Skip to main content

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

Abstract

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Seikkula J, Arnkil TE. Open dialogues and anticipations: respecting otherness in the present moment. 1st ed. Tampere: Finnish University Print; 2014.

    Google Scholar 

  2. 2.

    Seikkula J, Alakare B, Aaltonen J. Open dialogue in psychosis I: an introduction and case illustration. J Constr Psychol. 2001;14(4):247–65.

    Google Scholar 

  3. 3.

    von Peter S, Aderhold V, Cubellis L, Bergström T, Stastny P, Puras D. Open dialogue as a human rights aligned approach. Front Psych. 2019;10:387.

    Article  Google Scholar 

  4. 4.

    Seikkula J, Aaltonen J, Alakare B, Haarakangas K, Keränen J, Lehtinen K. Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: treatment principles, follow-up outcomes, and two case studies. Psychother Res. 2006;16(02):214–28.

    Article  Google Scholar 

  5. 5.

    Bergström T, Alakare B, Aaltonen J, Mäki P, Köngäs-Saviaro P, Taskila JJ, et al. The long-term use of psychiatric services within the open dialogue treatment system after first-episode psychosis. Psychosis. 2017;9(4):310–21.

    Article  Google Scholar 

  6. 6.

    Freeman AM, Tribe RH, Stott JC, Pilling S. Open dialogue: a review of the evidence. Psychiatr Serv. 2019;70(1):46–59.

    Article  Google Scholar 

  7. 7.

    Buus N, Bikic A, Jacobsen EK, Müller-Nielsen K, Aagaard J, Rossen CB. Adapting and implementing open dialogue in the Scandinavian countries: a scoping review. Issues Ment Health Nurs. 2017;38(5):391–401.

    Article  Google Scholar 

  8. 8.

    Tribe R, Freeman A, Livingstone S, Stott J, Pilling S. Open dialogue in the UK: qualitative study. British J Psychiatry Open. 2019;5(4):E49.

    Article  Google Scholar 

  9. 9.

    Gordon C, Gidugu V, Rogers ES, DeRonck J, Ziedonis D. Adapting open dialogue for early-onset psychosis into the US health care environment: a feasibility study. Psychiatr Serv. 2016;67(11):1166–8.

    Article  Google Scholar 

  10. 10.

    Parachute NYC: Tracing the origins, development, and implementation of an innovative alternative to psychiatric crisis. White Paper 2015.

  11. 11.

    Hopper K, Van Tiem J, Cubellis L, Pope L. Merging intentional peer support and dialogic practice: implementation lessons from Parachute NYC. Psychiatr Serv. 2020;71(2):199–201.

    Article  Google Scholar 

  12. 12.

    Guba EG, Lincoln YS. Competing paradigms in qualitative research. Handbook Qualitative Res. 1994;2:163–94.

    Google Scholar 

  13. 13.

    Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–40.

    CAS  Article  Google Scholar 

  14. 14.

    Sells D, Topor A, Davidson L. Generating coherence out of chaos: examples of the utility of empathic bridges in phenomenological research. J Phenomenol Psychol. 2004;35(2):253–71.

    Article  Google Scholar 

Download references

Acknowledgements

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

Funding

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

Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Ana Carolina Florence.

Ethics declarations

Conflicts of Interest/Competing Interests

Authors report no conflicts of interest.

Ethics Approval

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).

Consent to Participate

Informed consent was obtained in writing from all participants of the study.

Consent for Publication

Not applicable.

Availability of Data and Material

Not applicable.

Code Availability

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s11126-020-09732-7

Download citation

Keywords

  • Open dialogue
  • Qualitative research
  • Psychosis
  • Mental health