PEER-SUPPORTED OPEN DIALOGUE Taking The Agenda Forward Birmingham 15 January 2016 Mark Hopfenbeck Assistant Professor Norwegian University of Science and.

PEER-SUPPORTED OPEN DIALOGUE Taking The Agenda Forward Birmingham 15 January 2016 Mark Hopfenbeck Assistant Professor Norwegian University of Science and Technology 2 Global history of OD 1960s; Ross Speck, Carolyn Attneave & Uri Rueveni, network therapy 1975; Need-adapted treatment, Turku psychiatric clinic, Professor Yrj Alanen 1980; Systemic + narrative + constructivist family therapy 1985; Harlene Anderson and Harry Goolishian, language-based collaborative therapy 1990; Tom Andersen, reflective processes 1995; Jaakko Seikkula, Open dialogues in social networks 3 Psychotherapy of the Social Network We are dealing with the interface between society and the family. One might speak of dealing with the surrounds of families. My clinical work over the years has convinced me that the organization of social structures and society plays a larger role in the alienation of a person from himself and others than most clinicians are willing to accept at the moment. R. Speck (1967) Psychotherapy of the Social Network of a Schizophrenic Family 4 Network therapy The therapeutic potential is activated by collecting the patients and the family's social network at the same place - at the same time - with the intent to form a tighter organization of relations Speck og Rueveni (1969): Network Therapy: A developing concept 5 Retribalisation The goal for me was to establish sensible relationships between people that could stimulate one another and achieve the greatest possible mutual development.... In each case, I began to seek out the rhythm that characterized an already existing group and the natural, social and spiritual power sources that were available - and to apply my therapeutic measures relative to them instead of isolating the individual from these support mechanisms that they were part of. Speck & Attneave 1973 Family Networks p. 23 6 A network meeting is... a meeting in the Buber-ian sense, between a person and friends, family, and neighbors and colleagues and from the professional support system. The goal is to put together resources, ideas, energy and empathy around a social system that is in crisis. Together they develop the means that enables them to cope with a challenging life situation. Fyrand 2005 7 The seven principles of Open Dialogue 1.The provision of immediate help 2.A social network perspective 3.Flexibility and mobility 4.Responsibility 5.Psychological continuity 6.Tolerance of uncertainty 7.Dialogism 8 The provision of immediate help first meeting arranged within 24 (72) hours of first contact; the mobilization of resources creates a window of opportunity, involve significant others 9 A social network perspective families, carers, friends & other members of the professional and private network can always invited to the meetings: Who can help you right now? 10 Flexibility and mobility anytime, anywhere, anybody person-centred, empowering, normalizing 11 Responsibility first contact takes charge of whole process of organizing the first meeting: youve come to the right place we can help 12 Psychological continuity the same team is responsible for treatment, engaging with the social network for the entirety of the treatment process 13 Tolerance of uncertainty an active attitude of being with the network, co-creating a safe place and process based on transparency and authenticity, so as to avoid premature conclusions or decisions, taking the time to listen 14 Dialogism promoting new meanings and mutually shared perspectives; joint language and understanding through responding and reflecting; acceptance and insight creating hope and agency 16 17 Clinical fidelity criteria 1.Two (or More) Therapists 2.Participation of Family and/or Network Members 3.Use of Open-Ended Questions 4.Responding To Clients Utterances 5.Emphasizing the Present Moment 6.Eliciting Multiple Viewpoints: Polyphony 7.Creating a Relational Focus in the Dialogue 8.Responding to Problem Discourse or Behavior as Meaningful 9.Emphasizing the Clients Own Words and Stories - Not Symptoms 10.Conversation Among Professionals in the Meeting: The reflecting process, making treatment decisions, and asking for feedback 11.Being Transparent 12.Tolerating Uncertainty 18 Organizational fidelity 1.Person, Family and Support Centered Care Approach 2.Culture demonstrates respect, authenticity and collaboration 3.Teams meet routinely with person and network 4.Staff trained in dialogic practice and network engagement 5.Welcoming environment focusing on client experience 6.Connect services in clinical and community settings 7.Practice 12 Key Elements 8.Provide immediate support and access to services 9.Shared decision making process 10.Use OD as a mindful way of being 19 What makes POD different? (Peer-supported Open Dialogue) The explicit integration of; 1.Value-based practice 2.Trauma-informed care 3.Psychosocial network approach 4.Person-centered care and relational skills 5.Mindfulness and self-work 6.Peer-support 20 1) V alue-based practices are empirically-based practices Value-based practice is based on the premise that core values guide and direct a particular intervention... Best practices also are value-based