Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
doi: 10.1002/anzf.1099
The paper analyses open dialogicity in psychotherapy and juxtaposes it with education in order to find common
dialogical elements in all relational practices. The core is found in unconditional respect for otherness and gener-
ating dialogical space for voices to be heard. In traditional practice, professionals are tempted to plan interven-
tions according to the goals of change informed by their methods and in team work and multi-professional
practices they may even do this between themselves, away from the clients. Pre-set categories, plans and goals,
however well founded they may seem, hinder listening. Following what others present here-and-now calls for tol-
erating uncertainty. Insight into developing dialogical family therapy opens through focusing on how therapists join
in interacting with families instead of focusing on and interpreting the interactions of families. The conclusions
provide a set of reflective questions for improving being in the present moment in psychotherapy practice.
Key Points
1 In psychotherapy, as well as other relational practices, it is essential to foster dialogical space instead of pur-
suing strategic interventions aiming at changing others.
2 This calls for respecting the uniqueness of the other without conditions.
3 Following what the patient/client/family member presents here-and-now and responding to it instead
of guiding the process to normative goals, enhances possibilities for the person to be heard the core of
dialogical relationships.
4 Practitioners learn from reflecting together how they managed to join the patients and families rather than
how they managed to change them.
This article is a reflection on our learning and writing a book we published last
year Open Dialogues and Anticipations: Respecting Otherness in the Present Moment (Sei-
kkula & Arnkil, 2014). Tom, a researcher in social policy, interviewed his colleague
and friend Jaakko, a family therapist and psychotherapy researcher, in order to inves-
tigate with him core elements in dialogical practices. Coming from outside the psy-
chotherapy community allowed Tom to juxtapose Open Dialogues with other
relational practices, especially education, which was familiar to him as an educator
and a researcher. Open Dialogues as a mental health treatment system was originally
developed for work around psychoses and has since developed into a variety of open
and dialogical psychiatric practices. Openness to work openly up front and dia-
logicity to create shared meanings and language in the present moment are
care in Western Lapland, Finland. Research played a critical role right from the
beginning in developing the new practice. In one study by Professor Jukka Aaltonen
and Jaakko in the mid-1990s, the aim was to analyse the differences between the new
crises-oriented system that used mobile crisis intervention teams and the traditional
psychiatric system that took care of psychotic and other most severe mental health
problems by hospitalisation (Aaltonen, Seikkula & Lehtinen, 2011). The study
decided the main characterising phenomena of the treatment processes supporting the
optimal outcome. These seven main elements were thereafter seen as the main princi-
ples of Open Dialogue approach. They were, in brief:
1. immediate help (within 24 hours);
2. a social network perspective (always invite the patients, their families and other
key members of their social network to the first meeting);
3. flexibility and mobility (adapt the treatment offered to the specific and changing
needs of each case);
4. team responsibility (whoever on the team is contacted takes responsibility for gath-
ering the network);
5. psychological continuity (the team takes responsibility for the treatment for as long
a time as is needed);
6. tolerance of uncertainty (creating safety and trust in situations where no one yet
knows the answers); and
7. dialogicity (focusing primarily on dialogue, and only secondly on promoting
change in the patient or in the family).
Upon writing Open Dialogues and Anticipation (2014), we analysed Jaakkos pres-
ent clinical work, which takes places in a context different to the team work in Wes-
tern Lapland. Jaakkos current practice as a psychotherapist with individuals, couples
and families takes place mainly at a university psychotherapy clinic, where he acts
both as a therapist and a teacher. As part of their training in psychotherapy, Masters
students in psychology become co-therapists in therapy processes. For the most part,
the work is not acute crisis treatment; the therapists meet couples coming for treat-
ment because of depression and different types of marital problems. Our analysis
raised some important questions.
Do the differences bring to light important aspects of open dialogicity that go
beyond the specific example of Open Dialogues?
