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“Becoming Dialogical: Psychotherapy or a Way of Life?”

Article summary

Dialogue and dialogism is way of life, after birth first we learn breathing after that we

learn to engage in active dialogical relations. Writer of this article doesn’t see dialogue as a

therapeutic method and he believes all psychotherapies needs to be dialogic if you aim to

bring positive changes. Applying dialogical approach can be helpful for both patient and the

family members of the patient in terms of mobilising resources and in Finland dialogical

approach is critical for special methods of therapy in psychological treatment.

In Finland, Professor Yrjö Alanen and his team, the Turku team integrated systemic

family therapy into their treatments and named it Need-Adapted Treatment. This methods

idea was right diagnosis emerges in joint meetings and procedures. Later on, this method was

already integrating to different psychotherapies in the early 1980s.

The Need-Adapted Treatment approach’s one of the ideas was open treatment

meetings. and Turku team always preferred team-work approach. With open treatment

meetings method patients and their family are invited from the beginning to the process, all

management and decisions are made when everyone is present. Everyone who participate this

meeting sits in a circle in the same room and team members who called this meeting begins

first but every other team member can ask questions and first questions are open ended. Team

need to adjust their answer to what clients say this can be mean asking further question,

repeating what spoken in the dialogue to encourage further speaking on subject. After the

important aspects of the meeting issued, before closing the meeting they ask to client if there

is anything that they want do discuss and at the end of the meeting they summarize the

meeting. The length of this type of meeting can be vary but generally it takes 90 minutes.
 Writer of this article and his team tried to implement this system to their work, but

this method challenged their views of psychiatric and family therapeutic treatment in various

ways.

 Stable treatment planning was not possible but every meeting generated a new plan.

 Applying the idea of the therapist as initiating change in the family system is no

longer possible.

 In a public sector inpatient setting family work was possible.

 They aimed to having all voices being heard therefore the intervention’s goal was not

to initiate change but generate new words and happenings.

Starting point for treatment is language when family describing patient’s problem.

Therapist’s goal is not to make an intervention, it is listening and responsively responding

and while family listens commenting to each other as a reflective discussion as a whole

team.

Open dialogue used for describe a family with social network-centered treatment. The

treatment has two aspects, first members generate a new understanding through dialogue,

second it provided guiding principles for the practice in one geographic catchment area. This

provided principles for organizing a treatment system with dialogue. They realized resource

in the system to produce positive outcomes for psychotic, depressive and especially psychosis

patients are better than other approaches. These studies provided principles for treatment in

most severe crisis.

An optimal system for mobilizing resources should include: Immediate response

withing 24 after contact, social network perspective that includes relevant members of the

client’s social network and all the professional that involved in the crisis, flexibly and

mobility for the needs of the client and family, guaranteeing responsibility, being responsible
for organizing first meeting for decision making, psychological continuity with adding

different staff members, tolerating uncertainty and generating new community to talk

together, increasing understanding about the crisis and life of patients.

Observations of parents and infants shows us that the original human experiences of

dialogue emerges in the first days of life with facial expressions, hand gestures and this is a

dialogue, child emotions affects the parent emotions and the reverse. In meeting two

histories happen, first adapting ourselves to each other and creating a multi-voiced

polyphonic experience of shared incident. Secondly, therapist main focus is how to respond

to client, in here answering means demonstrating what has been said and if possible opening

up new point of view.

There is a horizontal and vertical polyphony. Horizontal polyphony includes all those

present as embodied human beings, everyone has their own voice and everyone have the right

to speak in their own way. In the other hand vertical polyphony includes all the voices a

single participant has in their dialogue, when a person speaks about a memory of someone all

the voices and experiences of that person becomes voices in the dialogue.

Main message is generating dialogues in multi-actor settings mobilises clients to use

their own resources. For generating a dialogical relation being heard and taken seriously is

essential. In his method goal is to look responses because dialogue is generated in the way we

respond to each other, Dialogue is both complicated and easy, but in the end, dialogue is

everywhere in our lives and we cannot escape it.

Important aspects for me:

 We don’t usually see this type of treatment method in this area, including patient’s

family in the process and discussing everything especially way of taking decisions,

every person in the room has a knowledge about treatment process, methods and

maybe logistics and all of this process happening while all the therapists and the

patient and his/her family in the same room is really fascinating and innovative, at

least in my opinion.

 The writer’s approach to dialogue was very interesting too, at the beginning I was

thinking just like the writer, dialogue is something we know after birth and always

with us so therefore it is in the therapy already, how can you make this a separate

dialogical therapy method? But this article showed me that what is exactly is dialogue

and dialogism and how can we use this as a separate therapy method. Even there is

some thinks that I don’t agree with the article right know I know there is way to

implement different technics to therapy or separate some basic thinks and make it a

distinct method. In this aspect this article showed me a little light for this kind of area.

 I don’t usually agree or understand the deep concept of group therapy or similar

therapy/treatment methods, after reading this article even the focus was not treating a

group but treating a person with their family and the other experts around was not

exactly group therapy, I think I gained an insight about the variety and methods of

working with group in terms of therapy/treatment. In this way the article was a ice-

breaker for me cause group therapy and using a group to treat a induvial is not the

same thing.
Things I don’t agree:

 First of all, I don’t think these methods can’t be used in different cultures or areas but

to apply this method you need a lot of effort because everything needs to align nearly

perfect. I know the writer talks about if some issue comes up how you can fix it or try

it but comparing the classic psychotherapy its seems so much work to me, you need to

find the right specialist/psychotherapist to start to group and then you need to have the

time and logistics for all of this people after then patient itself and their family comes

and you need to find a solution for them too. They may have some physical disability

or some problems about talking with the group, if they have some problem with the

group itself, I believe trying to fix these things will cost you a lot of time and energy.

Even this is much effective for hard cases or specific cases (at least comparing to

classic psychotherapy) I don’t think this method can easily generalized for a lot of

people and therapist. In the end it may be very helpful for specific cases but in general

I believe it’s hard to accomplish.

 Secondly, because this is a group work even every therapist is a professional what

happens if there is a misunderstanding or disagreement within the group, you can try

to fix it within the group but this will be unnecessarily time and energy consuming

and it will prolong the therapy. And you can’t try to fix little issues in the absence of

the patient and their relatives, but then this will conflict with the method itself because

everything needs to be talked about when everyone is present and “actively listening”.

 Lastly, because this is a kind of a new research in this area, I don’t think this is really

important right know but there is not enough mention of language or culture barrier,

and I think because how we engage in a dialogue both physical, verbal or horizontal

and vertical can be differ from the culture to culture and language to language.