Open dialogues with clients with mental health problems and their families

practitioners of some of the ways they are
introducing the organisational principles
of open dialogue and/or dialogicalpractices into their agency settings, anddiscussions of new UK-based trainings in
the approach. There are also discussionsof links between open dialogue andcontemporary theatrical-approaches,
while there are several contributions
expanding the conversation with othertherapeutic modalities, including narrative,
psychoanalytic and mindfulness-based
approaches. Although open dialogue
was initially developed as a therapeutic
approach to psychosis, it has much wider
applications and this issue includes anaccount of an innovative network-based
approach to helping a service user withlearning diﬃculties.
We are particularly delighted to include
articles by Ray Middleton and Jan Kilyon,
who write from their experiences of being
a service user and a carer, calling for thewider adoption of dialogical approaches byservices.
References
Alanen, Y.O. (1997) Schizophrenia: It’s Origins andNeed-Adapted Treatment. London: Karnac.
Andersen, T. (1990) (ed.) The Reﬂecting Team:
Dialogues and Dialogues about the Dialogues.
Kent, UK: Borgmann.
Cooke, A. (2014) (ed.) Understanding Psychosis
and Schizophrenia. British Psychological Society,
Division of Clinical Psychology. bps.org.uk
Laws, K., Langford, A. & Huda, S. (2014)
Understanding Pychosis and Schizophrenia: A
Critique. www.thementalelf.net
Penn, P. (1999) Metaphors in regions of
unlikeness. Human Systems, 10: 3-10.
Speck, R.V. & Attneave, C.L. (1973) Family
Networks. New York: Pantheon.

2

Open dialogues with clie
and their families
Jaakko Seikkula
In a psychotic or other severe mental
health crisis, it should be normal
psychiatric practice for the fi rst meeting
to take place within a day of hearing about
the crisis. Furthermore, both the clientand family should be invited to participate
in the fi rst meeting and throughout thetreatment process, for as long as is needed.
In these meetings, all relevant
professionals are invited to participate
and openly share their thoughts andopinions about the crisis. They should
stay involved for as long as help is needed.
All discussions and treatment decisions
should be made openly in the presence ofthe client and family. The fi rst aim is togenerate a collaboration that tolerates theuncertainty of the crisis to mobilise thepsychological resources of all involved.
Starting medication should be discussed
and decided openly as a part of this process.
These are the basic guiding principles ofthe open-dialogue approach that originatedin the Western part of Finnish Lapland. Its
development started in the early 1980s andthe open dialogue system has been goingon now for about 30 years.
In Finland, psychotherapeutic practice
has long been part of public healthcare. Especially important has been thedevelopment and research undertaken
in Turku by Yrjö Alanen and his teamsince the1960s. Starting with individual
psychodynamic psychotherapy, the Turku
team integrated family perspectives into
their treatments in the late 1970s and called
the approach need-adapted treatment(Alanen, 1997) in order to emphasise thatevery treatment process is unique andshould be adapted to the varying needs ofeach client.

Keränen, 1992; Seikkula et al., 2003; 2006;2011).
By summarising the observations inthese studies, seven main principles of thesystem emerged:
Immediate support;
A social networks perspective;
Flexibility and mobility;
Responsibility;
Psychological continuity;
Tolerance of uncertainty;
Dialogism.
These principles came out of the research
and were not planned before. Later on,
more general ideas about good treatment
were added. The approach is not diagnosis
specific, but describes an entire networkbased treatment that is especially practicalin crisis situations.

Immediate response
In a crisis, it is vital to act immediately
and not to wait for the client with psychosis
to become more coherent before a family
meeting. It is preferable that the fi rst
response be initiated within 24 hours,as this can prevent hospitalisation. The
meeting is organised regardless of who fi rst
contacted the response unit. In addition, a24-hour crisis-service ought to be set up.
Everyone, including the client,participates in the very fi rst meetings
during the most intense psychotic period.
The clients usually seem to be experiencing
something that has been unappreciatedor unacknowledged by the rest of thefamily. Although the clients’ comments
may sound incomprehensible in thefi rst meetings, after a while, it becomesapparent they are actually speaking ofreal incidents in their lives. Often, theseincidents include some terrifying issues,a threat or theme that they have not been
Open dialogues in organisingable to articulate before the crisis. Th is
psychiatric practiceis also the case in other forms of difficult
From its very beginning, the openbehaviour. In extreme anger, depression or
dialogue system has been based on
anxiety, the client is speaking of previously
rigorous evaluation of both the dialogicalunspoken themes. In this way, the mainprocesses in meetings with the clients andtheir families, and of the outcomes in crises person in the crisis, the client, reaches for(Aaltonen et al., 2011; Haarakangas, 1997; something that had not been touched byContext 138, April 2015

ents with mental health problems
others in their surroundings. The aim of thetreatment becomes the expression of theseexperiences that previously had no words,
especially those that had not developed ashared language.
During the fi rst couple of days of a crisis,
it seems possible to speak of things thatare difficult to discuss later. In the fi rst
days, hallucinations may be handled andreflected upon, but they easily fade away,
and the opportunity to deal with them may
not reappear until after several months ofindividual therapy. It is as if the window forthese extreme experiences only stays open
for the fi rst few days. If the team manages
to create a safe enough atmosphere by
responding rapidly and listening carefully
to all the themes the clients bring up, thenimportant themes may fi nd a space where
they can be handled and the prognosis
improves.

Context 138, April 2015

Flexibility
Flexibility is guaranteed by adapting
the treatment so that it is a response to thespecific and changing needs of each clientand his or her family, using the therapeutic
methods best suited to each family, their

specific language and their way of living.
During the fi rst ten to twelve days of acrisis, the need is quite different comparedwith the need three weeks later. For
instance, during the most acute phase, it isoften advisable to meet every day, which
is no longer necessary once the situation
has stabilised. In that later period, families
generally know how frequently they shouldbe meeting.
The best place for the meeting, if the family
approves, might be the client’s home. Home
meetings seem to prevent unnecessary
hospitalisations, since the family’s own
resources are more accessible in that sett ing(Keränen, 1992). In traditional psychiatry,families can easily refuse to participate intreatment. However, the need-adapted
approach, with its emphasis on taking into
account the uniqueness of each treatment
process, has been more successful inengaging with families.
Responsibility
Organising a crisis service in a catchment
area is difficult if all the professionals
involved are not committed to providing
an immediate response. A good ruleof thumb is to follow the principle that
whoever is contacted takes responsibility
for organising the fi rst meeting andinviting the team. The person contacting
the professional could be, for example,
the client, a family member, or a referring
practitioner. Th is means it is no longer
possible to respond to a request for help bysaying, “This has nothing to do with us, pleasecontact the other clinic”. It is important toreassure the family member contacting theservice that he or she has come to the rightplace and they will take care of organisinga meeting.
In the meetings, decisions are made as
to who will best form the team that will be
responsible for the treatment. In multiproblem situations, the best team is formed
with professionals from different units; forinstance, one from social care, one from a
psychiatric outpatient clinic and one fromthe hospital ward.
3

Open dialogues with clients with mental health problems and their families

Including the social network
The clients, their relatives, and other key
members of their social network are always
invited to the fi rst meetings to mobilise
support for the client and the family. Other
key members may be representatives ofother authorities such as state employment
and insurance agencies, vocationalrehabilitation services, fellow workers or
the supervisor at the client’s workplace, as
well as neighbours or friends.
Social networks can be seen as relevantin helping defi ne the problem. A problem
is one that has been defi ned as such in
the language of either those closest to theclient or by the client him or her self. In
the most severe crises, the fi rst notion ofa problem often emerges in the defi nitionof those closest to the client after theynote that some forms of behaviour nolonger conform to their expectations: forexample, if a young member of the family issuspected of using drugs. The young person
will seldom see using drugs as a problem,
but parents can be terrified by it. From a
network perspective, all these individuals
should be included in the process. It is
helpful to adopt a simple way of deciding

