Open Dialogue

Open Dialogue is a psychiatric service for people experiencing extreme emotional states or exhibiting signs of psychosis. Our approach is based on the idea that while crises can be times of difficulty, they also hold opportunities for growth. The goals of Open Dialogue are to help people manage these experiences as successfully, and with as few negative consequences as possible. We believe the best outcomes are more likely if the treatment team partners with the person in crisis; builds on the strengths of the person at the center of concern; respects that person’s preferences and values; and shares all decision-making about treatment.

Core Ideas

• When a person or family is in crisis, taking the time to really understand what is going on, from each person’s perspective, can be very helpful.
• The more we are able to make decisions collaboratively with the people directly involved in the crisis, the more likely we are to come up with effective solutions.
• In considering the use of medication, it is important to make sure that the person at the center of concern and others in the network of support fully understand the risks and benefits of using, not using, or delaying any medications.
• Many crises resolve or improve with time because of the strengths and abilities of the people involved, or because circumstances change in a positive way.
• It is only possible to practice the first four ideas in an outpatient environment if everyone is safe.

Guiding Principles

• Provide immediate help.
• Practice safety first.
• Include family and others important to the person at the center of concern.
• Encourage dialogue in the network of support.
• Listen deeply, especially to the person at the center of concern.
• Take time to understand and to let natural resolutions occur.
• Pay attention to the strengths of the person at the center of concern.
• Practice Shared Decision-Making.
• Ensure informed consent.
• Be fully open and transparent.  
• Have a crisis plan in case things don’t go well.
• When medication is used, practice Collaborative Psychopharmacology.
• Provide coordinated care.