To ‘be with’ our service users

Isabelle Ekdawi and Jo Allen (South London & Maudsley NHS Foundation Trust, SLaM) report on the Open Dialogue workshop they organised on May 24, 2018.

The Trust-wide workshop on the application of the Open Dialogue approach, was attended by 50 professionals, service users and family members.  Open Dialogue is; a philosophical and ethical approach to distress; a way of organising services; and a set of practices (and stance) for being with people.

This approach invites practitioners to look at their practice and see how we can promote dialogue and ‘be with’ our service users rather than ‘doing to’ them (a dialogical stance). It was hoped this day would promote such reflections.

Over the day, we enjoyed presentations by staff on their clinical and research work in the area, and were lucky enough to be joined by three families who had experienced dialogical work within SLaM, in the form of Open Dialogue informed network meetings.
This work is currently happening within Lewisham Early Intervention Service and within the Family Interventions Service in Croydon. We also heard from the doctors, care coordinators and psychologists involved in these projects.

These families described their extensive experience of other mental health services prior to Open Dialogue meetings, and talked passionately about their positive experience of Open Dialogue network meetings.   Themes which came out of this included families feeling really listened to; feeling respected and empowered; service users finding their voice; families understanding their difficulties in a different way. We heard about the difference this work had made in their lives, and the resources they were able to draw on and re-connect with, to enable them to go on with their lives in a positive way.

Moving personal stories

Hearing the personal stories from the families was very moving for all of us, and the feedback from the day reflected this.  Attendees used words such as ‘moving’, ‘motivating’ and ‘inspiring’ to describe the impact of hearing the service users’ and families experience.  The families also told us that they valued the chance to tell their story in this forum. One of the family members wrote the following feedback.

‘It was a great pleasure to participate in the Open Dialogue workshop, as my family and I have had positive experiences using this approach. The day itself provided me with a better understanding of how far we as a family have progressed in our communication with each other, and the mental health services we use. Although we had been using Open Dialogue for a while, we didn’t put a name to it or understand the theoretical underpinnings of the approach. So the workshop also allowed me to see how using Open Dialogue can help in many aspects of life. The biggest highlight for me was being given the opportunity to connect with other service users, and hear their experiences, and stories of resilience.’

As part of the workshop Jo Allen presented her research on the process of how a dialogical approach can support change in sessions. She analysed process in 3 dialogically informed therapy sessions looking at dominance, meaning development and responsiveness. There was some evidence that agency development through spaces created by the therapists and a focus on connecting and responsiveness in the moment supports the co-construction of meaning.
We heard about the experience of being on the three year Open Dialogue training course, from three clinicians (two from SLaM and one from Hackney), who talked about the changes this had brought about both in their professional and their personal lives.

One clinician talked about the training being ‘in the heart, not just the head’. They talked about the challenges of change in services but the importance of starting small and connecting with other agendas that fit with this way of working.

We also heard from Darren Barker, clinical psychologist, who has helped to develop an Open Dialogue service in Hackney. He described how he has been able to pilot a project of using dialogical approach to meeting with the families and care planning. He described the positive feedback from staff and families.

As well as being informative, the day was interactive and there was a good deal of discussion throughout. Feedback has been positive, and attendees used words such as: ‘Inspiring’; ‘refreshing’; ‘powerful’ and ‘collaborative’ to describe the day.

Isabelle Ekdawi is Trust advisor for family therapy.
Jo Allen is Lead for Family Interventions in Psychosis in Croyden and principle clinical psychologist.

2 thoughts on “To ‘be with’ our service users

  1. I feel extremely disappointed with not being able to access Open Dialogue.
    My son was detained under MHA in 2017 for 6 months and as a family we have had No support to try and make sense of what happened to my son!
    My son was given a dx of Bipolar type 1 and given medication that have left him with adverse side affects .
    And yet to this day not one professional has ask him “ what’s happened “ or helped him to try and make sense of what he experienced when psychotic.

    We was told that my son could not access Open Dialogue, because he was under secondary services- CMHT in Southwark under SLAM
    This makes no sense to me what so ever so it’s quite upsetting to read.

  2. As you know, and I’m sure I speak for Jo too, I would very much like to see Open Dialogueavailable to all those who could benefit from it. At the moment it’s only a very small number of us in SLaM, who have a special interest in Open Dialogue, who can offer an Open Dialogueinformed approach – and therefore its only available to a very small minority of clients.i

    It is also distressing to hear that no support of any kind was offered to this man’s family, and that he has not been given the space to try to make sense of his experiences. Whilst Open Dialogue is not yet in the NICE guidelines, family intervention and helping people to talk about their experiences are recommended by NICE for people with psychosis. In addition to this, carer support (including a carer’s assessment) should be routinely offered to those caring for people with a mental health diagnosis.

    I am grateful to this mother for sharing her experience of services, and hope it adds weight to developing family inclusive services in general, and Open Dialogue informed approaches in particular.

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