who should be invited to meetings. It canbe done, for instance, by asking the person
who made contact in the crisis:
1. Who is concerned about the situation or
who has been involved?
2. Who could be of help and is able toparticipate in the first meeting?
3. Who would be the best person to invite
them, the one who contacted the services
or the treatment team?
By doing it this way, the participation of
those closest to the client is suggested aspart of an everyday conversation, which
decreases any possible suspicion about theinvitation. Also, the one who has madecontact with the services can decide whois or isn’t present. If the proposal for a
joint meeting is made officially, by asking,for instance, “Will you allow us to contact
your family and invite them to a meeting?”,problems may arise in engaging both theclients and those close to them.
Another factor in identifying therelevant participants is to fi nd out whether
the clients have contacted any otherprofessionals, either in connection withthe current situation or previously. If theother professionals cannot attend the fi rst
meetings, a joint meeting can be arranged
later.
The people in the client’s social network
can be included in many ways. If theycannot be present, the client can be asked
if they want to invite others who could
possibly help. Some member of the network
can be given the task of contacting themafter the meeting and relaying the absent
person’s comments to the next joint
meeting. Those present can be asked, forinstance, “What would Uncle Mark have said
if he was present in this conversation? Whatwould your answer be? And what would hesay to that?”

Open dialogues with clients with mental health problems and their families

The team mobilised for the fi rst meetingshould take responsibility for analysing
the current problem and planning thetreatment. Everything needed for anadequate response is available in the room;
there is no other authority elsewhere thatwill know better what to do. Th is means
all team members should take care ofgathering the information they need for thebest possible decisions to be made. If thedoctor was not able to attend the meetings,
they should be consulted by phone and,if there is a difference of opinion aboutcertain decisions, a joint meeting isadvisable to discuss the choices in thepresence of the family. Th is empowers
family members to participate more in thedecision-making process.

individual psychotherapist does not wantto participate in the joint meetings. Th is
can intensify the family’s suspicion towards
the therapy, sometimes affecting the entire
treatment process. Th is is particularly
important in the case of children andadolescents.

Tolerating uncertainty
The fi rst task for professionals in a crisis
is to increase the safety of the situation,
when no one yet knows the reasons for the
problem or the solutions for it. The aim is
to mobilise the psychological resources of
the client and those nearest to him or her
so as to increase the agency in their own
life, by generating new stories about theirmost extreme experiences and building up
trust in the joint process. For instance, in a
Guaranteeing psychological continuity
psychotic crisis, meeting every day, at least
The team takes responsibility for thefor the fi rst ten to twelve days, can generate
treatment for as long as needed in bothan adequate sense of security. After this,outpatient and inpatient sett ings. Th is ismeetings can be organised on a regular
the best way to guarantee psychologicalbasis according to the wishes of the family.
continuity. Forming a multidisciplinary
Usually, no detailed therapeutic contract
team early increases the possibility ofis made in the crisis phase but, instead, atcrossing the boundaries of different
every meeting it is decided if and whentreatment-facilities and preventing people the next meeting will take place. In this
dropping out.
way, premature conclusions and treatment
In the fi rst meeting, it is impossible todecisions are avoided. For instance, in theknow how long the treatment will continue. fi rst psychotic crisis, neuroleptic drugs are
In some instances, one or two meetings is
not commenced during the fi rst few weeks.
enough but, in others, intensive treatment
Th is allows more time to understand thefor two years may be needed. Problems
problem and the whole situation. There ismay occur if the crisis intervention teamalso time for spontaneous recovery where,
meets three to five times and then refers
in some cases, the problem can dissolve by
the client to other authorities. In theseitself. A recommendation for neuroleptic
circumstances, even in the fi rst meetings,
drugs should be discussed in at least three
there is a danger of too much focus on
meetings before implementation, to clarify
actions to be taken and not enough onwhether those present think the drugs are
the process itself. Representatives of thenecessary. On the whole, it is advisable toclient’s social network participate in thesee if psychosocial help through intensive
treatment meetings for the entire treatment open-dialogue meetings is helpful insequence, including when other therapeutic increasing safety and thus enabling themethods are applied.
family to access their own resources to
One part of psychological continuity issurvive the crisis. If this is not enough,to integrate different therapeutic methods medication may be considered as an option
into a cohesive treatment-process where
after some weeks of therapy.
different methods complement each other.
Th is approach is in contrast to illnessFor instance, if individual psychotherapy is oriented approaches that focus on trying
recommended for the client, psychological to remove symptoms with drugs duringcontinuity is easily guaranteed by having
the early phase of treatment. For psychotic
one of the team members act as theclients, these are typically neuroleptics.
individual psychotherapist. If this is not
Psychiatric drugs can help, of course,
possible or advisable, the psychotherapist
but the risk is that they also decrease
could be invited to one or two joint
psychological resources. Neuroleptic drugs
meetings, in which ideas are generated
often have a sedative effect that calms
that can serve as the basis for an individual psychological activity and thus may be atherapy process. Problems may occur if the hindrance to psychological work. In our
4study, only 33% of acutely psychotic clientsused neuroleptics at all during the five-year
follow-up period.
Besides the practical aspects of seeingthat the family is not left alone with
its problems, increasing safety means
generating a quality in the therapeutic
conversation such that everyone canbe heard. Working as a team is one
prerequisite in guaranteeing safety in acrisis with loaded emotions. One teammember may start to listen more carefully
to what the son says when he is saying
he does not have any problems; it is his
parents who may need the treatment. The
other team member may become moreinterested in the family’s burden of not
being successful at stopping his drug
misuse. Already, in the very fi rst meeting,it is good to reserve some time for reflective
discussion among the team in addition
to these different or even contradictory
perspectives. If the team members canlisten to each other, it may increase thepossibility for the family members also tolisten to each other.
Situations in which professionals arein a hurry to get to the next meeting andtherefore propose a rapid decision, are
not the best use of the family members’
psychological resources. It would be better
to note that important issues have been
discussed, but no fi rm conclusions can bemade and thus the situation is defi ned as
open. One way to put it into words might be,“We have now discussed this for about an hour,
but we have not reached any firm conclusionof what this is all about or the best option toaddress it. However, we have discussed very
important issues. Why not leave this open andcontinue tomorrow?” After that, concrete
steps should be agreed before the next
meeting to guarantee family members knowwhat they should do if they need help.
Dialogicity – promoting dialogue
In meetings, the focus is primarily on
promoting dialogue and only secondarily
on promoting change in the client or in
the family. Dialogue is seen as the forum
through which families and clients areable to acquire more feeling of agency intheir own lives through discussing theirproblems (Haarakangas, 1997). A newunderstanding is generated in dialogue(Andersen, 1995). Professionals have to
become skilful in promoting dialogues
through which their specific expertknowledge becomes rooted in the context.
Context 138, April 2015

Open dialogues in the therapy
meeting

Context 138, April 2015

meetings can vary, but usually ninety
minutes is adequate.
Olson, Seikkula and Ziedonis (2014)
have written a summary of key elements inopen dialogue meetings and propose thatthe core aspects of the dialogues are:
1. Two (or more) therapists in the teammeeting
2. Participation of family and network
3. Using open-ended questions
4. Responding to clients’ utterances
5. Emphasising the present moment
6. Eliciting multiple viewpoints
7. Use of a relational focus in the
dialogue
8. Responding to problem discourse
or behaviour in a matter-of-factstyle and attentive to meanings
9. Emphasising the clients’ own words
and stories, not symptoms
10. Conversation amongst professionals(reﬂections) in the treatment
meetings
11. Being transparent
12. Tolerating uncertainty

Eﬀectiveness of the open-dialogue
approach
In Western Lapland, the effectivenessof open dialogue has been assessedin follow-up studies for fi rst-episodepsychotic clients. The results comparedwith treatment-as-usual are promising.
Clients diagnosed with schizophrenia
were hospitalised significantly lesscompared with the treatment-as-usual
group, an average of fourteen days perperson compared with one hundred andseventeen over a two-year period (Seikkula
et al., 2003). Only 33% used neuroleptics
during some phase of treatment comparedwith 100% in the comparison group.
Families were actively involved in all of
the cases, having an average of twenty-six
meetings over two years. When comparing
outcomes, open-dialogue clients diagnosed
with schizophrenia seem to recover betterfrom their crises. At least one relapse
occurred in 71% of the comparison groupof clients compared with 24% in the opendialogue group. Only 17% of the opendialogue clients had at least occasional
mild symptoms, compared with 50% in thecomparison group. As many as 81% had
returned to full employment comparedwith 43% in the comparison group.
5

