HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • Vicky GotsiPsychologist - Systemic Psychotherapist
  • Androula EliaPsychologist – Psychotherapist, Hellenic Centre for Mental Health and Research
  • Athina PistikouPsychologist – Systemic psychotherapist
  • Eleana KoumpiPsychologist – Systemic psychotherapist
  • Ioulia BalaskaPolitical scientist – Social Psychology (D.E.A.) – Systemic psychotherapist
  • Kia ThanopoulouMsc, ECP, Systemic Psychotherapist, Trainer and Supervisor, Family Therapy Unit, Psychiatric Hospital of Attica
  • openness
  • therapists
  • inspiration
  • reflections
  • dialogic practices

Translation: Vicky Gotsi, Eleana Koumpi, Athena Psilia


Therapists from different professional contexts have been meeting the last 2 ½ years, every 1 ½ month for 4 hours. The initial motive was the principles of Open Dialogue of J. Seikkula and the quest has been, and still remains, the incorporation of dialogic practices in the therapeutic process, the relationship between professionals and, in turn, between different professional contexts. Gradually, the group meetings have been expanding to include and interact with professionals from different professions. In the meetings, the notions of openness and difference are in constant questioning and negotiation, and create that secure place where inspiration, hope and humaneness may emerge.

Key Words: dialogic practices, reflections, openness, therapists, inspiration

The idea for the dialogues emerged from the regular meetings (2012-2014) of four colleagues who formed a group in order to study, understand and explore the possibilities of implementing the Open Dialogue Approach in psychotherapy.

The Open Dialogue Approach refers to the method of the Finnish psychologist Jaako Seikkula who, during the ‘80s, conceptualized a new way of dealing with psychotic episodes. He proposed that whenever a person was in crisis, a network of people should form and come together in-dialogue in order to help that person and decide on all necessary actions for his/her health: a network comprising of the patient’s family members, people from his/her support system and all professionals involved in the care of the patient.

The conversations of the original group of four gradually moved away from the Open Dialogue Approach and focused more on the value of dialogue and polyphony in the understanding and assignment of meaning to everyday life. However, they remained connected to two of its principles: The Tolerance of Uncertainty and Dialogism (Seikkula et al, 2006). They considered these principles valuable to psychotherapists and beneficial to our work with people. These principles are part of a way of thinking, a stance on human relations, a vision for the future of relationships. Embodied in this vision are the trust in people and the potential they have, the power of sharing and collectivity, and the value of polyphony in relationships and communication. Furthermore, these principles guide us to question the authoritarian elements in the therapeutic relationship, to strive for equality and try to be authentic instead of being an authority.

Following the above rationale, in January 2014 the group of four decided to open up the dialogue to an extended group of psychotherapists who would be interested in that way of thinking and acting. They invited 25 colleagues, proposing the co-creation of a network of therapists who, regardless of their theoretical background and specialization, would be able to communicate and cooperate on an equal basis, guided by the principles of professional solidarity and respect to individual differences. Dialogue held in such a context would lead to increased tolerance of uncertainty, through the cultivation of a sense of mutuality and collectivity, where everyone would be prepared to move to a new position by listening to the other. This new network was called  "Dialogues for Psychotherapy" .

During the first phase of the group, which lasted until June 2014, there were three meetings, one every month and a half. During those meetings, one or two colleagues shared with the group a few ideas on a subject and then we elaborated on them in smaller groups. In the end, we came back to the plenary to discuss the process, as well as the new ideas that came out of the groups and how they could be applied to our work. Furthermore, we reflected upon the whole meeting and decided on the next topic. The total duration of each meeting was 4 hours. The frequency, the duration and the structure are elements that have remained unchanged through all phases of our group.

Our meetings started again in September and lasted until June 2015. There were a few drop-outs and some new members joining in. During that second phase, the need arose for members to get to know one another better, to feel a greater sense of security. In order to do that, we decided that the ideas for elaboration in our meetings would come out of the work practice of our colleagues who wanted to share it with the group.

