Selected Experience as an Open Dialogue Training Director, Trainer and Supervisor

Selected Experience as an Open Dialogue Training Director, Trainer and Supervisor


privilege an honor to be here and I want
to thank Gina and Jaakko for making it possible and I also, like Doug, want to
acknowledge that I wouldn’t be standing up here without Jaakko, Chris Gordon, Gina
and Doug. I also want to say I have a bad head cold and in defiance of Open
Dialogue, I’ve taken as much medication as I can to suppress my symptoms so that
I don’t impose them on you and I don’t know whether this talk is going to be
inspired by the meds or whether I’m going to have a brain freeze, so whatever
happens, please be kind. Okay, so so I’m first and foremost a therapist, second a
trainer, and third a researcher. I’m going to talk today about my experience as an
Open Dialogue training director, trainer and supervisor. So I direct a three-year
training program in New York City under the umbrella of the Institute for
Dialogic Practice. I supervise a team in Ireland online at the West Cork Mental
Health Service. I’m a trainer in the pod peer supported Open Dialogue initiative
in the National Health Service. I’m a trainer at Emory University/Grady
Hospital which was a project that we started at UMass Medical School with
Doug. As he described, I was a trainer in the Open Dialogue UK program, both a
supervisor and a trainer, so I have international experience doing training.
I also added here that I directed a clinical externship in systemic Family
Therapy in the 90s and the reason that I bring that up is because systemic family
therapy was developed in Milan in Italy and Open Dialogue
is a product of the systemic family therapy tradition, so I say that because
I’m here in Rome and because there is there are antecedents to Open Dialogue
in Milan in Italy. Now like siblings or family members, I’m not sure the Open
Dialogue world and the Milan systemic family therapy world necessarily get
along so well anymore, but they are related. So I came into discovering Open
Dialogue in 2001 after many many years immersed in systemic family therapy at
one of the few places in the United States where this way of working was
practiced and that was Berkshire Medical Center and the head of that was a person
named Carlos Lisky who turned Berkshire Medical Center into an international
learning destination for systemic practitioners. So every two years he
would invite luminaries like Tom Anderson or the Milan men Gianfranco
Chicane, Luigi Boscola to train his staff and to give workshops. It was during
those years that I met Tom Anderson. I learned the reflecting process from Tom
Anderson. He was the person who supported me and advocated for me to get a – hello,
oh you wanted to stay there, okay – he was the person who supported and advocated
for me to go to Finland and study directly with Jaakko and learn Open
Dialogue. That was in 2001 and that started a collaboration that lasted for
many years where Jaakko was coming to the United States on a biannual basis. It was
a research and clinical collaboration and it culminated in the establishment of
the Institute for Dialogic Practice in 2011.
Now I say I wouldn’t be here without Chris Gordon because it was Chris Gordon
and the Foundation that provided the necessary support to launch our training
program. So here is our graduating class, and you can see Chris’s smiling face and
many of these people are clinicians from Advocates. At the same time, I was doing,
involved in a research project with Doug Ziedonis. I’m not going to go into
that, only to say that at the same time that I was developing research, we were
also developing fidelity criteria and I didn’t expect this, but the effect of
developing the key elements and writing the paper on the fidelity criteria is
that it immediately improved training. So this is to say that my approach as a
training director and as a trainer is that fidelity and training are interwoven, so my our idea is not simply “you train people and then you do research.”
Actually, in the US the development of training and the development of research
were hand in glove. We’ve since evolved our program and now we have, we’ve moved
it to New York City. We’ve added Russell, who’s going to come in and talk
with us about mindfulness and peer support. Of course we have Jaakko. Peter Rober who does beautiful work with with children and has a client feedback
scale that’s very helpful. Jorma Nazlim Hagmann is my main
collaborator and then Mia Kurta who’s a nurse who currently works at Keropudas Hospital. Now I think an answer to this question about training, I think
it’s maybe a contribution to describe how we’ve attempted to solve
this problem in the US. So I couldn’t agree more with Jaakko that the
three-year training is the best possible preparation for people to do excellent
clinical work in network based practice. That said, many agencies in the United
States say, “what are you talking about? That’s a luxury we cannot afford.” So this
multi-level training program has evolved in sort of a collaboration between the
standards we hold dear and the realities of the clinical mental
health world in the United States. We also have very very high turnover, for
example. We have high levels of burnout. Many times, agencies don’t want to invest
in three years because, unlike Keropudas Hospital, the
practitioners are not married to each other, you know, they’re not practicing
years and years and years together. So what we have done to address this is we
