiatry. We are inviting everyone to talk with each other as equals."
• Watch for: A clinic or professional organisation drifting into sole control, for example over the room, the publicity and the chair. Working if: all three groups appear on the invitation and turn up at planning meetings.

A2. Choose a neutral venue and timing

• Purpose / when: At founding, and again if the seminar is drifting towards a clinic culture.
• Steps:
  1. Find a public room that is not a treatment setting and not run by a user or family organisation. Examples in use are an adult-education college, a town hall, a community or deaf centre, a church hall and a university seminar room [source: Bock and Priebe 2005; Kaselionyte et al. 2016; Schwandorf and Basel flyers].
  2. Schedule after office hours, so that professionals come in their own time and not as part of their job [source: Bock and Priebe 2005].
  3. Check that the room is easy to reach by public transport [source: Kaselionyte et al. 2016].
  4. Budget mainly for room hire and refreshments [source: Bock and Priebe 2005; Kaselionyte et al. 2016].
• Watch for: Some seminars meet in the rooms of a social-psychiatric service, as Heidelberg does. If you have no other option, acknowledge that the venue is not neutral and keep clinic routines out of the room [synthesis].

A3. Recruit and publicise

• Purpose / when: Before each cycle, aiming for roughly equal thirds [source: Bock and Priebe 2005].
• Steps: These follow the East London pilot [source: Kaselionyte et al. 2016].
  1. Contact inpatient wards, day hospitals and community teams.
  2. Present at user and carer events.
  3. Use leaflets, posters, the intranet and the newsletter.
  4. Keep the flyer short. One participant in the pilot found it too wordy.
  5. Publish the dates and topics in advance.
  6. Make clear that no registration is needed and that occasional attendance is welcome. This is how current German flyers put it [source: Berlin-Tempelhof and Heidelberg flyers].
• Watch for: One group being missing. Professionals with several years' experience tend to be over-represented, and women slightly so [source: Bock and Priebe 2005]. If relatives are scarce, go to relatives' groups in person [synthesis].

A4. Plan the cycle and agree topics together

• Purpose / when: At the start of each cycle.
• Steps:
  1. Choose a frequency. Fortnightly is the classic pattern, and monthly or four-weekly also works. Plan cycles of 4–12 months followed by a pause [source: Bock and Priebe 2005]. The East London participants found weekly sessions requiring full commitment too demanding, and suggested fortnightly meetings with a core group plus drop-ins [source: Kaselionyte et al. 2016].
  2. Hold an opening meeting to set out expectations and choose priority topics [source: Kaselionyte et al. 2016].
  3. Set one theme per session. Themes published by current seminars include:
     • psychosis and relationships, addiction, sexuality, the media, and freedom and privacy;
     • balancing professional help and self-help;
     • psychosis in a religious context;
     • perception between reality and madness;
     • accepting psychosis;
     • paths to recovery;
     • loss of reality and ego disturbance [source: Berlin-Tempelhof 2026; Basel 2020/21; Schwandorf 2026 flyers].
  4. Keep some sessions open, with the topic chosen on the night, and close the cycle with a session on the trialogue itself [source: Basel flyer; Mac Gabhann and Dunne 2021].
• Example language (illustrative): "Which questions about psychosis would each of you most like to hear the other two groups answer?"
• Watch for: A list made up only of professional or diagnostic topics, such as medication side effects. Balance it with topics about experience and meaning [synthesis].

