Paper short abstract:

The Open Dialogue approach to mental health crisis care abandons diagnosis to facilitate dialogical conversations with clients finding openings out of crisis. Can an ethnographic stance emulate the generosity of clinical 'not knowing' that de-centres analysis through non-interpretive presence?

Paper long abstract:

The NHS is trialling an alternative non-diagnosis-based social network approach to treating serious mental illness that draws service user 'peers' into therapeutic teams: Peer-Supported Open Dialogue (POD). Key to POD practice is a non-interpretive, non-analytic stance in clinicians' relationships with clients, and having treatment discussions exclusively in 'network' meetings with clients/family networks. The underlying idea is that people in acute distress are often caught in 'rigid, constricted ways of understanding and communicating about the problems that absorb them' (Seikkula and Trimble, 2005: 462) and are stuck in the 'monological' treatment system that is unable to allow new ideas to emerge. Adopting Bakhtin's dialogism, new meaning develops in the inter-personal space requiring that clinicians abandon diagnostic prowess, learn how not to be interpretive and analytical, and instead, through attention to their own emotional selves, become a responding presence in-the-moment facilitating the meaning-making of client networks (using mindfulness techniques to this end). This paper reflects on the process of setting up an ethnographic study of POD (running alongside the first randomised controlled trial of the approach), the preparatory year-long practice-based training and membership of a community mental health POD team (serving a socially diverse London locality). It explores the possibility of an Open-Dialogue-inspired alternative ethnographic stance that shifts the location of analysis and description, and takes the capacity for meaning-making and reflective self-understanding (individual and institutional) rather than analytical-descriptive outputs as anthropological ends. It asks whether encouraging distributed interpretive processes might create openings out of a certain academic institutional 'stuckness'.