Letting In The Light – Open Dialogue Therapy. 81% Recovery Rates in Schizophrenia!
People who are distressed mentally or emotionally are often told, either explicitly or implicitly, that their beliefs, behavior or attitudes must necessarily change. How refreshing it would be to met with an attitude of acceptance and non-judgmental care. What would happen if the desire of the psychiatric community to control ‘madness’ was abandoned? If the experiences of the practitioners of Open Dialogue Therapy in Finland are anything to go by, outcomes would improve beyond belief. In the period between 1992 – 97, 81% of people experiencing psychosis treated with this kind of therapy were fully recovered (they no longer had any symptoms and were in employment). Between 2003 – 05, this figure had risen to 84%. In the UK the recovery rate is about 33%. In Western Lapland, the rate of schizophrenia has dropped from 33 per 100,000 to 2 (two) per 100,000.
What could possibly account for this virtual elimination of schizophrenia? Rigorous use of medication? Certainly not – only 35% of those treated by the Open Dialogue team ever use anti-psychotics, and their long term use is not encouraged. If necessary, sleeping tablets or tranquilizers are used to establish a normal sleeping pattern.
Maybe the astonishing success of Open Dialogue is due to encouraging people to develop ‘insight’? No – in Open Dialogue, the interaction between the treatment team and the patient is emphasized, not the need for change.
Perhaps the team teach the patient to control their symptoms? Wrong again. The idea of controlling symptoms is completely abandoned, presumably unless the symptoms include the desire to hurt oneself or others.
It is perhaps the refreshing idea that the patient has a story to tell, possibly a story that has never been heard before, that gives rise to the success of the technique. In most Western psychiatry, the decisions affecting the patients treatment are often mostly influenced by professionals, not the patient themselves (lacking, as they do, ‘insight’ – their opinions differ from the professionals). In Open Dialogue, family, partners, friends, even work colleagues are invited to attend the therapy sessions and take an active role in the process. ‘Meeting, not treating’ is the guiding ethos.
Another factor in the success of this method of treating distress is the idea of the patient, and presumably the treatment team too, learning to live with uncertainty. It could be that psychosis is a way of establishing certainty in a very uncertain world. Paranoia, for instance, provides a lot of answers to otherwise unanswered questions. In Open Dialogue, premature plans for treatment are avoided. Conclusions are not drawn and the way for all parties to proceed is left open.
It seems that perhaps this lack of a controlling influence, and the belief that it is the patient themselves who knows the best way to proceed and find their way back to a better way of functioning, is the key to the success of Open Dialogue Therapy. The patients own psychological resources are called upon, a truly person-centered, recovery-based approach.
It is unfortunate that Jaakko Seikkula (pictured above), whose talk on the Open Dialogue technique inspired this post, says that he believes that the technique could only work successfully in its home territory. The team has had decades to perfect the their way of working. Confronted with an unusually high rate of schizophrenia, they knew they had to do something and weren’t satisfied with just maintaining people on anti-psychotics for decades.
In his talk, Jaakko described a man who had been institutionalized for 30 years. After treatment with Open Dialogue Therapy, he was able to lead a relatively normal life. Jaakkos comment on this, delivered in a soothing Scandinavian accent, was greeted with much applause – ‘It’s never too late.’ Every service user across the globe who has taken their life back and regained hope, learned to be resilient and found ways to move on beyond merely coping to thriving, knows this to be true. Personally, I wonder how many mental health professionals know this simple fact to be a constant truth, not a mutable and variable opinion.