Paul is a client whom I have been working with for over a year, he is a professional man in his early 30’s personable, educated and articulate. Paul has experienced years of mental health issues but no effective diagnosis or treatment because he gives the appearance of being high functioning his needs are often negated, as he is perceived by clinicians as coping. Paul is not however coping because he has had a number of admissions and experiences of acute distress and confusion. Paul is also perceived as challenging by professionals as he will question treatment and the hierarchical nature of the mental health system. Paul will be vocal in his complaints if he does not feel heard and is active in his participation with the process questioning the status quo and the judgement of psychiatrists, which some find challenging.
Paul was one of the first clients to be treated by the newly formed Open Dialogue team in Kent and for him unlike others it was not a wholly satisfactory experience. Paul did not enjoy the network meetings which he attended alone as he is isolated from friends and family and this highlighted for him his detachment. Additionally he did not appreciate treatment occurring in his home as he felt it contaminated his private space and left him associating his living room with what he experienced as long, futile and painful network meetings.
At that time the team had only recently been established and a group of professionals from disparate teams were brought together unified by their Open Dialogue training and by a desire to implement their learning. There were however many difficulties encountered by this initial group, the first Open Dialogue team modelled on the Finnish team. The difficulties of setting up a RCT compliant team within the existing NHS structure that was providing a service for generic presentations was not fully considered. As was the opposition encountered to such a radical concept from middle management and assorted professionals, underestimated. The initial team was unclear about their remit and their fit with existing mental health services and the community and crisis teams. There was also a relationship that had to be reestablished with the Early Intervention in Psychosis service from which many of the professionals originated and where it was originally presumed Open Dialogue would be located.
I think that Paul picked up on the lack of clarity and clear guidelines in a team that was establishing itself and learning as it formed policy and procedure. I think also that Paul’s finely attuned sensibilities were attuned to the undercurrents of uncertainty in relation to the process and structure of how Open Dialogue was actually going to work in practice. The radical aspects of Open Dialogue which is an organisational issue in addition to a treatment option had not at that stage been established and this impacted on his experience.Paul has however from a distance now been able to critique his experience which provides learning for the team and the future of Open Dialogue.
Author Bio: Jane Hetherington, Principal Psychotherapist at KMPT and an employee at Early Intervention Services in Kent, has completed Open Dialogue course and will be a part of the new Open Dialogue Course. She is trained as an integrative psychotherapist and has experience working in primary care, substance misuse, and psychosis services. Here, she writes about a few psychotherapeutic theories.