As our meetings progressed and grew, the questions regarding our process multiplied and became more complex; questions such as ‘Which principles were important to us in order to cultivate a sense of security and trust?’, and ‘How should responsibility be distributed so that the flow and the continuation of the group will be ensured?’ During that phase there was a growing need to share the responsibility of organizing the meetings, which was originally undertaken by the group of four. Furthermore, we allowed for more time in the plenary session, in order to be able to reflect on the process, the proceedings of the group and the ways of decision making.

As was expected, we were faced with a multitude of difficulties that stemmed out of our differences. Different people means different views, different experiences, different timing and ways of working, even different vocabularies. The questions we dealt with were: How can we ensure a sense of acceptance of our differences so that all views can be included? How do we deal with conflicts and difficult feelings? How much of what we think or feel do we disclose in the dialogue? How openly do we listen to others without being restricted by what we already know or believe? How can we keep a flow in the process where we can be open and present to what transpires in the group? How do we retain our individuality while allowing the other to exist? How can our differences become a source of strength and transformation?

It is widely accepted that "the other" is crucial to our evolution. As philosopher Emmanuel Levinas points out, it is precisely the differences between people that make dialogue necessary and possible, "the Other is always more than one can perceive" (1961). The "other" excites us, awakens in us the need for new stimuli and perceptions, enriches the meanings and enhances relationships. According to Steiner (1989), the alterity that enters us makes us different. At the same time, the "other" is not always welcome and may cause fear. It represents something foreign and its appearance may cause confusion, tension and a sense of threat. As Arnkil and Seikkula point out (2015), "when worries arise, wishes to have better control of situations arise too, and this is where one might divert from dialogism and attempt to control how others think and act" (p.143). That’s when relationships are put to the test, as is our ability to negotiate our differences and to withstand the uncertainty that is produced.

As shown from the course of the group thus far, it seems that there was room for differences to be expressed. What we tried (and are still trying) to do was to open up the space, in each meeting, for all voices to be heard: voices of joy, of security, of contradiction, of doubt, of confusion. These are the voices that keep us in dialogue. As more voices get included in the polyphony of the dialogue, more and richer meanings emerge. Dialogism presupposes polyphony, pursues it, is based on alterity and through it determines the substance of each member (Bakhtin, 1984). This was not always easy. Often there were silences, and their content remained obscure. Nor can anyone say with certainty that all feelings or thoughts were expressed in the group. The dialogue, however, did not stop.

As Anderson (2003) says, "dialogue operates along a continuum: Sometimes we are less in a dialogical process and sometimes we are more so. The overall relationship and conversation is what counts and makes a difference. The encouragement and possibility for transformationand newness are inherent in these kinds of relationships and conversations" (p. 7). She continues, paraphrasing Wittgenstein, by saying that "dialogue allows each of us to find ways to go on from here. So, perhaps this is what is helpful in dialogue: We find ways to go on. Or, at least we have a sense or a hope that it is possible and that we will be able to go on" (p. 7).

The end of this second phase revealed the existence of a common culture in our group that was based on trust, mutual respect, tolerance, endurance, commitment, companionship, humor and friendliness. At the same time, we were faced with the question "And now what?" What was the vision of our group? What were its principles and values? We reflected on the key words that had emerged from our work so far: "identity", "in-and-out", "responsibility", space-in-between", "introversion", "birth", "alternation", "freedom", "variety", "openness", "phases of the group", "restfulness", "sharing", "understanding", "common language". Finally, we wondered how to ensure that the space would be kept open so that the individual needs, the sharing, the increased autonomy and the variety would best be served.

Therefore, thinking about what could be the most helpful way to work on these topics, we ended up compounding two well-known methods of work in large groups: the  _open space technology _ and the  _world café. _ We chose these specific ways of working because, initially, their structure includes equality and openness, they help the dream and the vision emerge, whilst at the same time they help the groups concentrate on the goal and reach conclusions. The responsibility for the work that is being done is divided to all participants, and everyone is involved in a creative process that enables cooperative dialogue and sharing of knowledge and ideas, so that a live network of dialogue and action can arise.

In a meeting where we worked as described above on the future of our group, we moved on to the 3rd phase which introduced the following changes: Firstly, regarding the procedures, the group moved to a stage where every member would bear the responsibility for equal collaboration. That meant that there would no longer be a leader in the group and everyone would participate equally, or in rotation, working on issues relative to the process or issues relating to the preparation and organization of the meetings. At the beginning, this shift was difficult for us, as our education has been instructional for so many years. At that instant, the dialogue was actually jumping into action, it was in our hands, as all needs were being heard respecting individual differences.

