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Implanting Rhizomes in Vermont: a Qualitative Study of How the Open Dialogue Approach was Adapted and Implemented


The Open Dialogue approach was developed in Finland in the 1980s as a form of psychotherapy and a way to organize mental health systems. It has been adapted and implemented in several countries in recent years. This qualitative study sought to explore staff and developers’ experiences with one adaptation of the Open Dialogue approach in the state of Vermont called the Collaborative Network Approach. In total twenty two staff members from two agencies participated in focus groups and three developers of the approach were interviewed. Three dominant topics emerged in the analysis process: impact of training; buy-in across levels; and shift in organizational culture. Findings revealed that 1) participants experienced the Collaborative Network Approach as positively impacting their clinical work, relationship with clients and families, and with colleagues; 2) buy-in across levels – colleagues, management and department of mental health - was perceived as crucial to the development and implementation of the approach; 3) the main challenges to full implementation were: inadequate billing structures, costly and lengthy training, and resistance to shift organizational culture to integrate the Collaborative Network Approach into agencies. We hope to have contributed to the field in a way that will support further efforts to develop and implement Open Dialogue-informed approaches by pointing to potential successes and challenges future program developers may face.

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The authors would like to thank all participants who gave up their time to share their experiences.


This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Ana Carolina Florence has received funding to carry out her doctoral research from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES). Gerald Jordan has received funding to carry out his doctoral and postdoctoral research from the Department of Psychiatry at McGill University; the Franke Program in Science and the Humanities; the Fonds de recherche du Québec- Santé; and the Canadian Institutes of Health Research.

Author information




Ana Carolina Florence, Gerald Jordan, Silvio Yasui and Larry Davidson contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ana Carolina Florence. The first draft of the manuscript was written by Ana Carolina Florence and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ana Carolina Florence.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Yale University School of Medicine Institutional Review Board (HIC/HSC # 2000024372).

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Florence, A.C., Jordan, G., Yasui, S. et al. Implanting Rhizomes in Vermont: a Qualitative Study of How the Open Dialogue Approach was Adapted and Implemented. Psychiatr Q 91, 681–693 (2020).

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  • Open dialogue
  • Qualitative research
  • Psychosis
  • Mental health