There are a number of philosophical and organisational principles that underpin Open Dialogue:
People are understood to be relational: dialogue is at the heart of the Open Dialogue approach – this refers not just to “talking therapies” but to an understanding of humanity as fundamentally relational and dialogical – crises and emotional distress are understood as being “between people”.
Not speaking about people/networks behind their backs: this is the “Open” part of Open Dialogue, and parallels one of the mottos of the consumer/survivor movement “Nothing about us without us!”. Many of those who are propagating Open Dialogue in diverse settings have reflected that this single principle – only speaking about the network while they are present – can be a transformative first step for mental health services interested in moving towards Open Dialogue.
Immediate help: responding promptly to people when they make contact (“don’t waste the crisis!”).
A social network perspective: when someone in crisis makes contact with the Open Dialogue service, they are asked about who else might be useful to bring into the conversation – this may be friends, family, other care-providers, or whoever else in the person’s life may have a useful perspective on the situation. This network is then invited to participate in a series of network meetings. There is space and respect for all voices (“polyphony”).
Flexibility and mobility: people are responded to in their own context, often at home, with responses remaining flexible to meet the different needs of different networks (e.g. the network may need to meet again the next day, or Skype may be used if the family is dispersed geographically, or someone may want a peer advocate to attend the meeting with them).
Responsibility and continuity: the same Open Dialogue practitioners are involved right from first contact, so that people in distress are supported by a small group of people, rather than being passed between different services or workers. Typically, two Open Dialogue practitioners are involved in a network meeting, with more practitioners involved if there are higher levels of distress/concern.
Open Dialogue practitioners endeavour to support networks experiencing crisis to sit with uncertainty – rather than reacting prematurely to contain the crisis – trusting that the network’s wisdom will emerge through dialogue. In practice, this often means that people tend to remain in their community (rather than being admitted to hospital), and the use of psychotropic medication tends to be very conservative and carefully considered over time.
Open Dialogue also adapts to its local context and practitioners internationally have been creative in how they adapt Open Dialogue to their own context. Open Dialogue has been embraced by both mainstream mental health services and those creating alternatives. Some elements of Open Dialogue are more challenging for existing mental health services to adopt, but many services are eagerly embracing Open Dialogue’s transformative potential (see, for example, the Parachute Project in New York, the POD trials in the UK).