The open dialogue approach to acute psychosis: its poetics and micropolitics

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Acute Disease; Finland; Humans; *Language; Mental Health Services; *Patient Care Team; Psychotherapy; Psychotic Disorders


Mental and Social Health | Psychiatric and Mental Health | Psychiatry and Psychology


In Finland, a network-based, language approach to psychiatric care has emerged, called "Open Dialogue." It draws on Bakhtin's dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: "tolerance of uncertainty," "dialogism," and "polyphony in social networks." A treatment meeting shows how these poetics operate to generate a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment. Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment-as-usual settings. In a nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild, psychotic symptoms remaining; and only 23% were on disability allowance.


Fam Process. 2003 Fall;42(3):403-18.

Journal/Book/Conference Title

Family process


At the time of publication, Mary Olson was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed