Consideration of the Possibilities of Open
Dialogue Patterns: through Creating and
Performing the Learning Program of Dialogue
Masafumi Nagaia1, Takashi Ibaba

Graduate School of Media and Governance, Keio University, Endo 5322, Fujisawa,
Kanagawa, Japan. mnagai@sfc.keio.ac.jpbFaculty of Policy Management, Keio University, Endo 5322, Fujisawa, Kanagawa, Japan.
iba@sfc.keio.ac.jp

Abstract There are many problems occurring in modern society due tocomplications among human relationships. In order to resolve such conflicts, it isnecessary to not only find causing factors within the individuals who are involved,
but to also gain perspective of surrounding relationships. Therefore, the authors of
this paper examined the method of "open dialogue", a dialogue-based approach
proposed in the field of mental health care, and created "Open Dialogue Patterns”,
a language of the tips on how to enable dialogue that improves humanrelationships for the people directly involved as well as their surrounding
relationships. Furthermore, the authors of this paper also implemented a program
to explore the possibility of applying "Open Dialogue Patterns" in other fields
such as collaboration and human relationships in general. As a result, it wassuggested that the patterns are effective in the following three ways: "Utilization
to deepen understanding in interpersonal relations", "Induce the Inquiry of
Effective Dialogue", and "Recognize the dialogue as a design issue".

1 Introduction
There are many problems occurring in modern society due to complications
among human relationships. Issues such as bullying and power harassment, arisingfrom problems in human relationships are constantly occurring in workplaces andschools, and dilution of human relations is becoming a noticed problem inpeople’s everyday lives. When trying to resolve these problems, the common
approach is to seek the causes in the particular individual that is involved. It is
generally considered that the problem exists within the individual, and that the1

Corresponding author: Masafumi Nagai, email: mnagai@sfc.keio.ac.jp

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problem could have been solved if the person's behavior was better. Some may
even blame the individuals, saying that "The problem happened because of yourbehavior," or "The problem would have not happened if you had done better”.
Although the guidelines for improvement of such approach is easy to understand,it ignores the fact that individuals exist within various relationships. In a certain
relationship, he/she may have been forced to take the action that resulted inproblems. Under these circumstances, it is necessary not only find causing factors
within the individuals who are involved, but to also gain perspective of
surrounding relationships.

2 Open Dialogue Patterns
Therefore, the authors of this paper examined the method of "open dialogue", adialogue-based approach proven to be effective in the field of mental health care,and created "Open Dialogue Patterns”, a language of the tips on how to enabledialogue that improves human relationships for the people directly involved aswell as their surrounding relationships. In organizing the knowledge, a method
called the "Pattern Language” was used. Pattern language was originally createdby architect Christopher Alexander, as a method of knowledge documentation to
make it easier for residents to participate in the design of urban buildings andtowns. A pattern language consists of patterns, which each contain a piece ofknowledge that is labeled with a "pattern name", and described in the order of"context", "problem", "solution", and "consequence” It is a method that has been
applied outside of the architecture domain, including software design and humanaction (Alexander. et al, 1977). The purpose of “Open Dialogue Patterns”, thepattern language presented in this paper, is to solve individuals’ problems by
inducing dialogue that involves various people related to the situation (Iba. et al,
2017; Nagai. et al, 2017).

2.1 Open Dialogue
Open Dialogue is a family therapy method developed by a team led by Mr.
Jaakko Seikkula of Jyväskylä University, which has been implemented at
Keropudas Hospital in the West Lapland region of Finland from 1980s.
Traditionally, medical doctors diagnosed symptoms such as schizophrenia andtook approaches such as medication treatment and hospitalization. The open
dialogue approach, however, is a treatment done through performing open
dialogical meetings with people related to the situation. In other words, it treatspatients as part of a larger social network, rather than isolating them as one
independent individual. Therefore, the dialogical meetings convene important
people around the patient as well as the medical professionals, instead of having a

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one-on-one medical examination with the patient. Furthermore, it is not a one-way
conversation like a diagnosis, is rather an interactive conversation. By repeatedly
conducting dialogical meetings and trying to talk about experiences that had beendifficult for the patient alone to express, the symptoms get better and behaviors
that have caused problems gradually cease to exist. The effectiveness of thisapproach has already been demonstrated in Finland. The recurrence-prevention
rate is high, and the hospitalization period is shorter than the patient receiving
normal treatment such as Pharmacotherapy (Seikkula & Olson, 2003).
Thus the open dialogue has a characteristic similar to COINs. That is, it brings
results by collaborating and sharing opinions directly with each other, rather than
through hierarchies and boundaries. In Open Dialogue, the patients’ problems are
solved by convening various stakeholders under the shared vision of "improving
the patients’ symptoms", and getting them to continuously share their opinions. In
both COINs and Open Dialogue, flat interaction brings results that are beyond theboundary, which would not have been born through a conventional approach.

2.2 The creation process of Open Dialogue Patterns
This section overviews the process of creating the Open Dialogue Patterns. The
project was organized by a total of six members who belong to same laboratory,
from September 2016 to January 2017. Referred literature is Seikkula's papers and"Dialogical Meetings in Social Networks" (Seikkula, 2002; Seikkula andOlson,2003; Seikkula, J. and Trimble,2005; Seikkula and Arnkil, 2006). First ofall, each member read Seikkula's papers and brainstormed the tips from theviewpoint of "what should be done in open dialogue,” for example “to invite thepatient’s family." As a result, we got 308 ideas, including some that overlap or
have similarities, and wrote each of them down on sticky notes. Taking the 308
sticky notes, we then went through a “Clustering” process, which is based on the
KJ method invented by Jiro Kawakita in 1967. During this phase, we grouped
together the sticky notes that had similar ideas. As a result, all of the data wasgrouped into 57 groups. Then we proceeded with writing patterns in the format of"Context", "Problem", "Solution", "Consequence”, and "Pattern Name."
Simultaneously, we also worked on putting the patterns into a structure, in order tocapture and create the whole language of Open Dialogue Patterns. First, we madegroups each consisting of three patterns in order to capture the components of thestructure, after which, we came up with three categories that represent the mostimportant key elements of the wholeness of Open Dialogue Patterns. In this phase,the integration of similar patterns was done more clearly, resulting in a structurewith a total of 30 patterns (Ishida. et al, 2017).

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2.3 Core Concepts of Open Dialogue Patterns
The Open Dialogue Patterns consists of 30 patterns in total. The core patterns
are ‘Experienced World’(No.1), ‘Various Voices'(No.2), and ‘Co-Created
Understanding’(No.3), supplemented by nine patterns for each core pattern thatprovide suggestions of specific practices (Iba, et al, 2017). Each category, alongwith a brief description of the pattern name and contents will be provided in theupcoming paragraphs.
The first core pattern, ‘Experienced World’(No.1) is about understanding the
speakers’ way of perceiving things through dialogue and using that frame to grasp
their experiences. To practice this pattern concretely, you can use nine patterns as
below. You do not let labels and expertise stop you to be ‘As a Living Person.’This also means recognizing others ‘As a Living Person’ too. It is important tohave a ‘Deep Listening’ to their pace of thoughts and utterance as well as choiceof words so that you can have an ‘Adaptation of Words.’ During the dialogue,
questions should not have Yes/No answers, so practice question that will allow us
to answer in own bare words such as ‘Open Question.’ Also, make a ‘Pause forThinking’ so that the person you are in a dialogue with can have a time to think
about what they want to say. When they have finally answered to your question,
make sure you also ‘Respond to What is Said.’ In order to understand their‘Experienced World,’ use not only your own point of view but also their ‘Inner
Frame.’ Sometimes there may be strong emotional expression, which is a great
opportunity to put those experiences that could not be expressed into words
through `Tunnel of Emotion.’ In case of these situation, make sure you settle a‘Respectful Mind’ towards dark and tough experiences they have had faced in thepast.
‘Various Voices’(No.2) means to have a dialogue with people in same situation
to share a variety of narrative from the person, and the various interpretations fromthe surrounding people. To practice this pattern concretely, you can use nine
patterns as below. First of all, we must have our ‘Significant Others’ to join in andhave everybody ‘Working as a Team.’ Then, gather those members in one place
and let them ‘Sitting in the Circle.’ As for dialogue, send out ‘Invitation for
Utterances’ from the beginning and ask them questions. Rather than trying toquickly summarize the story, it is important to proceed with `Slow-Paced
Conversation’ and to create gaps that anyone can speak frankly. Make sure to
respond back to any utterance so that we can create ‘Chain of Responses.’ Also,
not only paying attention to words, but also pay attention to the ‘Tiny Sign’ thateach person gives, such as a little expression and tension. Moreover, thinking thatthe move of your own feelings is more natural than ‘As a Living Person’
participation, express it and let ‘Emotional Resonance’ happen. Showing‘Reflecting’ with the supporting team members will create a gap to think forthemselves which leads out to a new voice.
‘Co-Created Understanding’(No.3) means to capture the circumstances behindthat has generated the problem, and by re-speaking it in the dialogue, we will start5