Regarding the way of working, we were led to the idea of three workshops functioning simultaneously at every meeting, each having a different content. Specifically, a Workshop for Collaborative Research on Dialogue was created. In this context, one could always find an annotated bibliography on Open Dialogue and dialogic practices, as well as a computer with internet access to enable members of the group that chose to participate to study and investigate a topic of common interest. Furthermore, a Workshop for Clinical Applications of Dialogue emerged. This second workshop would give the participating members the opportunity to discuss freely issues regarding their practice, concerns or even ways in which they had imagined working and would like to share with the group. Finally, the third workshop was born out of a need for creative freedom and even maybe reflection on the team – being a small group that would reflect on what was happening in the larger group and would freely create something with that stimulus. It was named Workshop for Reflecting through Art (playroom). The workshop members wouldn’t be permanent, thus enabling everyone to decide in which workshop they wanted to join each time.

We also decided to maintain two additional roles that we borrowed from the aforementioned ways of work, the "bee" and the "butterfly". That is if we felt, during the meetings, that we were not productive or that we were losing our interest for what was going on in our space, we could move, like bees, into another workshop. Or even if we felt the need to rest in a non-active space, we could wander around, like butterflies, outside the groups.

We maintained the old structure: plenary – small groups – plenary. Finally, we agreed on making provision for having time at the end of every plenum for propositions that might occur or decisions that needed to be made regarding the topic of the next meeting or the group’s procedures. We also decided that any changes would have to be almost unanimous. As long as there was dispute, no changes were made.

The space that was created in order to hold all the different needs was apparently adequate as there was joy, rest, creativity. The dialogue flowed effortlessly in the small groups as well as in the plenary. There was a shift from a hierarchically structured dialogue to a dialogue among peer discussants, and the responsibility of organizing the meetings was shared with all the members.

Probably the most interesting thing in this way of work, but sometimes difficult or even awkward, was (and still is) that there is no other objective than making room for the dialogue itself. Of course, it was an open forum available for discussion on topics regarding our practice, but in a totally new way. It was neither supervision in technical terms nor analysis in the context of a specific psychotherapeutic approach. After all, there are people participating in this group coming from different approaches and starting points. Therefore, we could say that the group of the Dialogues for Psychotherapy was and still is a condition offering the luxury of dialogue  _for _ the dialogue, with no other goal. “Any subject can be included and no content is excluded. Such an activity is very rare in our culture” (Bohm, Factor & Garett, 1991). It’s a process in which, rather than concentrating on the subject itself, we allow our thinking to slow down so that we can observe it as it occurs. Where there is no specific goal, there is no pressure, there are no expectations and openness is at work. The members free themselves from some established professional positions that can sometimes be hierarchical or narcissistic, and they reposition themselves, they revise and reflect and finally they bring all that openness back to their own practice.

Dialogue is a relational and collaborative activity, a mutual act, that gives us the opportunity to meet (one’s meaning meets the meaning of the other) but also to transform; in this and through this dialogical search, the meanings and understandings are continually interpreted, reinterpreted, clarified and revised, and thus possibilities are generated for thought, feeling, emotion, action, questioning and so forth (Anderson, 2003). According to M. Bakhtin, (1986), the dialogue always remains open and new meanings are co-created. They develop in the interpersonal space between the discussants and are generated and transformed from response to response. It’s a process that can be interrupted but can never be concluded. Sharing the experience forms a feeling of “togetherness” that sends away the feelings of despair and helplessness (Seikkula J. & Arnkil T., 2006). Isaac W. (1999) describes dialogue as “the art of thinking together”. As everyone’s uniqueness is welcomed with genuine interest and we feel that we are heard as human, unique individuals, the group is experienced as a safe place where openness and dissimilarity are in constant negotiation thus allowing inspiration, hope and humaneness to emerge.