A5. State the ground rules at every session

• Purpose / when: At the opening of every session, and whenever a newcomer arrives. In the East London pilot, unclear rules and expectations were the main problem [source: Kaselionyte et al. 2016].
• Steps: Cover the following points.
  • Attendance and speaking are voluntary. Anyone may stay silent.
  • Let people finish, and do not interrupt.
  • Listen and take each other seriously.
  • Accept different views and experiences.
  • Speak from your own perspective.
  • Anonymity is an option. First names only, and no one needs to say which group they belong to.
  • Keep what others say confidential. [source: Heidelberg flyer; Mac Gabhann and Dunne 2021; Kaselionyte et al. 2016, which suggests anonymity, respect, listening and prioritising subjective perspectives]. Confidentiality and starting on time come from current flyers and [synthesis]. The original Hamburg model, as described in the papers used here, sets no fixed written rules [source: Kaselionyte et al. 2016]. The Irish network developed its own rules and tips for facilitators [source: Mac Gabhann and Dunne 2021; its rules appear only in a figure that was not read in full, so the list may be incomplete: uncertain].
• Example language (illustrative): "Everyone here speaks for themselves. You can just listen. Please let each person finish, and what is said here stays here."
• Watch for: Rules turning into a lecture. Keep them under a minute.

A6. Moderate (chair) the session

• Purpose / when: Every session. Bock lists "skilled moderation" as a condition [source: Bock 2017].
• Steps:
  1. Choose a model:
     • a chair who rotates among the three groups (the classic form, also used in East London);
     • two moderators (the Irish form);
     • moderation by a core group (Basel). The East London pilot considered a paid professional facilitator but noted the extra cost and complexity [source: Bock and Priebe 2005; Kaselionyte et al. 2016; Basel flyer].
  2. Open the session with a welcome, the ground rules and the topic.
  3. Make sure all three perspectives are heard on the topic, and actively invite whichever group has been quiet.
  4. Hold back dominant speakers.
  5. Call the break.
  6. Close without imposing a conclusion. Steps 2–6 are [synthesis]: the sources give only the role, the 2-hour length and the break.
• Example language (illustrative): "We have heard a lot from the relatives tonight. I'd like to hear what this looks like from someone who has been through it, and then from the professionals." When closing: "We won't reach one answer. Take away whatever was useful to you."
• Watch for: Uneven participation, which was the main process problem in the pilot [source: Kaselionyte et al. 2016]. Working if: each group contributes, people pick up on each other's words, and the language becomes more shared.

A7. Run the trialogue exchange (session core)

• Purpose / when: The main body of every session.
• Steps:
  1. Introduce the theme with an open question, or with a short personal account from a volunteer.
  2. Invite answers from each perspective, for example: how this felt from inside, how it looked as a relative, and how it looked as a professional.
  3. Encourage questions across the groups rather than answers to the chair.
  4. Explore differences openly, without trying to resolve them.
  5. After the break, deepen one thread. [synthesis: the published aim is a "mutually respectful dialogue", subjective perspectives and a shared language (Bock and Priebe 2005; Stimmenreich). The ordering above is this guide's own.] Mac Gabhann and Dunne add three points. Participants suspend their assumptions. They explore how their views differ. Early exchanges are often guarded, and coherence grows with practice [source: Mac Gabhann and Dunne 2021].
• Example language (illustrative): "What would you have wanted the people around you to understand at that moment?" "As a parent, what did you see that the staff didn't?"
• Watch for: The exchange sliding into a question-and-answer session with the professionals. If that happens, turn the question back to the room.

A8. Respond to an acute emergency

• Purpose / when: Only if someone has an acute medical need during a session.
• Steps: Professionals present are responsible only for acute medical needs. Bock and Priebe report that no such cases had occurred, and that no physical violence had occurred, although verbal aggression can [source: Bock and Priebe 2005]. Agree in advance which professionals will take this role, and keep local crisis numbers available [synthesis].
• Watch for: Using "safety" as a reason to medicalise ordinary distress or strong feelings in the room [synthesis].

A9. Review the cycle

• Purpose / when: At the end of a cycle.
• Steps: Use a short open-ended feedback form and analyse the content. The East London pilot did this with 10 respondents [source: Kaselionyte et al. 2016]. Make the review trialogic as well: hold a closing session on "the trialogue today and in future", as Basel does [source: Basel flyer].
• Watch for: Bock and Priebe note that the seminars have not been systematically evaluated. Keep the review descriptive and do not present it as outcome measurement [source: Bock and Priebe 2005].

