Every time I read about Open Dialogue, I see the ethos of restorative justice in its principles. Open Dialogue is a ‘social network approach’ in which clinicians work as a team (minimally as a pair) with patients (clients) along with members of their family, friends, colleagues, support workers, neighbours or any other persons they wish to involve. The focus of treatment represents a shift from individual psychopathology to empowering social networks for a relational approach to recovery, involvement of the same team in the care pathways of people wherever they go and adapting the care processes according to the clients’ needs (Mosse, 2019). This approach, pioneered in Finland, is different to much of mental health care in the UK, but it has been discussed for many years with interest by several NHS Trusts around the country and is now being implemented in the UK. It is unique and innovative and has recorded striking results in Finland, Germany and parts of the USA. For example, in international non-randomised trials, 72 percent of those with first episode psychosis treated via an Open Dialogue approach returned to work or study within two years, despite significantly lower rates of medication and hospitalisation compared to treatment as usual (Stockman, 2016).
Open dialogue and restorative justice share foundational principles of healing, rehabilitative goals and dialogic relationships to allow for diverse individuals to find meaning and the space to recover. While there are many definitions of restorative justice, the overarching understanding of restorative justice is that it is an ethos. As an ethos, it is not only a methodological tool for the restoration of harm and rebuilding relationships, but also encompasses a sensitivity to and an orientation towards the values, principles and ethics of respect, equality and community collaboration. There are 4 foundational principles that Open Dialogue shares with restorative justice:
The “individual” as more than labels
One of the key foundations of the ethos is the acknowledgement that individuals are complex beings who are shaped by socio-political, cultural and economic factors. To slot people into arbitrary categories of “good” and “evil” limits the possibility of justice and a journey towards healing because it forecloses the possibility of conceiving of a solution and the capacity to build a relationship with the “other.” While this does not mean that there is no harmed party and a harming party in a crime, practising restorative justice enables both parties to interact and converse and see each other beyond the boundedness of the crime. It allows the offended person
to ask unanswered questions and explain the impact that the crime had on their life. It also gives a chance for the offender to reflect on their actions, make amends and work towards refraining from causing future harm.
Open Dialogue involves a radical shift from the traditional psychiatric treatment model of labelling and giving meaning to people’s experiences such as diagnosing them with schizophrenia or psychosis. These diagnoses are based on narrow definitions that lead to a predetermined pattern of treatments or interventions to ease the symptoms (Waddingham, 2017). What the Open Dialogue approach offers is the time and space to engage with someone’s own meanings and the many different meanings that already exist in a family/social network. It would be easy for practitioners to talk ‘about’ the person, to take an expert position and puzzle over what would be best for them. ‘Witness thinking’ in Open Dialogue orients practitioners to a more ethical way of being with people. It demands that they do their best to be alongside someone, to figure things out together. It’s about nurturing a relationship and calls for a recognition of the autonomy, wisdom and personhood of those they are trying to support (ibid.). Dialogic and relational space
In restorative justice, there is a shift from a punitive stance to a dialogic intervention. The traditional approaches in criminal justice are like monologues framed within bureaucratic systems which are often experienced negatively by people who feel that they are misunderstood, not heard or treated with dignity. Restorative justice instead focuses on a relational approach, where the conversations, interventions and nature of relationships between different parties is co-designed and co-produced by everyone (Gavrielides, 2022). Restorative justice assumes the existence of “social liaison” that bonds individuals in a relationship of respect for others’ rights and freedoms and recognises people as agential beings who can take responsibility for their own actions.
Open Dialogue is based on these values of reframing the therapeutic space and the involvement of the client. It aims to shift from an expert-led diagnostic language to discovering ways out of crisis, new openings and agency through a dialogue involving social networks and the therapeutic team. Clients are seen as agents who have the capacity to generate new emotions and construct narratives with others in their lives that can help in healing. The underlying principle is that rather than focusing on expert-led treatment and intervention, clients are given the space to speak, reflect and co-create interventions with a group involving family members, friends, caregivers and medical experts.