In our search of bibliography relevant to dialogue and its applications in practice, we came across the work of David Bohm, a theoretical physicist interested in quantum physics, neuropsychology and the philosophy of mind. Having worked with dialogue groups, Bohm describes his experience of the process as follows: “It can therefore be seen as an arena in which collective learning takes place and out of which a sense of increased harmony, fellowship and creativity can arise. Because the nature of Dialogue is exploratory, its meaning and its methods continue to unfold. No firm rules can be laid down for conducting a Dialogue because its essence is learning - not as the result of consuming a body of information or doctrine imparted by an authority nor as a means of examining or criticizing a particular theory or programme, but rather as part of an unfolding process of creative participation between peers.” (Bohm, Factor and Garrett, 1991, p.1).

Following a natural flow and growing aware that other people might work in similar ways, our group felt the need to open a dialogue with other fields, too. It felt like a natural next step. Nevertheless, a step to openness is not always an easy one. It took some time to make things happen; the amount of time needed by each one of us to move on our own pace. Along with our desire to openness and our need of sharing there were also reluctance and silence.

Once one feels safe with themselves and their surroundings, one is more open to new stimuli, new knowledge and new relationships. Our group had been through the necessary phases to gain a sense of security and trust, to reach parity and, last but not least, to experience in practice the basic principles of dialogue: respect for the others’ diversity and uniqueness, in other words dialogismand polyphony. It was a step consistent also with the original concept of our group’s formation that held a vision for the future of relationships. Having always kept in touch with everyday realities, our group has always had social concerns; in fact, that was one of its characteristics from the outset.

Our thought led us to people from the field of Arts, art being itself dialogue, sharing, vision, free expression; it can be solitary and collective at the same time. Furthermore, therapy and art have much in common. Both art and therapy create a space wherein develops an ever-evolving dialogue; wherein, through their relationship, both parties evolve: the therapists and the clients, the artists and the public; wherein what happens changes what  is.  Therapy and art are in constant contact with society, always with a look to the future. We chose whom to invite by the same criteria that had generated our group: they would be people who shared the same principles and would work in ways founded in dialogue.

Our first contact with a professional from the Arts was realized in March 2016 and we considered it an extraordinary experience. Our meeting was one of exchange and sharing, and involved both information and feelings; some were familiar and close to our experience, others were entirely new, all of them stimulating our minds and souls and opening new paths.

We will conclude this account on our group work with a description of the current phase we find ourselves in; we are living such a vivid emotional experience in our dialogue that we tend to agree with D. Patterson (1988) when he refers to dialogue as ‘not just as a method of conversation, but also as an act of  love. ’ The space and time dedicated by our group to dialogue in order to find meaning, to research, to be creative, to interact with one’s self and with the others in a context of safety and strong emotional bonding, help us become more humane as we enter the therapy room. The freedom to be ourselves as experienced in the group is transferred to therapy.

If our humaneness were to be defined as the art of walking alongside with one another with an awareness of their needs, then one might also say that dialogue encourages us to humanize our practice and allows us to make the best of our human essence so as to connect with our clients, in order to help them with their difficulties, responding with genuine respect and sensitivity to their uniqueness and their diversity.

The experience of dialogue in our group connects us directly to our hunter-gatherer ancestors who, also in bands of 20-40, met with no apparent agenda nor any predetermined purpose to talk together; Nevertheless, such gatherings seemed to provide and reinforce a kind of cohesive bond or fellowship that, by the end of the meeting, allowed its participants to know what was required of them without the need for instruction or much further verbal exchange. The experience of a coherent culture of shared meaning emerged and still emerges in groups both then and now. (Bohm, Factor and Garrett, 1991).

A story emerged in the playroom of our group that reflects and depicts this phase of experience that we all share:

