Authority and Agency in Open Dialogue Network Meetings: A Conversation Analysis

Abstract

Open Dialogue is an approach to working with people and their social networks in times of mental health crisis. The approach centres around principles emphasising the responsiveness, responsibility, and flexibility of the treating team as well as the ability of the therapists to tolerate uncertainty by not rushing decisions on diagnoses or interventions (Seikkula & Arnkil, 2006). Open Dialogue places particular importance on the promotion of dialogue including an openness to hearing and understanding the experience of the client and network members, a commitment to collaborative understandings through the voices of all those present and following the lead of the network, and a willingness to be public with their own thoughts. Open Dialogue focusses on the moment-to-moment unfolding of a conversation and the therapists’ responsiveness to the changing demands of the interaction. This thesis uses Conversation Analysis, an approach that focusses on describing the conversational practices and normative expectations that are present in conversations, and how these practices achieve social actions. The study data comes from 14 hours of video recorded therapy sessions by Open Dialogue therapists (n=12) and their clients and social network (n=36) in a child and youth mental health service. This thesis is organised around chapters analysing how therapists construct proposals to transition to a reflecting conversation, how therapists elicit stance positions and introduce new areas of discussion with multiple participants, the functions of therapists repeating the prior talk of the family, and how therapists construct a reflecting conversation. Throughout these studies therapists oriented to issues of deontic authority, or the ability to determine the future actions of others, and epistemic authority, or who has primary rights to knowledge. Therapists assume deontic authority in nominating topics for further development and selecting next speakers, while also deferring to the epistemic authority of the recipients, and promote particular forms of agency by fostering flexibility in responses. These studies demonstrate some of the ways that therapists manifest dialogical principles in practice and provide a more detailed understanding of the work that is done by Open Dialogue therapists.