1. Open Dialogue in
Dutch Psychiatry:
Will Revolution help or
is it just a Fata
Morgana?
van oenen @ cornelis 2013
2. Goal of the workshop:
discuss desirability and
possibility of a dialogical
approach in the setting of the
Outreaching Psychiatric
Emergency Service (OPES) in
Amsterdam
van oenen @ cornelis 2013
3. Setting Outreaching Psychiatric Emergency
Service (OPES) Amsterdam:
Emergency psychiatry and (subsequent) brief
therapy
Multidisciplinary team
Reasons for referral: psychiatric disorders,
suicidality, psycho-social problems,
behavioral problems, public nuisance
Systemic and psychiatric approach
van oenen @ cornelis 2013
4. Three different systemic approaches
1) Medical, linear, approach .
Therapist asks system for information, diagnoses patient, gives family
psycho-education.
van oenen @ cornelis 2013
5. Three different systemic approaches
1) Medical, linear, approach .
Therapist asks system for information, diagnoses patient, gives family
psycho-education.
2) Consensus oriented Systemic Interviewing and Intervention.
Therapist facilitates structure and content of meeting with identified
patient and relatives. Part of plan can be psychiatric examination.
Result will be discussed.
van oenen @ cornelis 2013
6. Three different systemic approaches
1) Medical, linear, approach .
Therapist asks system for information, diagnoses patient, gives family
psycho-education.
2) Consensus oriented Systemic Interviewing and Intervention.
Therapist facilitates structure and content of meeting with identified
patient and relatives. Part of plan can be psychiatric examination.
Result will be discussed.
3) Open dialogue approach.
Different voices can be heard without psychiatric labelling in open and
equal encounter, without preconceived intentions or stategies. Aim is
creating open space for new perspectives
van oenen @ cornelis 2013
8. Position of therapist in different
approaches
Medical approach: expert.
Directs conversation from a controlling position,
operates in monologue.
van oenen @ cornelis 2013
9. Position of therapist in different
approaches
Medical approach: expert.
Directs conversation from a controlling position,
operates in monologue.
CSII: consultant.
Directs and facilitates dialogue („expert in
consultancy‟) and participates from a „semi-equal‟
position.
van oenen @ cornelis 2013
10. Position of therapist in different
approaches
Medical approach: expert.
Directs conversation from a controlling position,
operates in monologue.
CSII: consultant.
Directs and facilitates dialogue („expert in
consultancy‟) and participates from a „semi-equal‟
position.
Open dialogue: participant.
Facilitates and participates in an equal postion.
Subjective experience counts, no framing is offered.
van oenen @ cornelis 2013
11. Historical development systemic
positions
Starting as an expert in cybernetic, structural
and strategic school.
Shifting towards consultant position in
circulair questioning and solution focused
school
„Ending‟ in equal participant in narrative and
open dialogue approach.
(and back…?)
van oenen @ cornelis 2013
12. Thesis 1
Therapist has to switch between
positions, fitting to the client,
relatives and specific situation
van oenen @ cornelis 2013
13. Thesis 2
Open dialogue is often not
applicable in Outreaching
Psychiatric Emergences Service
Amsterdam
van oenen @ cornelis 2013
14. Often not applicable because:
1) It does not fit into the Dutch culture of the
patient and his relatives: “One is in crisis and
wants help from an expert who solves the
problem!”
2) The assurance asks for a psychiatric
diagnosis.
3) Patients are sometimes too ill or too
aggressive to have a dialogue. (I.e.: manic
patients.)
4) Feedback (CDOI) worked counterproductive
van oenen @ cornelis 2013
15. Case
Woman, 34 years.
Referral: anxiety, panic, suicidal thoughts.
History: has suffered from severe depession 5
years ago.
Actual situation: partner has to move abroad
for job. Client anxious for renewed
depression. „If I get depressed again, I‟d
rather die‟.
van oenen @ cornelis 2013
16. Questions
Which position would you take?
Which goal would you define for yourself?
How would you explain your approach to the
client and relatives?
van oenen @ cornelis 2013
17. Case continued
Client: wants to talk about events in the past,
stressing need for help; concentration
diminishes, level of anxiety rises.
Partner: asks urgently for advice
No solution comes up.
What would you do?
van oenen @ cornelis 2013
18. Question
Which position would you take?
Which goal would you define for yourself?
How would you explain your approach to the
client and relatives?
van oenen @ cornelis 2013