B. The clinician who takes part or refers

B1. Take part as a "modest professional"

• Purpose / when: Whenever you attend. Professionals come for their own learning and to reflect on their role. Bock calls the benefit "Dreifach-Supervision ohne Bezahlung" (triple supervision without payment) [source: Bock and Priebe 2005; Bock 2017].
• Steps:
  1. Attend in your own time, without a clinical function.
  2. Introduce yourself by first name. Mention your profession only if it helps the dialogue.
  3. Speak about your own experience as a worker, including your doubts, rather than giving expert answers.
  4. Ask the other groups questions.
  5. Accept being unsettled. Bock calls this "rechtzeitige Verunsicherung" (timely unsettling) and names it as a gain for students [source: Bock 2017].
  6. Do not diagnose, advise or treat anyone in the room. The steps are [synthesis] built on the published role description.
• Example language (illustrative): "In the clinic I often decide about coercion under time pressure. I'd honestly like to hear how that felt from the other side."
• Watch for: Lecturing, defending your service, or summing up for others. Working if: you leave with a question about your own practice.

B2. Assess fit and refer a client

• Purpose / when: When a client who has experienced psychosis wants to make sense of it, find a voice, or see other people's recovery paths; or when stigma and isolation are central. The Blue Brochure explicitly advises people with experience to find self-help groups or come to the psychosis seminar [source: Blue Brochure].
• Steps:
  1. Check what the client wants from it. Users typically seek involvement and change in care [source: Bock and Priebe 2005].
  2. Judge whether the client can currently tolerate a group of 20–60 strangers and a public discussion about psychosis. If they are acutely unwell or very paranoid in groups, defer the referral [synthesis].
  3. Give the local programme, and say clearly that the seminar adds to treatment rather than replacing it [source: Bock and Priebe 2005].
  4. Explain the format: drop-in, listening only is fine, and anonymity is possible.
  5. Let the client choose whether to tell you they went. Steps 2, 4 and 5 are [synthesis].
• Example language (illustrative): "There's an evening group where people who've had psychosis, family members and professionals talk as equals. Nobody is treated there, and you can just listen. Would hearing how others make sense of it interest you?"
• Watch for: Making attendance a condition of treatment or treating it as a compliance marker [synthesis].

B3. Prepare the client for the first visit [synthesis]

• Purpose / when: Before a client's first session.
• Steps:
  1. Look at the programme together and pick a topic that is relevant but not overwhelming.
  2. Plan how the client will get there, whether to bring a companion, and how to leave if it gets too much.
  3. Rehearse a one-line introduction, or decide to say nothing.
  4. Agree whether to talk about it in your next session.
  5. Tell the client that if you attend the same seminar you will greet them only as they wish, and will never refer to their treatment there.
• Example language (illustrative): "You don't have to say you've been a patient. 'I'm here to listen' is enough."
• Watch for: Anticipatory anxiety. Shorten the plan to "go for the first half".

B4. Refer and prepare relatives

• Purpose / when: When relatives want knowledge and a place to share their feelings, as Bock and Priebe report [source: Bock and Priebe 2005]. Also when relatives feel blamed or have been offered only simple explanations [source: Stimmenreich, p. 11]. Bock calls the effect for relatives "Familientherapie ohne Familie" (family therapy without the family) [source: Bock 2017].
• Steps:
  1. Offer the seminar alongside relatives' groups. The Blue Brochure points relatives to groups in every federal state [source: Blue Brochure].
  2. Explain the benefit of distance: hearing other families' stories, and other people with experience, is often easier than talking with one's own relative [source: Bock 2017, the paradox "understanding is easier at a distance"].
  3. Discuss whether the relative and the client want to attend the same seminar or different ones [synthesis].
• Example language (illustrative): "Sometimes it's easier to understand your son by listening to someone else's son."
• Watch for: A relative using the seminar to look for a verdict on their own family. Remind them that people there speak for themselves.