to gain new understanding and dissolve the problem itself. To practice this patternconcretely, you can use nine patterns as below. We will first have ‘First Meetingin Crisis’; a meeting from the timing when the person's emotions and speech areeasy to come up. In addition, because it is an unstable period, ‘Everyday Meeting’and ‘Continuous Engagement’ with the same members are required. It will bring
psychological continuity and security. In the dialogue, we grasp and share that
there are ‘Diverse Ideas,’ not like who is right or wrong. In the middle of theprocess, ‘Tolerating Ambiguity’ will continue for a while, but rather than trying toquickly summarize it, it is necessary to endure the uncertain state. By doing so,
you and your ‘Significant Others’ will finally lead to ‘Construction of Meaning’ of
the situation. Furthermore, important thing is to have a ‘Joint Decision’ where
everybody in the team is asked to discuss at the meeting. And not converging to
one agreement point, continue the dialogue with the image to bring ‘EverWidening Perspectives’ so that it will eventually be a ‘Co-Created
Understanding.’ The experience of such a dialogue creates ‘Community of
Narrative’ which will be the foundation for their future.
As mentioned above, with a total of 30 patterns of three core patterns and nine
practical patterns for each support the practice of Open Dialogue.
Fig. 1. The Whole Structure of Open Dialogue Patterns.

3 Application of Open Dialogue Patterns into other fields
Open dialogue is a method used in the field of mental health care, but thesignificance of this approach is that an individual’s problem is regarded as an
issue arising from various relationships with surrounding factors, and takes theapproach of resolving the problem by continuous dialogue. Therefore, by writing
patterns that capture the method on a more abstract level, it is possible to utilize it
outside the specific field of psychiatric care.

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3.1 Outline of “Dialogue Class”, a Learning Program of Dialogue
In order to know how the Open Dialogue Patterns can be effective whenapplied in other contexts such as collaboration or human relationship, we held
"Dialogue Classes”, a program targeted toward those with interest in Open
Dialogue, and those that want to train their dialogue skill in general "Dialogue
Class" is a learning community with the purpose of acquiring knowledge andskills of dialogue, using “Open Dialogue Patterns” as a support tool for learning.
In this program, each participant first decides the area in which they wish to gainskill, upon which they apply the “Open Dialogue Patterns” during the classes.
Each participant learns from each other's experiences by periodically sharing theirlearning based on their practices. Through this system, we promote theparticipants to put the patterns into practice and ultimately aim to improve theirdialogue skills. There are two key characteristics in this "Dialogue Class.” Thefirst is that it uses a pattern language as a learning tool, and the second is that a“generator” plays a role in the classes.
Pattern language has functions as a "media of conversation" and a "discovery
media" (Iba, 2013). Even those who have completely different experiences in a
specific context can learn from each other's experiences by using pattern language
as a "common language”. This is the function as the "media of conversation.”
Furthermore, the patterns allow people to perceive their current situation from the"Open Dialogue" point of view, which enables them to come up with ideas from adifferent approach. This is how pattern languages function as a "discovery media"
that enables you to procure "discovery" that advances such creative activities.
With such a tool, it is possible to acquire concrete practices and discoveries basedon your current situation.
Also, “generators" are placed in "Dialogue Class" to support the participants'
practices and learning. A “generator” is a person whose role is to assist the processof inquiry (Nagai. et al, 2016).A generator not only supports to proceed with theopportunity like a facilitator, but also actively participates in the creation of new
discoveries and ideas along with participants, and is a role found in the field of
education, workshops, co-cooking, etc. By having a generator, it is possible toprovide opportunities for each participant to practices and learn effectively.

