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It’s Therapy — But With Your Mom, Your Wife and Your Boss

Open Dialogue, which originated in Finland, is an innovative model of mental health treatment that involves everyone in your circle. Could it catch on in the U.S.?

So you finally get up the motivation to go to therapy, but when you walk into the room, it’s not just your therapist and a couch in there — it’s your mom, your dad, your best friend, your significant other and maybe even your boss.

No, it’s not your worst nightmare. It’s a new and innovative form of therapy that directly addresses your quality of life by setting up shop in it. “Difficult human experiences and life situations aren’t the problems of a single person, they’re always mutually related to the wider social contexts,” Finland-based clinical psychologist Tomi Bergström explains. “So it’s better to ‘treat’ these networks rather than a singular person.”

As such, Bergström and a growing number of clinicians outside of the U.S. are practicing Open Dialogue therapy, which involves sessions between the person struggling, those closest to them and typically more than one therapist, all of whom collaborate on the best course of action. In America, conversations between therapists about a client generally happen behind closed doors, but with Open Dialogue, there is no such hierarchy.

Ever since Open Dialogue was first developed in the 1980s in Finland, more and more evidence has emerged that it may be one of the more effective ways of treating psychotic disorders, such as schizophrenia. Psychosis is defined as having symptoms of delusions or hallucinations that aren’t based in reality, as well as disorganized thought patterns. A schizophrenia diagnosis generally applies to those who experience these symptoms for at least six months. (However, there’s a history of diagnoses being doled out unnecessarily, inconsistently and disproportionately to Black Americans in the U.S.)

With Open Dialogue, immediate intervention at the first sign of psychotic symptoms is key. Typically within the first 24 hours of contacting the Keropudas Hospital in Finland, a treatment team will gather family, friends and sometimes coworkers for a joint session on how to approach the problem. This can be done at the hospital, though home is preferable to decrease the stigma of going to the hospital and increase the likelihood of integrating treatment interventions into daily routines. While the strategy isn’t anti-medication, sedatives and antipsychotics are used sparingly, and only when other less invasive methods don’t work.

Studies show that more than 80 percent of people with psychosis who are treated with Open Dialogue returned to work, and over 75 percent had no residual signs of psychosis. In contrast, the approach to treating psychosis in the U.S. has emphasized the immediate use of heavy antipsychotic medications, and has resulted in 90 percent of people with schizophrenia not maintaining a job and being dependent on public assistance.

The notion that people who deal with psychosis have to be medicated for the rest of their lives may be directly to blame for such a poor prognosis. Repeated studies from the World Health Organization since the late 1970s have found that individuals with psychotic symptoms in developing countries have consistently better treatment outcomes than those in the U.S. — and report consistently lower levels of medication compliance. Multiple studies in the U.S. have similarly shown that people with schizophrenia have a greater chance of recovery when they discontinue medications, and that long-term use of antipsychotic drugs increases the likelihood of future episodes and shrinks the frontal lobes of people’s brains.

As opposed to focusing primarily on medication, Open Dialogue requires bringing in an individual’s support system as interpreters and stakeholders in their well-being, who can brainstorm how to help. That way treatment providers can better “understand root causes of difficulties and also conduct treatment in a more individualized, need-adapted manner,” Bergström says. “Often, the respectful human interaction itself is enough, and life goes on.”