It's just not right.
Grumpy old psychiatrist wonders why - and tries things to escape oppression, institutionalisaton, industrialisation of mental health and digital tyranny.
Hopefully by only bending the rules, but never breaking them.
Well, we'll see.
Is 'Open Dialogue' the new mental health revolution ...or just the latest 'big thing'?
The Round Chapel, Hackney
When they cancelled the lunches by email, the day before, I
wondered if there would even be a dozen people there – but I was wrong to doubt the
strength of this movement, as there were 120. It looked pretty slick – in that
MBA/project management/young entrepreneur sort of way – too: QR code check-in at registration
(although hardly anybody had printed out their tickets or had them available on a
smart phone – these are mostly NHS therapist types, after all! – so they were
just nodded in), and a folksey singer playing the grand piano. Wires, a big
mixer desk and sound systems with video cameras on high tripods at both sides of
the hall. Strange red lights (which turned out to be heaters) dotted about the
auditorium. The auditorium itself is well-worth mentioning – it is a
deconsecrated round church, elegantly restored, in Clapton, Hackney. Despite
lots of stations in Hackney, it seemed to be just about the most difficult
place within the M25 to get to by public transport. But was this a gig or a
A musical welcome
The ‘main man’ of Open Dialogue UK was the warm-up: Nick
Putman. A cross between the looks of a singer-songwriter like James Taylor and
the demeanour of Ricky Gervais in The Office,
he told us tales of early inspiration by Ronnie Laing’s work, and how he
dropped out of clinical psychology training, travelled, qualified in
psychotherapy – and more recently chanced upon Open Dialogue from Western
Lapland in Finland. He is now a trainee in the Open Dialogue movement in USA.
The approach is now catching on in other northern European countries, it seems,
and he has set up Open Dialogue UK to bring it to these shores – and hopefully
in a way that’s deeply embedded in the NHS. Of which, more later. This, he
explained to us in a somewhat sleep-deprived state, is the first full six-day
event in the UK to ‘spread the word’. It comprises three whole weekends held
over a couple of months. A full training programme is anticipated for late 2014.
So we were introduced to the headline act: two longstanding therapists from the original
project in Western Lapland, Markku Sutela and Maria Kurtti, who worked as a
‘double act / reflecting team’ through the rest of the weekend. They explained
how the approach had developed in Finland over about thirty years, much of
it by serendipity. I was rather taken with how they saw it as an approach,
maybe a therapeutic philosophy, rather than a brand-in-a-box (see my previous
post from BIGSPD about ‘alphabetti spaghetti’ therapies for a rant about that
particular point!). And also, the fundamental embracing of uncertainty that it
demands, and the absolute requirements of flexibility, spontaneity and openness.
But it’s also harder than that – as the method demands that you can never be
certain that what you are doing is right. "The
way that can be named is not the true way…". This is the sort of therapy that I have respect for...
We also did some small group work – for half an hour at a
time in groups of about ten, with built in reflecting teams. One interesting stream
of thought in ours was ‘what do you have to give up, as a therapist in your own favoured tradition, in order to work in this way?’. We felt that it was the
‘security blanket’ of theory, from our own long-cherished therapeutic trainings. Working in this ‘unlabelled’ way, perhaps like Laing described as ‘unlabelled
living’ at Kingsley Hall, leaves us with only our selves and our relationships
to work with. But it is all strictly done with shared responsibility – so one
is never alone. The one question left hanging in the air for me was what we in the UK see as 'service user involvement' - not only doing the clinical work in authentic partnership with service users, but also the choice of services that people want - and the administrative clockwork (of real jobs etc) to go with it. Open Dialogue is clearly a very professionally run outfit, without the inevitable confusion and messiness we have to negotiate and hopefully enjoy when working absolutely alongside service users in planning and developing new services.
The therapeutic influences were explained – with the
strongest influence being Milan-style systemic family therapy with extensive,
integral and continuous use of reflecting teams. The one powerpoint slide that
blew my mind was what they call their ‘Principle Number One’, dating back to
1984: “You are not allowed to talk about patients or their families when they
are not present”.
I think that is sufficiently radical to stop there, and
reflect on it…