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Fig. 2. The Image of “Dialogue Class”

3.1.1 Contents of ‘Dialogue Class’ as a case study this time
The "Dialogue Class" conducted was done as a program consisting of four
rounds of classes. Each session was carried out in two and a half hours, over
online video call. The first author of this paper took on the role of the generator,
and a total of 4 people who with an interested in dialogue around 20 to 30 years ofage participated. In the first round of the class, the 10 patterns regarding the"Experienced World” category was shared with participants as a textbook,supplemented by an oral explanation, and the area upon which each participant
would use the patterns was decided. By deciding the area, it becomes under toparticipants what circumstances the Open Dialogue Patterns should be used,
thereby making it easier to take into action. The second round of class was
conducted in two parts. The first part is "practices and learning sharing". During
this time, each participant share their practices and learning, so that they can lookback on their experiences and also learn from others' success stories. In the second
part, we shared the 10 patterns from the "Various Voices” category as a textbook
and explained its content. In the third round of the class, as in the second round,
we shared the patterns of the "Co- Created Understanding" category as a textbook
and explained its content and had another "practices and learning sharing” session.
In the last round of the class, after the "practices and learning sharing", weconducted a "dialogue on dialogue” session. Based on the skills and knowledge
accumulated during the course of the program, each participant captured what
“dialogue” is for themselves once again.

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3.2 Results
This time we carried out this program for about a month with a total of 4participants. The result of the program is shown below.

3.2.1 Utilization examples of each pattern
During the course of the “Dialogue Class”, a total of 10 cases in which thepatterns were utilized, were confirmed. Regarding the utilization results of thepatterns, they are summarized in the form of “Patterns performed”, “Area ofpractice”, "What was practiced”, “Consequence”, and “Learning”. These criteria
aim to make participants become aware of the influence of their actions, and get
discoveries from it. Since detailed contents are listed in the Appendix as a table,
here we introduce the contents lightly.
The breakdown of "Patterns performed" is the following: 7 patterns from thecategory of “Experienced World”(‘Experienced World,’ ‘As a Living Person,’‘Deep Listening,’ ‘Adaptation Words,’ ‘Open Question’ and ‘Response to What is
Said’); 1 pattern from the category of “Various Voices”(‘Emotional Resonance’);2 from the category of” Co-Created Understanding”(‘Diverse Ideas’ and ‘Joint
Decision’).
"Area of practice" is diverse. For instance, there were things like "When toadvice colleagues", "Relationship with girlfriend", "About human relationships
within the share house", "Relationship with friends from the same project", "atevents to hold" and so on.
Regarding "What was practiced", basically they are practicing Solution andAction of patterns according to the situation at that time. For instance, there were
examples of participants practicing the patterns’ solutions and actions according totheir circumstances, such as one participant who noted, "I had always beenadvising my colleague in the form of 'you should try ~~,' but this time I
consciously talked to him in a way to encourage him to think for himself what hewanted to do.” Another participant said, “even when we are fighting, I brought
myself to respond to what my girlfriend was saying.” There were also results that
did not work. For example, for “Diverse Ideas”, although they are behaving
according to the "Solution" which is "Talk while distinguishing each other's
opinions and perceptions consciously, it resulted in them only claimed their own
perceptions and their opinions never matching up, ending up in a dictatory
conclusion.”
In "Learning", there was also "Learning about the pattern itself" and "Learning
about the relations of each patterns”. Regarding "Learning about the patternitself", there was an impression from the participant like "By being conscious torespond to what she says, I could listen carefully to what she meant". Regarding"Learning about complementary relationships of each pattern,” there was evidenceof learning from a participant who noted, "At some timings, I said 'It is better for9

you to do this'. I think it would have been better to practice ‘Deep Listening’ or‘Pause for Thinking’.”