Open dialogues with clients with mental health problems and their families

the questioning and thus all staff members
can participate in interviewing. On other
The name ‘open dialogue’ was fi rst used occasions, the team can decide in advancein 1996 to describe the entire family andwho will conduct the interview.
social network-centred treatment process.
The team does not plan the themes of
It includes two aspects: fi rst, the meetings the meeting in advance. From the very
described earlier in this article in which
beginning the task of the interviewer(s)all relevant members participate from the is to adapt their answers to whatever theoutset to generate new understanding by
clients say. Most often, the team’s answer
dialogue; secondly, the guiding principles takes the form of a further question thatis based on, and has taken into account,for the entire system of psychiatricwhat the client and family members havepractice in one geographic catchment
said. Often, this means repeating wordarea.
for-word some part of the utterance and
The main forum for dialogues is theencouraging further dialogue on thetreatment meeting where the major
subject. If the client does not want toparticipants in the problematic situation
participate in the meeting or suddenly
join with the client to discuss all theruns out of the meeting room, we discuss
relevant issues. According to Alanen
carefully with the family members(1997), the treatment meeting has threewhether or not to continue the meeting.
functions:
If the family wants to continue, a staff
1. To gather information about themember informs the client that she or
problem;he can return if they want. During this
2. To build a treatment plan and makediscussion, we do not make any otherall decisions necessary on the basis ofdecisions concerning the client.
the problem that was described in theEveryone present has the right toconversation; andcomment whenever she or he is willing to
3. To generate a psychotherapeutic
do so, but comments should not interrupt
dialogue.
an ongoing dialogue. Every new speaker
On the whole, the focus is on
should adapt his or her utterance to whatstrengthening the adult side of the clientand on normalising the situation, instead was previously said. For the professionals,
this means they can comment eitherof focusing on regressive behaviour.
by inquiring further about the theme
The starting point for treatment is theunder discussion, or by asking the otherlanguage of the family, how each family
professionals about their thoughts inhas, in its own language, described the
response to what is being said. Most oft en,client’s problem. Problems are seen as
in those comments, specific phrases area social construct and are reformulated
introduced to describe the client’s mostin every conversation (Shotter, 1993).
difficult experiences.
All present speak in their own voices.
When the staff members have to remind
The stance of the therapists is different
from the traditional one in which it is the the family of their obligations and duties
in this specific treatment-process, it istherapist who makes the interventions.
advisable to focus on this toward the end
While many family therapy schools areof the meeting, after family members
especially interested in creating specifichave spoken about what are the mostforms of interviewing, in focusing oncompelling issues for them. After deciding
generating dialogue, listening andthe important issues for the meeting
responsively responding becomes
have been addressed, the team member
more important than the manner ofinterviewing. Team members canin charge suggests the meeting be closed.
comment on what they hear with each
It is important, however, to close theother as a reflective discussion, while themeeting by referring to the client’s own
family listens (Andersen, 1995).
words and by asking, for instance, “I
The meeting takes place in an open
wonder if we could begin to close the meeting.
forum. All participants sit in a circle in the Before doing so, however, is there anythingsame room. The team members who have else we should discuss?” At the end of thetaken the initiative for calling the meeting meeting it is helpful to summarise briefl ytake charge of leading the dialogue.
the themes of the conversation, especially
On some occasions, there is no prior
whether or not decisions have been madeplanning regarding who takes charge of
and, if so, what they were. The length of

Open dialogues with clients with mental health problems and their families

At five-year follow-up (Seikkula et al.,2006), results were still positive, with 85%
of the open-dialogue clients returning totheir studies, work or to active job-seeking.
These results have generated somecriticism; for example, querying whether
the cohort was selected so that only theeasiest-to-treat psychotic clients were
included. Partly in response to thiscriticism, but mainly out of interest to see
if the results stayed the same, the design
was repeated after ten years, includingfi rst-episode psychotic clients who
contacted the Western Lapland treatment
system during 2003-2005 (Seikkula etal. 2011). The outcomes were the sameas earlier. About 1/3 used antipsychotic
medication and 84% had returned tofull employment. For the most part,
it could be verified that outcomes had
stayed the same, but some interestingchanges were noted. First of all, thegroup of psychotic clients in the 2000s
seemed to be different, in the sense they
were younger and included fewer with aschizophrenia diagnosis. The duration of
untreated psychosis had declined to halfa month, compared to 3.5 months during
the 1990s. Secondly, differences occurredin the remaining psychotic symptoms,
with fewer symptoms in the 2000s thanin the 1990s. Other outcomes – including
employment status – remained the same.
However, in the third period, the relative
proportion of brief psychotic episodes washigher than in the fi rst two groups.
Together with the results of anotherstudy by Aaltonen et al. (2011), it wasnoted there has been a remarkabledecline in schizophrenia in the Western
Lapland province. In 1985, the incidenceof schizophrenia was 33 new cases per
100,000 inhabitants, while a systematic
analysis during ten years until 1994 noteda decline to 7 per 100,000 inhabitants. At
2005, the incidence was 2-3 per 100,000
inhabitants (Seikkula et al., 2011).

