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Journal of Marital and Family Therapy

July 2002,V0l. 28, NO.3,283-284

MONOLOGUE IS THE CRISIS-DIALOGUE BECOMES THE


AIM OF THERAPY

Jaakko Seikkula
University of Jyvaskyla and University of Tmmso

The best dialogue is the one in which you feel that you have learned. Having this opportunity to
dialogue with my two highly appreciated colleagues, Harlene Anderson and David Trimble, has taught me
more about what I wrote.
What seems to be most interesting to me is that both point to monologue as the core nature of crisis
itself. In Trimbles (this issue) comments he sees monologue as a search for security for the family in crisis.
He said: They are understandably fearful of the inherent confusion and . . . seek safety in the order and
certainty of monologic constructions of themselves (p. 276). The family-but the patient sometimes as
well-is searching for monological answers to their suffering. What to do? What is wrong with our son?
are questions that represent legitimate needs of our clients. But these questions can be answered in many
ways. One opportunity is to give monological answers and, by doing so, increase the risk of interrupting the
process which begins to create new meanings for the family. By giving such monological answers as, We
are going to hospitalize your son, and medication is needed because it is a question of schizophrenia,
therapists can think of themselves as easing the crisis, but what they are doing is making the clients more
dependent on the treatment system, because the system has the knowledge that the family does not.
The dialogical approach aims at a different process-a process in which the potential resources of the
patient and those nearest h i d e r start to play a more important role in determining how to proceed. As
Anderson (this issue) points out, referring to Harry Goolishian, the monological language of the psychotic
patient forms a trap. Patients sayings are often responded to with silence or neglect, which increases the risk
of isolation and difficulties arising from not understanding what the patient is trying to say. The aim of
treatment should be to break the isolation of the patient in any way possible. One possibility-the most
familiar to me and my colleagues in Western Lapland in Finland-is to focus on the dialogue itself How to
create a language in which all voices can be heard, both the patients and those nearest the patient, at the
same time. In the two excerpts of dialogue in the first treatment meetings (Seikkula, this issue), one
succeeded in answering the patients utterance, but the other one did not. This is not to say that it is only the
team who has the power to become the agent in the dialogue; it is always applied in the presence of the
family. But what these excerpts are saying is that perhaps the (only) thing we should focus on in the very
first meetings in a (psychotic) crisis is orienting ourselves to create dialogical exchange of utterances: How
to listen, how to hear, and, what is most important, how to answer each utterance of our clients. Answering
comes first. After answering what the clients said, we have the possibility of learning if we heard and
understood correctly.
This is what Harlene Anderson together with Harry Goolishian have taught family therapists. Listening
attentively aims at hearing what our clients are saying. Hearing is witnessed in our answering words. We do
not plan in advance our next question, or even the interview as a whole, but, instead, the next question is
created in the answer of the clients. In this way, everyone, even the patient with hisher psychotic ideas, can
experience how to become an agent in the new story of their suffering.

Jaakko Seikkula, Department of Psychology, University of Jyvaskyla, Finland and Institute of Community Medicine University
of Tromso, Norway.
Correspondence concerning this article should be addressed to Jaakko Seikkula, Department of Psychology, University of
Jyvaskyl$ Box 35, FIN-4035 I Jyvaskyla. E-mail: sei!&kd@psyka.jyu.fi

July 2002 JOURNAL OF MARITALAND F M I L Y THERAPY 283

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In this, I see two most essential presuppositions. These could be seen as ideas for working with the
dilemma highlighted by Anderson (this issue). In most severe crises-not only psychotic crises-always
work as a team. The optimal number of team members is three. If only two are present, they can be trapped
in the monological need of the family, but if the third is present, one member is always present who is
listening, who is engaged in the inner dialogue and in that way forms a different perspective on the problem.
The second prerequisite is in every case to include those nearest the patient (social network, e.g., family,
friends, others who know and care about the patient) in the first meeting to guarantee the beginning of a
construction of joint language. When the patient is speaking about not understandable experiences, those
people to whose lives he/she is refemng are present in this multivocal reality. See more about this in two
recent papers (Seikkula,Alakare, & Aaltonen, 2001u, b).
Many phases have occurred in developing the Open Dialogue approach. One of the first phases was
interest in the early foundations of network therapy. This was helpful in seeing the importance of the
contemporary social context of the patient, instead of searching for reasons in the individual or the familys
past. What we learned, as well, was the focus on accepting strong emotions in the meeting. That is
something that has remained in treatment meetings. Although no longer aiming at depression phase, (See
Trimble, this issue, p 275.) the dialogue usually becomes very emotional. Most often this means, however,
not expressing dramatic emotions in the meeting, but to let, for instance, the sadness land in between us.
When I started my career as a systemic family therapist this was, in the beginning, rather confusing. At that
time, I thought the idea of neutrality meant also having a guideline of being neutral without strong
emotional involvement in the issue that was being discussed. Now I realize that in the practice of open
dialogue in treatment meetings many times the themes of dialogue move you as a therapist as well. What I
have come to understand is, as Trimble (this issue) also says, the embodied emotional quality of dialogue.
That is one reason why it really can become a powerful intervention in itself. Dialogue becomes, both the
prerequisite as well as the forum for handling our experiences. It can be generated in many ways, for
example, in a series of treatment meetings, in individual work with art therapy, or in individual
psychotherapy. In serious crisis, a lot of work is needed, but, at the same time, the task becomes simpler.
Dialogue is the new relation. Not so much else is needed.

REFERENCES

Seikkula, J., Alakare, B., & Aaltonen, J. (2001~).Open dialogue in psychosis I: An introduction and case illustration. Journal
of Constructivist Psychology, 14, 247-265.
Seikkula, J., Alakare, B. & Aaltonen, J. (2001b). Open dialogue in psychosis 11: A comparison of good and poor outcome cases.
Journal of Constructivist Psychology, 14, 261-284.

284 JOURNAL OF MARITAL AND FAMILY THERAPY July 2002

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