Do we gain more understanding of core elements common to all dialogic relational
practices?
One of the leading conclusions of Jaakko in the process of writing the book was:
Do not put your best tools for change to work, there are better things on the way!
Tolerating uncertainty and respecting otherness is a challenge when you are not work-
ing as a team, and this is certainly true when you work solo as do many couple
and family therapists. Nevertheless, not jumping to interventions is pivotal for dialog-
icity. Previous training in systemic family therapy would have afforded tested and
tried methods for change. However, powerful methods for change can also be power-
ful in closing alternative doors. Thus, instead of taking the shortcut to change-ori-
ented interventions, Jaakko would slow down, and instead of rushing into reframing
or interpretations he would follow moment by moment what the patient presented.
The task was to generate dialogical space.
words either. Instead of explaining the plot and the words the teacher encouraged the
children to discuss them, and one thing led to another and soon there was lively discus-
sion about word meanings, spelling, grammar and translations a lesson in Italian lan-
guage in other words. One girl in the class became obviously distressed, and started to
walk around the classroom, but this did not disturb the other children. They knew that
she liked to walk.
The teacher explained to Tom, who was observing the class, that they had discussed
what the girl was and was not able to do, and what she liked and did not like and
that this had led them to discuss whether people can know themselves if they cannot
utter their own name, which led to the question, What does knowing oneself actually
mean?
Children had been asked to fold a paper in a certain way and to write down what they
themselves could and could not do, and what they liked and disliked: this was an exer-
cise in craft as well as writing and a way to collect personal material for further dis-
cussions. All this had been set in motion by a boy snorting that all that the girl with
disabilities could do was drool, which led the teacher to respond by asking everyone if
that was actually all the girl could do.
Tom, who used to be a teacher in the 1970s, was fascinated by this school.
Instead of imposing educational subject matter onto the experiences of the children
and more or less ignoring their mental state in the here-and-now a group of teach-
ers in the school strived to generate a favourable atmosphere for learning by engaging
in dialogue with the children.
The educational themes grew like plants out of the dialogue. The music lesson had a
song about a bat as the theme. Children sang in lively canon after discussing how dif-
ferent the world looks for someone hanging upside down, and how different it looks
from a range of different viewpoints.
The group of teachers at 2 Istituto Comprensivo di Brescia who followed this
approach, called it conversational pedagogy, not dialogues; however, in Toms view
the process afforded beautiful dialogical moments. The teachers said their approach
was a kind of acrobatics tightrope walking between the possibilities opened up by
the childrens comments in the present moment, and the subject matter waiting to be
covered. The teachers gave preference to the present moment and dialogues, wasting
time in order to create a safe atmosphere where the children were not afraid to
express their thoughts.
interpretations, the therapists merely follow carefully the story of the clients. The wife,
Victoria, was a Swedish student who wanted to come to the session, because her hus-
band Alfonso an Israeli teacher at the university no longer wanted to speak with
her about the challenging issues in their life. Prior to their visit Victoria had been suf-
fering depression for some two years and when she started to recover, Alfonso almost
panicked when she wanted to speak about some relational issues.2 Alfonso had been a
great help to Victoria when she was depressed.
The following three episodes of dialogue3 happened in the second session. The
session started with Victoria and Alfonso filling out the Outcome Rating Scale (Miller
& Duncan, 2004), in which they evaluated in a simple way their previous week. Vic-
toria seemed to be unwilling to attend the meeting and therefore they were delayed
some five minutes from the start.
V: well, I feel differently, I did not want to come here today I am not usually like
this . . .
T1: mm . . .you didnt want to come here today . . .(44 ) for some specific reason or?
V: I think that I have just been working too much and I am tired
T1: ah-huh
V: I didnt have time to sleep or I just feel a bit sad, because this thing I dont know
why we feel so differently
T1: mm . . .you are a bit sad because of these differences or [points to the paper]?
V: No, I am happy that he feels good . . .