B5. Use the seminar in ongoing therapy [synthesis]

• Purpose / when: After a client or relative has attended.
• Steps:
  1. Ask what the client heard that fitted or did not fit their own experience.
  2. Explore new words they found for their experience.
  3. Link this to their own account of the meaning of the episode, as in C1.
  4. Let any changed views of their treatment feed into shared decisions or a treatment agreement, as in C4.
• Example language (illustrative): "Was there something someone said that you'd like to use to describe your own experience?"
• Watch for: The seminar being used only to attack or idealise treatment. Explore both sides.

C. Trialogic practice carried into treatment, and related formats

Bock presents the following as lessons from the trialogue for clinicians and psychotherapists [source: Bock 2010]. The concrete steps are [synthesis].

C1. Ask about subjective meaning

• Purpose / when: From the first contact with anyone who has had psychotic experiences. Bock reports survey data (the SuSi study) on this. Over 80% of respondents linked their psychosis to life events, and those who made that link were more hopeful [source: Bock 2010].
• Steps:
  1. Do not dismiss symptoms as nothing more than features of illness.
  2. Ask what was happening in the person's life before the episode, what the experiences meant to them and what they want to keep from them.
  3. Look for "islands of clarity" within acute states and strengthen them [source: Blue Brochure].
• Example language (illustrative): "What do you make of what happened to you? What was going on in your life at the time?"
• Watch for: Pushing meaning onto someone who prefers a medical model. Respect their framing.

C2. Include relatives (the trialogue in treatment)

• Purpose / when: Routinely, unless the client refuses. Bock: "Angehörige einbeziehen (Trialog)" [source: Bock 2010; Stimmenreich, p. 13, where trialogue means negotiating goals and paths as partners, with relatives naturally included].
• Steps: Invite the relatives, with consent, to a joint meeting. Negotiate the goals and paths of treatment with all three parties. Treat the relatives' observations as expertise [synthesis on the meeting format]. Bock also names Open Dialogue meetings for first episodes as a trialogic practice in Hamburg [source: Bock 2010; Bock 2017].
• Watch for: The relative and the client using the meeting to fight it out. Slow down and give each perspective its turn.

C3. Choose language and early contact with care

• Purpose / when: Especially at first contact. Bock: "Je früher, desto vorsichtiger" (the earlier, the more careful) [source: Bock 2010].
• Steps:
  1. Avoid stigmatising labels and prognoses.
  2. Keep recovery in view, not only symptom reduction.
  3. Respect self-will (Eigensinn) as a resource.
  4. Be flexible about time, setting and place, and secure continuity across services [source: Bock 2010].
• Watch for: Your own language in notes and letters. Bock says de-stigmatisation begins in one's own actions [source: Bock 2010].

C4. Treatment agreements (Behandlungsvereinbarungen)

• Purpose / when: Advance agreements between the person and the clinic about treatment in future crises. Bock names them as a trialogic practice [source: Bock 2010; Bock 2017], and the Blue Brochure cites Dietz et al. (1998).
• Steps: The specific procedure is [uncertain]. At a minimum, agree with the client, and with relatives where wanted:
  • early signs of a crisis;
  • preferred and refused interventions;
  • who should be contacted;
  • medication preferences, discussed with the prescriber. Record these and review them after each crisis [synthesis]. The Blue Brochure's "self-protection measures" cover early signs, basic needs and agreements about medication [source: Blue Brochure].
• Watch for: Agreements the clinic later ignores, which damages trust more than having no agreement.

C5. Involve peers

• Purpose / when: In ongoing care. Bock lists people with experience as "Lebenslehrer" (life teachers), recovery helpers and peer counsellors (EX-IN Hamburg), and peer counselling for users and relatives in all Hamburg clinics [source: Bock 2010; Bock 2017].
• Steps: Find out what peer and EX-IN services exist locally, offer them to clients and relatives, and treat peer workers as colleagues [synthesis].

C6. Related trialogic formats

These grew out of the seminars [source: Bock 2017; Bock 2010]. Their procedures are [uncertain].

