Paradoxical Practice 

On 2nd February 2016 I attended a conference on Open Dialogue in London. [This is not a live blog].

Whilst I’ve come across dialogical practice from a coaching and learning perspective I wasn’t so familiar with the use of open dialogue as an approach for mental health treatment, and yet the more I heard the more I knew they were speaking to the converted.

Should we have a exploratory, mutually conversation with patience in a mental health setting? Yes

Should we be treating people like people? Yes

Should we listen more? Yes

It’s 2016 and we’re asking these questions. It’s better than not asking them at all.

This isn’t new. The idea of demonstrating a ‘way of being’ that connects you to another is definitely not new. We know, they know, and paradoxically  whilst “It’s so simple, it’s also so hard” (Dr Russell Razzaque – @MindfulRussell).

It’s bigger than this blog and bigger than psychiatry but what stood out was that to practice this way is to undo all existing and prevailing medical-model based training. It was going to be harder for professionals to be human. To speak to a patient. During the conference a guest speaker quoted her son:

“she had all this experience and expertise in mental health but she didn’t know how to speak to me …and I didn’t want to let her down”.

Further speakers encouraged the audience to be better in their practice by learning to attend to their own thoughts, to develop self-awareness and exercise an ease of urgency to problem solve and auto-diagnose. I’ll repeat that, innovate and dynamic psychiatrists are asking fellow mental health professionals to practice meta-cognition.
Recently I offered a group learning together the option to simultaneously (okay not in the same moment but essentially in the same experience) be the subjects of the session, and switch to a meta position of the facilitator. There was little response. The reflection appeared hard and contributions rapidly defaulted back to their own current experience.

In medical care, as of 2013 it’s the legal right of anyone to choice where they go, for GP and consultant referral, and yet I’m hearing “nobody uses it because it makes no difference where you go”. What if it did? What if mental health consultants and psychiatrist believed something different about the people in front of them? (that’s a whole other blog).

To not auto-diagnose is to go against the grain of years of training, to become the person who does diagnose. Against the grain of power and structure. Then we were reminded that it’s not your knowledge of the DSM that makes it work, it’s your ability to connect to another, and notice and hear and understand their individual experience. The power and essentiality of empathy again.

It’s simple but it’s hard. But I think thats why we’re here right.

 

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