T1: okay, okay . . .(4) but you are sad, you feel sad.
This sequence takes place at the outset of the session while discussing how they
are. First they rated the ORS and afterwards Jaakko asked if they would like to say
something about how they felt. Alfonso first said that he felt good and then Victoria
said that she did not want to come here today. She said this with an irritation in her
voice and the opening of the session was quite tense. For therapists this means taking
care not to aggravate the situation more, in order to make collaboration possible. The
therapist answered by repeating her words and then asking her to say something more
(. . .for some specific reason . . .?). All these comments were open-ended, leaving the
possibility for the clients to speak about what they wanted to say. And once more
when she said that she felt a bit sad, the therapists repeated the answer word for
word.
In the next sequence after some 15 minutes in the session, the tension culminated
when Victoria spoke of her being overloaded by work.
V: Yes because Ive been, for the last weeks Ive been working like approximately
fifteen hours per day and I am never home and then if I am home, he is not, because
he has some friends to see or something. So mostly its my fault but not anyway like
I am away only because of work. So I feel like some evening being home its never at
the same time with him.
T1: ah-huh . . .
A: I actually dont feel like that . . .
is nothing more terrible than a lack of response (p. 127). Respecting the dialogical
principle that every utterance calls for a response, dialogical practitioners strive always
to answer what is said. However, answering does not mean giving an explanation or
interpretation but, rather, demonstrating in a response that one has noticed what has
been said and, when possible, opening up new points of view on what has been said.
Dialogical relational practitioners respond to the utterances of clients, families,
and pupils as fully embodied persons, with a genuine interest in what each person in
the room has to say, avoiding any suggestion that someone may have said something
wrong. They adapt to the emerging natural rhythm of the conversation. As the pro-
cess enables participants to find their voices, they also become respondents to them-
selves. For a speaker, hearing their own words repeated respectfully and responded to
widens the possibility to understand more of what they themselves have said.
Expressed in everyday language with which clients/families/pupils are familiar, profes-
sionals questions facilitate the telling of stories that incorporate mundane details and
the emotions of the events being recounted.
It is this responding that needs to happen in a dialogical meeting and actually not
very much more, because this is something that resonates with the first dialogical
experiences that we have from the first moments in our lives. Being heard is a basic
human experience as relevant to survival as breathing.
Questions for the Reective Practitioner: How Can We Improve Being in the Present
Moment
In our view, to be more dialogical means being more present, more in the here and-
now. In summarising the ideas that we have discussed, the following aspects could be
helpful in moving in this direction. Because of the emphasis on generating dialogue,
each meeting is unique and cannot be guided by pre-planned manuals for the conver-
sation. In order to foster our awareness of how we engaged with others we ask our-
selves questions like the following in retrospect.
Did I/we prefer themes of the actual conversation instead of clinging to narratives of the
past?
Each person chooses what he or she responds to in encounters. Responding to what
happens here and now between the participants opens up wide possibilities for dia-
loguing wider than aiming at reaching explanations of the past. For instance, if a
person becomes moved by the word he or she is using while speaking of emotional
issues, space is needed for that to happen instead of rushing into the next issue.
Stories that people tell of their lives provide important issues to be discussed in the
present moment, and should not be overlooked.
Did I/we follow clients stories and were we careful with our own openings?
The point of departure for dialogical practice is to take the words of the clients/
patients/pupils as the starting point, instead of proposing the practitioners themes for
the discussion. There are, of course, themes to be covered, as is evident in the field of
education. Also for those who work with families in the public sector, particularly in
areas of crisis, there are treatment plans to be made, and it is important that profes-
sional duties are taken care of. It is a challenge for dialogical skills to do this in ways
that do not take the possibilities out of dialogues, but instead, improve new resources
Did I/we notice different voices, both our inner voices and those of people present?
