The Experiences of Practitioners Implementing the Open Dialogue Approach within the NHS in the UK

Background: Historically, researchers have tended to focus on biomedical explanations for Psychosis (Read, Bentall & Fosse, 2009). More recently, emphasis has been placed on the role of early experiences and relationships (e.g. Read & Gumley, 2008). This has been reflected in the type of interventions offered, including recommendations of family therapy (NICE, 2014). One such intervention which has received growing attention is the Open Dialogue approach (Seikkula et al., 2003), which aims to provide psychotherapeutic support to service users within their own personal support systems. Good outcomes have been demonstrated in Finland and several other countries, including the United Kingdom, are in the process of implementing Open Dialogue within services. Little is known, however, about the transferability of this approach to the National Health Service (NHS). This study aimed to fill this gap, using qualitative methodology to explore practitioner experiences. Method: A narrative approach was chosen. Interviews were completed with nine practitioners. Data were analysed across four levels, including the content of stories and the way in which stories were told, as well as how practitioners were positioned by others and positioned themselves within the context of the NHS. Results: The findings suggest that Open Dialogue had a positive impact on practitioners’ work. The process of implementing Open Dialogue, however, is embedded within a complex organisational, social and political context in which discourses about mental health are medicalised. In this transition practitioners have had to negotiate a number of complex dynamics and positions, which were often confusing and conflicting. Discussion: The findings are discussed in relation to the existing literature. Overall, despite the difficulties encountered by practitioners in the transition to Open Dialogue, this work appears to be in a good position to influence change at multiple levels. This includes the organisational, social and political.