A fairytale: ”Life goes on as usual in the Indian village named Centrisystemitherapoc. Everyone wakes up at dawn and gathers around the oak tree at the centre of the village. Each one brings any food supplies they have and shares them with everyone else. Young, old and elders sit in a circle and begin to recite their dreams in the daylight. Some have dreams full of concern for everyday life’s worries. Others bear dreams of concern for their relationships with their relatives and fellow villagers. The elders’ dreams bring images from myths and stories from the land of their ancestors. For those with unsettling dreams, talking under the oak tree is soothing. Everyone can talk freely, laugh and ask whatever they want to learn, have different opinions or disagree. Even the small child who needs to speak her first words is heard. Then, everyone goes after their pursuits. The spirit of the morning gathering follows them, supports them, inspires them, and gives them answers. Everyday there is a cause for celebration in the village. They celebrate sunshine or fair weather; they celebrate bad weather, cloudy sky and hail because all elements are in-dialogue, but have their own individual merit, too. Every day the villagers of Centrisystemitherapoc visit other villages and work there. They transmit their own way of doing things and they take up anything new that other places have to give. Sometimes, in the midst of exchange they have a hard time. When so, they gather around the oak tree, then tensions break out and hard feelings flare up. But the circle makes room for everything, and everything is heard. So, after a while, the tension abates. And then, they all smoke the pipe of peace and chill out.  (laughter)  Because there was something gained; they have now a clearer picture of what is valuable to them and what is not. At the end of the day, they all get together in a circle, sitting by the fire under the starry sky. Laughing and singing they rejoice togetherness and celebrate the day they lived through and look forward for the day to come, enjoying the riches within and around them. All eyes turn to the sky and dream”.

PS. If anyone would like to share their thoughts with us, please send us an email to the following address: dialoguesforpsychotherapy@gmail.com

*The present paper concerns the whole group of Dialogues, comprised of a larger number of colleagues, women and men –mostly women- whose voices are included in this work in a way.


**Anderson, H. ** (2003).  _Some Notes on Listening, Hearing and Speaking and the Relationship to Dialogue. _ Paper presented at the Eighth Annual Open Dialogue Conference: What is Helpful in Treatment Dialogue? Tornio, Finland

**Arnkil T., E. and Seikkula, J. ** (2015). Developing Dialogocoty in Relational Practices: Reflecting on Experiences from Open Dialogues.  _Australian and New Zealand Journal of Family Therapy, 36: _ 142-154

**Bakhtin, M. ** (1984).  _Problems of Dostojevskij' s Poetics. Theory and History of Literature, Vol. 8. _ Manchester University Press.

**Bakhtin, M. ** (1986).  _Speech Centres and Other Late Essays. _ Austin, TX:University of Texas Press

**Bohm, D. ** (1996)  On Dialogue,  Ν.Υ.: Routledge

Bohm, D., Factor D., and Garrett P. (1991).  Dialogue: A proposalhttp://www.david-bohm.net/dialogue/dialogue_proposal.html#7.

**Isaacs, W. ** (1999).  _Dialogue and the Art of Thinking Together: A Pioneering Approach of Communication in Business and in Life. _ New York: Currency/Doubleday.

**Levinas, E. ** (1961).  Totality and Infinity: An Essay on Exteriority . Translated by Alphonso Lingis. Pittsburgh, PA: Duquesne University Press.

**Olson, O., Seikkula, J. & Ziedonis, D. ** (2014).  _The Key Elements of Dialogical Practice in Open Dialogue: Fidelity Criteria. _ The University of Massachusetts Medical School. Worsester, MA

**Owen Η. ** (1993).  Open Space Technology Users Guide,  http://elementaleducation.com/wp-content/uploads/temp/OpenSpaceTechnology--UsersGuide.pdf.

**Patterson, D. ** (1988).  _Essays on Bahtin and His Contermporaries. _ Lexington, KY: University Press of Kentucky.

**Seikkula, J. & Olson, M. ** (2003). The Open Dialogue Approach to Acute Psychosis. Its Poetics and Micropolitics _. _ Family   Process42 :403-418.

**Seikkula J. & Arnkil T. E. ** (2006).  _Dialogical meetings in Social Networks. London: _ Karnac.

**Seikkula J. et al ** (2006). Five year experience of first episode nonaffective psychosis in open dialogue approach: Treatment, principles, follow-up outcomes, and two case studies ,   Psychotherapy   Research , 16(2): 214-228

**Slocum Nikki ** (2005).  _Participatory Methods Toolkit. A practitioner’s manual Method: The World Café, _ King Baudouin Foundation and the Flemish Institute for Science and Technology Assessment, www.kbs-frb.be or www.viWTA.be.

**Steiner, G. ** (1989).  Real presences . Chicago: University of Chicago Press.


Support the online journal "Systemic Thinking & Psychotherapy" by making a donation today.Donate