For all mental health professionals, service users and carers. Open Dialogue. The way forward for care and recovery in psychosis. Jaakko Seikkula.
Care and Recovery in Psychosis
Developed By Jaakko Seikkula.
Over the past two decades, Dr. Jaakko Seikkula’s hospital team in Finland has advanced and refined “Open Dialogue,” a family and social network approach to first episode psychosis care, and this way of working has garnered widespread attention for dramatically improving outcomes.
Open Dialogue de-emphasizes US-style pharmaceutical intervention and instead establishes a dialogue with the patient, provides immediate help, and organizes “a treatment meeting” within twenty-four hours of the initial contact. The results consistently show that this way of working reduces hospitalization, lowers use of medication, and leads to less recurrance of crisis when compared with psychosis treatment as usual.
For example, in a five-year follow-up (Seikkula et al. 2006), 83% of patients have returned to their jobs or studies or were job seeking, thus not receiving government disability. In the same study, 77% did not have residual psychotic symptoms.
Open Dialogue is gaining growing support after Robert Whitaker, in his book Anatomy of An Epidemic, featured Open Dialogue as an effective alternative to the poor treatment outcomes associated with overuse of medications.
Please take the time to watch this video. The success rate is phenomenal (83% for first presentation with psychosis to recovery) and a great example to the rest of the world.
This is very similar to the Early Intervention Team approach currently operating on Wirral with excellent outcomes. It can also be used for people who have been in services for a long time with great results. Hopefully this psychosocial approach will now rolled out to everyone with the new StAR Model and Health and Wellbeing Centres.
Clinical psychologist, family therapist
Jaakko has been mainly involved in developing family and social network based practices in psychiatry with psychosis and other severe crises. Since early 80’s until 1998 he was a member of the team in Western Lapland in Finland for developing the comprehensive Open Dialogue approach, which Jaakko has been studying both concerning the processes of dialogues and the outcomes in treatment of acute psychosis. The power of dialogue became evident in the remarkable results when 85 % could return to full employment and over 80 % living without any psychotic experiences at five year follow up. This was reached by minimum use of antipsychotic medication, in 2/3 of cases none.
After moving to University of Jyväskylä he has become involved in many development and research projects. Recently ideas of open dialogues have been applied in social work with children’ problems, in organization consultation, supervision and teaching. Research has focused on outcome and process studies on family therapy of psychosis and depression and social network interventions. Concerning outcome studies in psychotherapy the main focus is on developing methods for naturalistic designs to see how the psychotherapy affect in real world, in every day clinical practice.
Another line of developing and research has focused on research methods for dialogues in family therapy settings. A new method – at the moment named as Dialogical Methods for Investigations in Happenings of Change – is in progress. The main aim is to develop tools for making sense of what happens in multi actor dialogues, especially focusing on the responses in dialogues.
This is related with Jaakko’s main language philosophical interest on Mikhail Bakhtin’s works for 25 year. Jaakko wrote first text referring to Bakhtin 1987 and since then Bakhtin has been the main inspiration for understanding the power of dialogue in human life. During last years the importance of the being present in the moment in the “once occurring participation in being” has become the most important aspect of therapy and writing and teaching about therapy. Jaakko is invited for tens of workshops and congress presentation every years.