• Trialogue forums for other conditions: borderline, bipolar disorder, and coercion as a theme. Heidelberg's forum also covers depression, anxiety and compulsions.
• Anti-stigma encounter projects: Irre menschlich Hamburg runs school and workplace encounters, including "Psychiatrie macht Schule". People with experience meet pupils together with professionals.
• Trialogic training: for teachers, health workers, youth workers, the police, probation services, journalists and housing staff. A pre-post evaluation with police (N = 160) found less social distance after training.
• Participatory research: for example the SuSi and EmPeeRie projects.
• Trialogic complaints offices and advisory boards.
• Service development: the Irish Trialogue network used trialogue to improve local services and as a participatory action research method [source: Mac Gabhann and Dunne 2021].
• Watch for: Token involvement, where users and relatives are invited but have no influence.

5. Handling problems

Items marked [source] are reported in the sources. Everything else is [synthesis].

Problems at the level of the seminar

• Unclear expectations about format and rules. Newcomers did not know what the format was or what was expected of them [source: Kaselionyte et al. 2016]. Response: hold an opening meeting, state the rules every time (A5), and add a short paragraph on the flyer explaining that this is not a group therapy or a lecture.
• Dominant speakers or groups, and uneven participation [source: Kaselionyte et al. 2016]. Response: use stronger or shared moderation, or two moderators. Use rounds by group, for example "one voice from each perspective". Remind the room, without singling anyone out, to let others speak. If one person keeps dominating, the moderator speaks to them briefly at the break.
• Low or falling attendance. Weekly sessions requiring full commitment put people off [source: Kaselionyte et al. 2016]. Response: meet fortnightly or monthly, keep a core group and welcome drop-ins, publish topics in advance and keep the flyer short.
• One perspective missing, for example no relatives or no professionals. Response: recruit through relatives' groups and staff newsletters. Ask senior clinicians to come in their own time, and say openly in the room which voice is missing.
• Guarded, superficial early sessions. Early exchanges are often cautious [source: Mac Gabhann and Dunne 2021]. Response: ask for personal, concrete accounts. Volunteers who have attended before can model this. Accept that dialogue skills take time to build [source: Mac Gabhann and Dunne 2021; Stimmenreich, p. 15].
• Verbal aggression [source: Bock and Priebe 2005, which reports it can occur and that no physical violence had been reported]. Response: the moderator names the rule calmly, acknowledges the feeling underneath, and offers a pause or the break. If the aggression continues, ask the person to step out with a member of the organising team.
• Lasting conflicts of interest between the groups, for example about coercion, medication or family blame. Bock notes that interests stay different even as respect grows [source: Stimmenreich, p. 13]. Response: do not push for consensus. Make the difference itself the topic, for instance by inviting each group to say what it fears the others think of it.
• The seminar drifting into psychoeducation or a Q&A with the experts. Response: turn questions back to the room, rotate the chair away from professionals, and review the topic list for balance (A4).
• Polarisation, where the seminar becomes a forum only against psychiatry or only for it. Response: moderators protect minority views from every side. Point out that the model complements services rather than replacing them [source: Bock and Priebe 2005].

Problems for an individual in the room

• Acute distress, or someone becoming visibly psychotic. Professionals are responsible only for acute medical needs [source: Bock and Priebe 2005]. Response: a pre-agreed member of the team quietly offers the person time outside and asks what would help, and who they would like contacted. Escalate to emergency services only for genuine risk. Do not turn the rest of the session into case management.
• Disclosure of suicidal thoughts or risk to others. Response: acknowledge the disclosure in the group without discussing it further there. Afterwards a team member speaks with the person privately and follows current standard practice: ask directly about suicidal thoughts, plans and intent, find out about current care and supports, agree next steps, and give crisis contacts. Say before the cycle starts that confidentiality has this limit.
• Your own client, your own patient's relative, or your own team are in the room. Response: do not refer to treatment in the room, and greet the client only as they prefer. If you are the moderator, consider handing over that session. Afterwards, raise it in therapy only if the client wants to. Where possible, refer clients to a seminar outside your own service area.
• A breach of confidentiality, for example someone repeating another person's story outside the seminar. Response: restate the rule at the next session. Speak with the person concerned. Agree with the group whether stories may be shared outside without names.
• A relative and the person with experience from the same family both present. Response: agree with them beforehand whether they want to speak about each other. The moderator can steer them towards speaking from their own experience.