Conclusions and reﬂections
The results show open dialogue
produces a remarkable change in the
prognosis for severe mental illness. As
one well-known professor of psychiatry
noted in a personal communication, “We

6have not previously seen any of these kindsof results with psychosis”. Th is suggests
our approach to psychiatric crisis shouldchange. We are used to thinking of
psychosis as a sign of schizophrenia andschizophrenia as a relatively stable statethat affects the client throughout his or
her entire life. In the few long-term followup studies of fi rst-time psychotic clients,
after fi ve years treated by traditional
methods, more than a half are said to beliving on a disability pension. The positive
outcomes using the open-dialogue
approach may indicate that psychosis
no longer needs to be seen as a sign ofillness, but can be viewed as one way of
dealing with a crisis and, after this crisis,
most people are capable of returning totheir active social lives. And, given so few
actually need neuroleptic drugs, we can
ask whether our understanding of theunderlying problem needs to change.
New ways of thinking about psychoses
have emerged through the introductionof open dialogues. Instead of primarily
focusing on controlling symptoms withmedication, attention can be focused onorganising meetings for those involved,
including family members and otherrelevant individuals from the personalsocial network and from professional
networks. In these meetings we should be
more interested in generating dialogues byfollowing what family members are saying
than in planning interventions aimed atchange. If so, the training of professionals
should be restructured to include these
new aspects: not only to read books about
medical interventions, but also to reflect
upon the philosophy of how to generatedialogue and listen to people instead of
dominating the therapeutic process.
References
Aaltonen, J., Seikkula, J. & Lehtinen, K. (2011)
Comprehensive open-dialogue approach I:
Developing a comprehensive culture of needadapted approach in a psychiatric public healthcatchment area the Western Lapland Project.
Psychosis, 3: 179-191.
Alanen, Y. (1997) Schizophrenia: Its Origins andNeed-Adapted Treatment. London: Karnac.
Andersen, T. (1995) Reﬂecting processes. Acts of
informing and forming. In S. Friedman (ed.) The
Reﬂective Team in Action. New York: Guilford.
Haarakangas, K. (1997) Hoitokokouksen äänet.
[The voices in treatment meeting. A dialogicalanalysis of the treatment meeting conversations
in family-centred psychiatric treatment process
in regard to the team activity. English Summary.]
Jyväskylä Studies in Education, Psychology andSocial Research, 130: 119-126.
Keränen, J. (1992) The choice between outpatientand inpatient treatment in a family centred
psychiatric treatment system. English summary.
Jyväskylä Studies in Education, Psychology andSocial Research, 93: 124-129.
Olson, M., Seikkula, J. & Ziedonis, D. (2014) The
Key Elements of Dialogic Practice in Open Dialogue.
Worcester, MA:The University of Massachusetts
Medical School. September 2. Version 1.
Seikkula, J., Alakare, B., Aaltonen, J., Holma,J., Rasinkangas, A. & Lehtinen, V. (2003) Opendialogue approach: Treatment principles andpreliminary results of a two-year follow-up
on ﬁrst episode schizophrenia. Ethical Human
Sciences and Services, 5: 163-182.
Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas,
K., Keränen, J. & Lehtinen, K. (2006) Five-year
experience of ﬁrst-episode nonaﬀective
psychosis in open dialogue approach: Treatment
principles, follow-up outcomes, and two casestudies. Psychotherapy Research, 16: 214-228.
Seikkula, J., Alakare, B., & Aaltonen, J. (2011) The
comprehensive open-dialogue approach (II).
Long-term stability of acute psychosis outcomesin advanced community care: The Western
Lapland Project. Psychosis, 3: 192-204.
Shotter, J. (1993) Conversational Realities:
Constructing Life Through Language. London:
Sage.

Jaakko is a clinical psychologist and family
therapist. From the early 1980s until 1998
he was a member of the team in Western
Lapland in Finland developing the opendialogue approach. He is professor of
psychotherapy at the University of Jyväskylä,
Finland. Email: Jaakko.Seikkula@psyka.jyu.ﬁ

Context 138, April 2015