I am in love. I’m in love with this way of working. And I won’t stop. Open Dialogue Washington began in 2018 upon my graduation/commencement from Jaakko Seikkula’s dialogic approaches to couple and family therapy trainer/supervisor training, in collaboration with Dialogic Partners and the University of Jyväskylä.
In 2016, I embarked to partake in the best training course I had ever experienced as a family therapist. The embodiment I experienced working with my Open Dialogue colleagues felt like the missing key in psychiatry and psychotherapy. Something intangible, yet what I knew all along. Something ineffable, yet also a shared language. Something deeply and autonomically human, yet unrepeatable and fleeting. It led me onto a moment-by-moment path where everything I learned in my 27-year long career about systemic family therapy and emergency psychiatric protocols ebbed, and the present moment of love flowed, neither the ebbing knowledge nor the cresting wisdom having any lesser value than the other. The complete work we do in mental health care is this ocean of love.
We are in constant change when we are in crisis. Timelessness sets in. Growth is happening. We don’t exactly know what we need. That is what mental health work is, sitting with this human happening. In the in-between space something happens, and we don’t know what will. This is the paradox. We are navigating the ebb and flow of incoming knowledge we have from research and the ebb and flow in each patient and family’s difficulties (the meanings they make of them.)
“It cannot be taught, but it needs a teacher.”
Darn, I missed the boat. The government’s consultation on its new proposal for mental health education in schools closed in November, and I didn’t know it was happening. Am I alone in thinking that consultations are often too perfunctory, too brief, and only ask the questions to which the government thinks it already knows the answers?
I’m disappointed, because while many of the proposals are great, the stuff on mental health begs some important questions. Including the big one: what does ‘mental health’ actually mean?
What is a mental health problem? Are some of us mentally well and others of us mentally ill – because something has gone wrong in our brain that needs fixing by an expert? Or are we all just different, with different experiences, different areas of strength and difficulty, and all, at any one point in time, somewhere on a spectrum of wellbeing? And, if, as they do, experts differ in their views on these questions, what is ‘mental health education’ actually educating students about? That we all experience distress and need to look out for each other? Or that we need to be alert to signs of an underlying disease process and refer to the experts?
The draft guidance suggests that school pupils should be given ‘factual information about the prevalence and characteristics of more serious mental health conditions’, and ‘should be enabled to judge whether what they are feeling and how they are behaving is appropriate’.
I always feel a bit wary when read statements like that. The problem is: mental health is a contested area. Scientists and clinicians don’t agree about what the ‘facts’ are, or about what is ‘appropriate’.Read More
“Open Dialogue”—a network approach to severe psychiatric crises developed at Keropudas Hospital in Tornio, Finland–first began to attract notable attention in the United States a decade ago, although many ideas and practices that influenced its evolution in Finland actually came from the US. In particular, the Finnish team refined and advanced elements of US family therapy. Among these US linkages are Gregory Bateson’s Palo Alto research on family communication (1952-1962); Ross Speck and Carolyn Attneave’s network therapy for schizophrenia that flourished in the late sixties at the Philadelphia Child Guidance Clinic, and Harry Goolishian and Harlene Anderson’s collaborative-language approach that emerged in the eighties at the Galveston Institute in Texas. While holding in mind that Open Dialogue is indebted to these and other US ancestors, this brief essay will focus on the recent wave of interest in the Finnish approach.Read More
This post helps make sense of the mountain of bipolar drug research. It distills into an infographic the pros and cons of five classes of bipolar drugs and gives observations on what it means for people who face choices on bipolar care.
(The infographic is kept fresh as research evolves. The latest version with footnotes is always here.)
A few key perspectives behind this infographic deserve attention:Read More
Psychiatric Services, a leading US journal, has published two important papers on Open Dialogue. Freeman and colleagues did an extensive literature review and analysis of currently available research. Their paper is accompanied by a commentary by Kim Mueser, PhD, Director of the Boston University Center for Psychiatric Rehabilitation and one of the world’s experts in his field.
Freeman and colleagues begin their paper with a detailed explanation of the criteria for inclusion into their investigation. They identified 23 studies for review. Papers selected were published in English and evaluated Open Dialogue effectiveness using either case study, qualitative, quantitative, or mixed methods. Studies were conducted in Finland, Norway, Sweden, and the US.