have a three year program, and to borrow Doug’s term, those are the champions.
Those are the people who are going to go back and be the supervisors and the
trainers in their settings. We also offer a five-day introductory intensive which
gives a broad orientation to an agency – what is this all about.
We also, because of the nature of funding and the structure of mental health in
the United States, we offer one, two and three-year – the one to three years as
discreet. In other words, people can do one year, they can leave. They can come
back and join the program when the next training cycle happens, so we’ve adapted
to the practical realities of the system in the U.S. We also offer consultation
and supervision. I think the biggest shift that I’ve made in my own evolution
as a trainer is an emphasis on ongoing supervision. What we have done in our
three-year program is shift the number of hours to supervision and then we’ve
added monthly supervision. Now I think the idea of peers, you know, peer
supervision, people supporting each other in their settings, is a beautiful
wonderful idea, and I also think that there is a place for supervision by
people not necessarily who are smarter or better or more creative, but who have
been doing this for years and years and years and it’s this emphasis on
supervision, on what happens moment by moment, looking at transcripts. I think
that’s the single biggest shift we’ve made that has improved. I think the
clinical effectiveness of our trainees – we have trained 60 people to this
advanced level, hundreds more in shorter trainings. We have international students –
I think Nick was our first international student from the UK – also from Canada,
Latin America. We trained professionals and peers together. We don’t adapt for
the peers, but we honor how peers want a position or want to
position themselves in this Open Dialogue movement. So, for instance, at one
agency, (can I mention Keith?) Okay, so Keith’s got a absolutely
brilliant visionary peer leader in our two-year, initial two years with
Advocates, was very supportive I think of the practice but said, “I don’t
really see peers as having a place in this, in the network meetings.” Is that
what he said? No? He was very happy to have peers involved in Open Dialogue meetings, but he wanted them to be positioned as members of the network… Okay, thanks. And the
other thing that’s very important in our training is that you have to have a
clinical practice. You have to be involved in seeing families. This is a
very dense, busy slide describing the content. Again, I think when I was
thinking about this talk, okay, three minutes. I just want to emphasize, what do
I talk about the most? I mean, we talk we introduce, we talk about trauma, we
talk about violence, we talk about the unspeakable dilemmas of social
identity, we talk about Open Dialogue as a social justice and human rights
movement, but what I find myself coming back to over and over again is to
talking with, going over the details of clinical practice. In other words, you
have the fidelity steps and skills but how do you teach people how to dance? So
it’s not enough just to have the fidelity. There’s something else and
that’s where I think over and over till I’m blue in the face, I talk about
creating a frame. Holding an embodied presence, managing and monitoring intensity, tolerating uncertainty, asking relational questions,
inviting relational descriptions, hesitations, creating a common language,
holding your ideas lightly and witness thinking. That, I think, is really the core
of our training. I was, I’m gonna go forward here. I was asked by
the steering committee to come up with ideal characteristics for the Open
Dialogue research sites. I think it’s absolutely brilliant that you’ve made
having an organizational culture in place a criteria for mature teams to
participate. Doug Ziedonis and I, when we went to Emory, I
the fact that he went in as an organizational consultant and worked
with the highest levels of administration there, it made all the
difference. So I couldn’t agree with you more.
That said, I really thought about Advocates when I made this list because
I think, “what did Advocates have?”, and they have sustained this against great odds.
First of all, they’re energetic, open and they were well respected in the
community. They did the training and they sought out other forms of training. They
were committed to training – they showed a high standard of clinical competence
from the beginning and they produced examples, like the example, I mean, when
you go and work with a mature team there should be some number of examples that
meet the criteria of the story that Chris told. That you had someone who was
in a first-time psychosis, that they came out of the psychosis, that they’re off
medication, that they’re back in school. I’ll go through these really quickly –
continuous learning and self-improvement. So we’re not just self congratulatory –
“we’re Open Dialogue clinicians, we never have to think again” – we are always trying
to think how do we improve ourselves. This is the need adaptiveness of Open
Dialogue. How do we do the best for our clients? How do we help them? How do we do
the best for them? I think supervision. I think evidence of
creativity – how are you going to respond to be consistent with your setting? You
need a healthy emotional atmosphere on the team. You need a recovery orientation
and you need administrative support. Okay.


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