Open Dialogue and the importance of the continuity of care
Another key feature of the Open Dialogue training is the understanding of the importance of continuity of care and what this means to the service user and their family. In services both the NHS and social care, it is extremely important to the individual to have a practitioner who knows their story and who is familiar with their individual considerations and family circumstances. The importance of therapeutic engagement and a relationship cannot be underplayed. The vast majority of literature in relation to improved outcomes in psychological treatment confirms that it is the qualities of the practitioner and their ability to engage the service user that results in an improvement in the service users psychological wellbeing not the approach of the therapist. The arguments that have resulted in the promotion of CBT to the detriment of a wide range of other psychotherapeutic interventions have been based around the use of measures in this approach. This allies CBT more with the medical model and the ability to provide empirical research which fits with the NICE guidelines as so called gold standards. Unfortunately this quantative research often is unable to measure the qualitative and more subtle and sustainable aspects of the therapeutic encounter which results in a profound change and the healing of the wounded psyche.
Continuity of care is also sadly lacking in the current system whilst being a feature of the Finnish service where practitioners in Tornio, in Western Lapland often remain with the service for the whole of their working life. Finnish practitioners all experienced the 3 year Open Dialogue training as part of their generic role within services, although apparently this is not the case currently however there are plans to remedy this. Clinicians in Tornio subsequently stay with the service where the practitioners operate as a close team with a knowledge of one another’s lives and experiences. In the UK teams are more changeable with practitioners moving area, or team or acquiring additional skills etc. so teams are not as stable as their Finnish counterparts. In addition in the UK there are a number of teams that operate with locum staff so there is not the stability and the in depth knowledge of the client and their family network that would be present within the Finnish team. Another factor of importance is that the demographic of Western Lapland is such that the team would often have personal knowledge of the service user and their family background.
In the UK service users and their families often have to tell and retell their stories to a range of practitioners from different teams and services, as they make their way through the mental health system and this is distressing for them and unnecessary. This results in inconsistencies in note taking and important factors of the clients story being missed. It also leads to practitioner bias and misinterpretation in instances where service user behaviour has been reflected on and recorded inaccurately. These biases will be perpetuated in notes and result in the service user on occasions being misunderstood and treated detrimentally. The importance in Open Dialogue of continuity is reflected in the initial contact and subsequent network meetings where there will be a core of practitioners involved from the outset. These practitioners will be a constant throughout the network meetings and the service user’s journey through services.
About Author: I am Jane Hetherington Principal Psychotherapist with KMPT currently working in Early Intervention Services n Kent. I trained as an integrative psychotherapist and have worked in substance misuse, primary care and psychosis services. I have completed the Open Dialogue training and will be involved in the new Open Dialogue Service.
