The Open Dialogue Approach to Acute Psychosis: Its Poetics and Micropolitics

Abstract

In Finland, a network‐based, language approach to psychiatric care has emerged, called “Open Dialogue.” It draws on Bakhtin's dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: “tolerance of uncertainly,”“dialogism,” and “polyphony in social networks.” A treatment meeting shows how these poetics operate to generate a therapeutic a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need‐Adapted Treatment, Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment as‐usual settings. In a nonrandomized, 2‐year follow up of first‐episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild psychotic symptoms remaining; and only 23% were on disability allowance.