An Auto‐Ethnographic Study of “Open Dialogue”: The Illumination of Snow

• DOI: http://doi.org/10.1111/famp.12160
• Published date: 01 December 2015
• Date: 01 December 2015
• Author: Mary Olson

An Auto-Ethnographic Study of “Open Dialogue”:

The Illumination of Snow

MARY OLSON*

This auto-ethnographic study describes the changes in the author’s thinking and clini-

cal work connected to her first-hand experience of Open Dialogue, which is an innovative,

psychosocial approach to severe psychiatric crises developed in Tornio, Finland. In chart-

ing this trajectory, there is an emphasis on three interrelated themes: the micropolitics of

U.S. managed mental health care; the practice of “dialogicality” in Op en Dialogue; and

the historical, cultural, and scientific shifts that are encouraging the adaptation of Open

Dialogue in the United States. The work of Gregory Bateson provides a conceptual

framework that makes sense of the author’s experience and the larger trends. The study

portrays and underscores how family and network practices are essential to responding to

psychiatric crises and should not be abandoned in favor of a reductionist, biomedical

model.

Keywords: Open Dialogue; Dialogi c Practice; Biological Reductionism; Auto-ethnography;

Dialog

Fam Proc 54:716–729, 2015

INTRODUCTION

‘Epistemology is always personal. The point of the probe is always in the heart of the explorer.’

—Gregory Bateson (1979, p. 87)

Open Dialogue is a network approach to persons suffering severe psychiatric crises.

Starting in the early 1980s, it was developed by a team led by Jaakko Seikkula,

Birgitta Alakare, and Jukka Aaltonen at Keropudas Hospital in Tornio, Finland. This

way of working has garnered international attention for its research showing impres-

sive outcomes for first-episode psychosis (Aaltonen, Seikkula, & Lehtinen, 2011; Seikk-

ula et al., 2006). While integrating insights from other approaches (Karon &

VandenBos, 1981/2004), Open Dialogue is rooted primarily in the systemic family ther-

apy tradition that descended from the research of Gregory Bateson and made language

and communication central (Hoffman, 1981, 2002). It represents an intersection of this

tradition with the philosophical writings of Russian philosopher Mikhail Bakhtin

(Bakhtin & Holquist, 1981), particularly his concept of “dialogue” as a model of the liv-

ing world. Seikkula was the first to conceptualize therapeutic conversation as “dialogic”

*Department of Psychiatry, The University of Massachusetts Medical School, Worcester, MA.

Correspondence concerning this article should be addressed to Mary Olson, P.O. Box 905, Haydenville,

MA 01060. E-mail: Mary.Olson@umassmed.edu.

I thank Jaakko Seikkula and Lynn Hoffman for their comments on an earlier draft of this article. The

paper was completed with support from the Foundation for Excellence in Mental Health Care and the

Fulbright Program.

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Family Process, Vol. 54, No. 4, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12160