3.2.2 Impressions from participants
As written below, we collected feedback from participants after the program
was over. The participants were asked through a free description questionnaire
about the Open Dialogue Patterns and about the dialogue class.
About “Open Dialogue Patterns”: “Although it is difficult to actually use thepatterns as written, it is quite effective in applying to many cases and getting toknow open dialogue. I actually learned more from patterns that I could notpractice than those I was able to practice.” “Since it is possible to recognize themethod of each dialogue as a pattern, I think it will be easier to judge what I am
doing right or not doing right” "I thought the Open Dialogue Patterns is a way toshow the direction of communication to deepen understanding with others.”
About “Dialogue Class”: “There were difficulties due to the short duration of
the program. I think that I could have learned more deeply if I got a double
structure of having a look at the actual opportunity of dialogue and observe it.” "I
think that if you talk about what you have experienced, you will discover morethings because others will refer to it from a different viewpoint. However, we may
spend too much time for one episode, which is inevitable since I think that it will
depend on the flow of the conversation.” “I think that the dialogue is also
influenced by the relationship with others. I think that it was good to do it in aperiod of one month because it is possible to see others only from my own senseof values since the other participants were people who I met only once or twice.”“I thought that it is better to have two-week intervals between the classes. I feellike one week is a bit short to put what I learned into practice.”

3.2.3 Consideration
From the results and impressions of the program we have conducted, we
consider the effect of Open Dialogue Patterns in the following three points.
The first point is “Utilization to deepen understanding in interpersonal
relationship.” It was examined that it is relatively easy to utilize the Open
Dialogue Patterns in everyday life to deepen the understanding of an individual.
The patterns which were practiced many times were patterns from "Experiencing
World" where "context" assumes one-on-one conversation. There was also an
impression, which said, "I thought the Open Dialogue Patterns is a direction ofcommunication to deepen understanding with others.” From these feedbacks, it
could be said that the Open Dialogue Patterns is useful in deepening
understanding with others in daily life. Open dialogue itself is intended to resolve
symptoms through the dialogue with stakeholders, but the aspect of having

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common words to share with others seems to have made it more useful ineveryday life.
The second point is “Induce the inquiry of effective dialogue.” By choosing touse patterns, you can become aware of your actions that you were doing
unconsciously before. Then you can know what kind of influence your action
impacts, so you can use it as a trigger to explore better dialogue. For example,
when the practice goes well to a certain extent, there is learning about the effect ofa pattern such as “By being conscious to respond to what she says, I could listen
carefully to what she meant.” On the other hand, even if the participant feels thathe/she did not do well like "Diverse Ideas" or "Experience World" examples, theparticipant says "I often learned from the patterns I could not practice”. Fromthese facts, it can be regarded that the significance is not about whether what is
written in the pattern is exactly feasible, but that the guidance of exploration andlearning is directed by the patterns.
The third point is “Recognize the dialogue as a design issue.” Although"dialogue" is an act that is not physically visible, participants were able to think
about how to combine different elements to “design” better dialogue. For
example, one participant noted, “not only claiming 'Diverse Ideas', but also 'Deep
Listening' and 'Tunnel of Emotion' must be carried out at the same time” and "Insome timing, I said 'It is better for you to do this'. I think it would have been betterto practice ‘Deep Listening’ or ‘Pause for Thinking’.” These comments show thatparticipants were able to think that combining and using the patterns can improve
the quality of his/her dialogue. Therefore, we can conclude that the Open Dialogue
Patterns enables people to think about dialogue, as something that can be designed
upon will.

4 Conclusion
This research of using the Open Dialogue Patterns suggests that the patterns are
effective in the following three points - "Utilization to deepen understanding ininterpersonal relationships", "Induce the Inquiry of Effective Dialogue" and"Recognize the dialogue as a design issue". On the other hand, due to the bias in
the specific patterns, we also saw the possibility that there may be patterns which
are difficult to be practiced in everyday context. For this reason, we would like tocontinue putting the patterns into practice and closely examining the utilization
possibilities of each pattern. Furthermore, it is expected that learning styles likethe ‘Dialogue Class' we designed for people to learn about the Open Dialogue
Patterns, could be applied as a method of learning other pattern languages. Fromthe participant's voice that "I think that if you talk about what you haveexperienced, you will discover many things because others will refer to it from adifferent viewpoint", it could be suggested that this way to acquire patternlanguage through learning with others has potential for future application.

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Acknowledgments We thank Ayaka Yoshikawa and Haruka Mori for their assistance in writing
this paper, and all members of the Open Dialogue Patterns Project.

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Appendix All utilization examples of each pattern.