Crucial to the idea of creating a dialogic space is the ability to relinquish power and the desire to have one’s social will and authority prevail in a relationship. Applying restorative justice principles requires the practitioners to reflect on their own impulses, thoughts and actions and change the way they use power to dominate or influence other individuals (Gavrielides, 2022). This requires a continuous conversation with oneself and a more active integration and learning of how to respect and respond to diverse people’s opinions and thoughts in a way that is rehabilitative and healing for everyone.
Similarly in Open Dialogue, the idea is to re-shape patient and professional hierarchies, where the therapist’s job is not to offer authoritative expertise, but to respond and say what it feels like to hear the things being said. In this therapeutic space, the therapist is a ‘conversational artist’ having ‘an expertise in asking questions from a position of “not knowing”’ to allow ‘locally’ constructed understandings and vocabularies (Anderson, 1992 as cited by Moss, 2019, p. 12). This not knowing involves a shedding of unequal power dynamics in healthcare and embracing new modes of relating, knowing and being-with clients that gives everyone an equal space to co-construct the healing process.
There are core principles underlying restorative justice, but the beauty in this approach is that it is flexible and always open to new values and interpretations. While this aspect may be criticised for being un-scientific and lacking clarity, the notion of justice and collaborative approaches in the interest of all parties cannot be bound by rigid rules and meanings (Gavrielides, 2022). The idea of an intersubjective and dialogic space requires a constant shift, fluidity and reconfiguration of actions, interventions and communicative strategies to allow for an impactful and meaningful process of healing and recovery that suits the needs of the parties involved. Since it is based on lived experiences and is a way of being and doing in everyday life, defining restorative justice to a narrow understanding will itself be an injustice to the dynamic and diverse realities and experiences of people.
Open Dialogue is an approach that is also acknowledged as constantly evolving. It has no fixed frames of reference or meta-language and does not claim to hold answers to the complexity of emotions and experiences involved in the process of recovery or treatment. Rather, it derives its strength from the idea of recovery as arising between the productive, emotional and reflective interactions among diverse groups of people (Mosse, 2019, p. 6). Every immersive period with different stakeholders in the therapy has its own trajectory and conceptualisation of what counts as healing. It involves a practice of “being with” others and an “aliveness” that exceeds our existing categories and styles of thinking (Stevenson, 2012, as cited by Mosse, 2019).
In adopting its foundational principles and values, I believe the Open Dialogue approach embraces the ethos of restorative justice. Embracing this ethos allows for a kind of psychiatry and mental health treatment that fosters interactive meaning-making, a responsiveness to each other’s experience, the ability to reflect on an awareness of our emotional selves and co-creating healing and restorative interventions. While an understanding of restorative justice and its application in models like Open Dialogue is an ongoing process, these approaches are remarkable and heartening developments that have the potential to contribute towards gentler, more respectful and impactful models of care and restorative change.
Anderson H., Goolishian H. (1992) The Client is the expert: A not knowing approach to therapy. In Therapy as Social construction, McNamee S., Gergen K. New York:Sage Publications.
Gavrielides. T. (2022). Introduction to Restorative Justice Art: Four steps to restoring mental health, London: RJ4All Publications.
Mosse, D. (2019). Reflections on Open Dialogue in mental health clinical and ethnographic practice. In Emma Gilberthorpe, (ed.) Anthropological Perspectives on Global Challenges. (ASA Monograph Series). New York & London: Routledge.
Razzaque, R., Stockmann T. (2016)An Introduction to peer-supported Open Dialogue in mental healthcare. BJPsych Advances, 22. 348–356.
Waddingham, R. (2017). Some of the things that excite me about Open Dialogue. Behind the label. https://www.behindthelabel.co.uk/open-dialogue-excites-me/