As the authors point out, most of the available research comes from the Western Lapland group that developed Open Dialogue (OD). This poses a fundamental source of weakness in the evidence base. Their studies had small sample sizes, there was no control group, and the ratings were not blinded. In addition, there were not consistent methods for either defining or evaluating OD.
Many of us learned of Open Dialogue because of their reported excellent outcomes for individuals who experienced a first episode of psychosis. We are eager to see if these results can be replicated elsewhere. But there are other important questions.Read More
(Lauren Spiro) – This week we e-release this new free booklet, Pathways to Enhance Well-Being. The evolving story provides an example of how we can follow the life pulse that moves through us – in this case – it moved through the three co-authors and manifests something new that we hope will be helpful for many people.
My co-creators and I, and seemingly the stars too, were aligned on this project. For each of us, our life story has in large part been about finding pathways to enhance our own well-being and to assist others in doing the same.
We came together with heart-based and soul-based intention to share some of the practices that have transformed our lives, opening our bodies and minds which allowed joy and passion to flow through us. We don’t write about our transformative process in the booklet but make no mistake – this is the energy that flowed through us and we hope that you, the reader, can feel in yourself as you expand or deepen your use of body/mind/spirit practices.Read More
After high school I got a job at Macy’s. I just wanted something super easy because inside I was fighting this terrible mental battle and didn’t believe I could handle a job that made me think. I worked there for about four years but realized I didn’t want a minimum wage job for the rest of my life, so I needed to figure out what to do next. I thought getting into the medical field would be a great career, not knowing what I wanted to do in the field, so I applied as a receptionist at a doctor’s office to get my foot in the door. After working there for about a year, I hated it and realized I didn’t want to go to school for something in the healthcare field. Also, at this point I was feeling so out of control in my mind. I was fighting with friends and family and cutting them out of my life, so they didn’t have to see me self-destruct. I felt it was time that I should go see a doctor and figure out what was going on in my head.Read More
My story begins when I was a teenager. I knew something wasn’t right with me because I would be extremely happy one day – euphoric like, then the next day I’d be extremely depressed and wouldn’t want to get out of bed and face people. I would often ask my mom why I’m like this and she’d brush it off that I was a moody teenager. I knew I was moody with my hormones being all over the place, but I felt this went beyond normal teenage angst.
As I got older, my anger, depression, and anxiety was getting worse and I started self medicating with alcohol because this would take my pain away for a while. My mom wouldn’t listen to me, that I wanted to see a doctor about my problems, because we don’t talk about mental health in my family. Ironically enough, it runs on both sides of my family, yet it’s a forbidden topic. I tried to talk to my grandma about it but she said I was exaggerating my issues.
By the time I was 16, and I could hardly stand to be in my own skin, and my mom and I were fighting daily- making it a very toxic situation, so I left home.Read More
Hearing voices is a common experience, yet it’s one that’s seldom talked about.
Although the latest stats have shown that up to 12% of young people hear things, see things or sense things that other people don’t, they tell us that the misinformation, fear and stigma surrounding these experiences makes it incredibly difficult for them to share what’s going on and to seek support if they’re struggling.
That’s where we aim to help.
About Voice Collective
We launched the Voice Collective service in 2009, with the aim of building capacity within existing programs to enhance their support for children and young people who hear voices, see visions or have other unusual sensory experiences, paranoia or unusual beliefs or multiplicity.
Although many children and young people who have these experiences aren’t distressed by them, others describe a combination of positive, negative and neutral experiences. Some young people can find their voices or visions overwhelming, confusing, frightening or upsetting, and some struggle with feelings of powerlessness, worthlessness or hopelessness. They may be self-harming, feeling suicidal or have attempted to end their lives.
We support children and young people in distress by normalising what they’re going through, reducing isolation and stigma and increasing coping skills, self-esteem and their capacity to live lives that they’ll love.Read More
(World Psychiatry) – People with severe mental illnesses (SMIs) – including schizophrenia, major depressive disorder (MDD) and bipolar disorder – have excessive caloric intake, a low‐quality diet, and poor nutritional status compared to the general population1, 2. Poor diet increases the risk of diabetes and cardiovascular mortality in this population3. Furthermore, excessive consumption of high‐fat and high‐sugar foods can increase systemic inflammation4. Indeed, all classes of SMI show heightened levels of peripheral inflammatory markers, which is linked to worse prognosis in these conditions. However, there currently is an absence of large‐scale studies comparing the nutritional intake and inflammatory profile of the diets of individuals with SMIs.Read More