Our utterances should recognise the words spoken, but also the unspoken reactions of
the participants. One can hear the horizontal voices of the participants, whereas the
vertical inner voices become evident in emotional movement in the middle of an
utterance. The first sign of this may not become evident as visible reactions, but
rather as an inner embodied feeling of the practitioner. If I am moved, most probably
someone else has been moved too, including some of the other participants also. This
experience of being moved is not said out in the open. The practitioners task is not
to define the emotions in words, but, for instance, to proceed more slowly in order
to have more space for them. Practitioners in psychotherapy and social welfare work
deal with difficult issues of human life that always cause emotional responses in us. It
is thus important that we listen to our own embodied responses and voices that may
be activated by the stories of the clients.
Did I/we make our utterances dialogical: Did we invite responses, and did I speak in the
first person?
Firm, authorless statements do not generate and foster dialogues in the way that
speaking as a person in the situation does. Dialogue is only possible between embod-
ied human beings, not with categorised statements, and to invite dialogic responses it
can be helpful to say things like: In my mind, I am wondering what you think . . .,
or According to my experience, but I am not sure . . ..
Did I/we proceed peacefully: Did I/we afford moments of silence to enhance the power
of dialogue?
The last point on our list may be one of the most challenging aspects. Colwyn Tre-
varthen (2012) speaks about the rhythmical co-ordination of dialogical responses of
the newborn with the adult. Dialogical rhythm between interlocutors calls for pauses
and silent moments which make it possible, not only to say aloud what one is think-
ing, but also to have space for inner dialogues where one can hear what one has said
to oneself and to others. The dialogical music of life takes place in mutual responsive
actions and attuning to each other. These silent tuning moments are needed for one
to see oneself and others at the same time.
Conclusion
Are we writing the same book? Jaakko exclaimed in the process of co-writing Open
Dialogues and Anticipations. We had come together once again to reflect upon our
experiences in fostering dialogicity. Our points of departure and practices are some-
what different, which affords rich possibilities for crossing boundaries and learning,
but at times the approaches drifted quite wide apart. Jaakkos training and experience
is mainly from psychology and the clinical context, Tom went from primary school
teaching to sociology and social policy and network muddles around families with
multiple clientships. The way to find firmer common ground was to add listening.
Jaakko had moved to new contexts of practice and it seemed helpful to analyse in
detail whether he was doing the same thing in the new setting or as it is likely that
contexts talk back if he and his co-therapists had altered the practice, perhaps
noticing some changes, maybe not aware of some. Thus, instead of making already
achieved conceptualisations the driver we tried to put practice in the drivers seat. This
called for recalling and reflecting without too much of a hurry towards conclusions
for others to read. What is our own practice trying to teach us?
The conclusions in this are, therefore, notions about how useful it is to listen care-
fully to ones own experiences and how helpful it is to do it in dialogue. The person
speaking can say nothing wrong, he or she has to have the chance to be heard, without
conditions, and the other does not necessarily have to agree. Asymmetry is not an obsta-
cle to dialogicity, unless there is a bigger need to formulate than to elaborate ideas as
we noticed ourselves in the course of writing and discussing. Each persons unique per-
spectives do not become similar through dialogue, but they can become richer.
We hope that the set of questions above is helpful in reflections upon practice and
lead to more awareness of how one actually engages with others and to evolving
practice and better reflective questions.
End Notes
1
Tom was visiting the school with his daughter Marikki, fluent in Italian, to negotiate a research
project. Marikki is presently analysing a wide body of empirical material for her PhD dissertation in
pedagogy.
2
The identification information has been changed. Some parts of the case have been analysed in Olson,
Laitila, Rober and Seikkula (2012). A book including seven different ways of looking at the process in
this particular couple therapy is forthcoming (Borcsa, M. & Rober, P., Eds.).
3
The dialogue was carried out in English, which was not the first language for anyone in the meeting.
4
The number within parenthesis, like (4) refers to the length of pause in seconds.
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