Problems in the referral and in the therapy

• The client is "stuck" and will not go. Response: explore their fears, offer to go with them the first time if your role allows, suggest listening only, or try a different topic or a smaller seminar such as Basel's limit of 20. If they still do not want to go, drop it. Attendance is voluntary.
• The client uses the seminar as a reason to stop treatment. Response: treat this as Eigensinn worth talking about [source: Bock 2010, on self-will as a resource]. Explore what they heard and what they want, and negotiate changes jointly, for example through a treatment agreement (C4). Do not argue against the seminar.
• Clinician resistance, where colleagues dismiss the seminar or feel exposed by it. Response: invite them to attend once as a learner, framed in Bock's terms as "supervision without payment" [source: Bock 2017]. Raise trialogic topics in team meetings.
• Relatives feel blamed again. Relatives are tired of blame and simple explanations [source: Stimmenreich, p. 11]. Response: moderators actively prevent blame narratives, and clinicians debrief the relative afterwards.
• Ruptures between clinician and client after the seminar, for example when the client heard critical stories about services, perhaps about your own clinic. Response: name the rupture, ask what struck them, acknowledge any valid criticism without getting defensive, and link it to what they want from you now.
• Online or hybrid formats. Online and hybrid formats are not covered by any source used here [uncertain]. Response: if you use them, keep the same rules, add rules on cameras, chat and recording, and have a plan for responding to someone in distress who is not in the room.

Sources

Sources:

• Bock T. Trialog (lecture slides, DGBS annual conference 2017)
• Bock T, Priebe S. Psychosis seminars: an unconventional approach. Psychiatric Services 2005;56(11):1441–1443 (abstract or summary page)
• Kaselionyte J, Dirik A, Tulloch S, Priebe S, Giacco D. Psychosis seminars: an open forum for service users, carers and professionals. BJPsych Open 2016;2(5):330–334
• Mac Gabhann L, Dunne S. Trialogue Meetings: engaging citizens and fostering communities of wellbeing through collective dialogue. Frontiers in Psychology 2021;12:744681
• AG der Psychoseseminare (ed. Bock, Buck, Dörner et al.). Es ist normal, verschieden zu sein. Verständnis und Behandlung von Psychosen ("Blaue Broschüre"), 5th ed., DGSP
• Bock T, Buck D, Esterer I. Stimmenreich. Mitteilungen über den Wahnsinn (publisher's free e-book, Psychiatrie Verlag)
• Bock T. Psychotherapy and psychosis: lecture (Bundespsychotherapeutenkammer, 2010)
• Psychose-Seminar Tempelhof, programme flyer, 1st semester 2026
• HeidelbergTrialog Psychose-Seminar, flyer 2026
• Psychose-Seminar "Trialog" Basel, programme 2020/21
• Trialogisches Psychoseseminar, VHS Schwandorf, 2026

Further reading (not drawn on) [uncertain]:

• Hamburg Sozialbehörde, Leitfaden Gründung Psychose-Seminar / Trialog-Forum. The site blocks automated access.

Further reading (not drawn on):

• Bock T, Buck D, Esterer I (2000). Es ist normal, verschieden zu sein: Psychose-Seminare – Hilfen zum Dialog (Arbeitshilfe 10). Psychiatrie Verlag. The title is as cited in the Blue Brochure [uncertain].
• Dietz A, Pörksen N, Voelzke W (eds.) (1998). Behandlungsvereinbarungen. Psychiatrie Verlag. Cited in the Blue Brochure [uncertain].