practices that have recovery values underlying the practice. - Farkas & Anthony (2006) System Transformation Through Best Practices. Psychiatric Rehabilitation Journal 21 What are the core values of POD? Openness transparency Nothing about us, without us Disclosure and self-disclosure Authenticity Trust, equality, common humanity, vurnerability Genuineness, the real relationship (Gelso) Unconditional warmth Acceptance, compassion, empathic listening, love Connectedness, support, recognition, validation 22 2) Trauma-informed care realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma; and responds by fully integrating knowledge about trauma into policies, procedures, and practices and seeks to actively resist re-traumatization SAMSHA (2014) Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol, p. 9 23 3) Psychosocial network approach to develop a dynamic amongst a collection of network members thereby creating a group process. The theoretical basis is partly based on a social model and partly on traditional psychotherapeutic elements of family therapy, group therapy and community work. Together, this provides an intervention that is unifying, short and powerful. Schoenfeldt et al (1985) Network therapy: an outcome study of twelve social networks 24 4) Person-centered care Is based on an extraordinary trust in the client and in the potential of human beings to grow, heal and find their own path towards psychological health, given the right conditions. Freeth (2007) Humanising Psychiatry and Mental Health Care: The Challenge of the Person-centred Approach, p. 20 25 and relational skills "Interpersonal skills are core competencies in mental health care... Increasing relational skills and improving the ability to collaborate require that the topic be addressed and prioritized so high that sufficient time and resources are made available." Steihaug & Loeb (2007) Mental health services for resource intensive users 26 What are those skills? Being flexible, honest, respectful, trustworthy, confident, warm, interested, open, explorative, reflective, noting past therapy success, interpreting accurately, facilitating the expression of affect, and attending to the patients experience contribute positively to the therapeutic alliance Ackerman & Hilsenroth (2003) A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1-33 27 5) Mindfulness training therapist attitudes characterized by warmth, unconditional positive regard or acceptance, and genuineness have proved quite difficult to teach as a skill. Training programs have either neglected these personal attitudes or relied upon personal psychotherapy, sensitivity training, and the like for their development. In this regard mindfulness training may be an extremely promising addition to clinical training because it may indeed foster attitude change toward greater acceptance and positive regard for self and others. Lambert & Simon (2008) The Therapeutic Relationship: Central and Essential in Psychotherapy Outcome 28 Self-work .. a simultaneous exploration of ones inner world and private thoughts When we begin training, we embark on two simultaneous journeys; one outward into the professional world and the other inward, through the labyrinths of our own psyches The more fearless we become in the exploration of our inner worlds, the greater our self-knowledge and our ability to help clients. Cozolino (2004) The Making of a Therapist 29 6) Peer Support Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. Peer support is not based on psychiatric models and diagnostic criteria. It is about understanding anothers situation empathically through the shared experience of emotional and psychological pain. Mead, et al (no date) Peer Support: A Theoretical Perspective 30 Peer Support Establishment of Peer Support Networks and meeting places Local community-based cultures of recovery Respite centres, club houses; connecting and contributing Stigma reduction and network building Its normal to be different Everybody hurts sometimes 31 Foundation diploma in peer-supported open dialogue, social network and relationship skills Four five-day residential modules for 2016; January, April, June, October In collaboration with London South Bank University in trainers from 5 different countries; Jaakko Seikkula, Mary Olson, Mia Kurtti++ Dialogues, experiential exercises & role-play Trainers; Mark, psychiatrist Russell Razzaque & family therapist Val Jackson 32 UK Multi-centre RCT Currently training underway 60 students completed, 80 starting in January 2016 Growing levels of national interest among service users, carers and clinicians April 25 th Second national conference (1000 participants expected) DoH very supportive BBC potentially filming documentary around training & trial Open Dialogue Development and Evaluation of a Social Network Intervention for Severe Mental IIlness (ODDESSI) Phase 1 Development of adherence measures Testing trial design and obtaining the right outcomes Phase 2 Cluster randomised trial comparing OD with standard care Phase 3 Service user and carer experience of care Staff and peer workers experience of OD Phase 4 Organisational changes need to support OD implementation 34FB group; Network for Open Dialogue Practices and Reflective Processes https://www.facebook.com/groups/ /