Open POD pod

2.1 Always include the person

• Amanda Bueno, Gareth Jarvis, Fiona Eastmond • Season 2 • Episode 1

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In this first episode of Season 2 of Open POD pod, we continue to create dialogue about dialogue. We talk about the origins of Open Dialogue, what it actually IS. We reflect about how Season 1 was made and our feelings about Billy Hardy our good friend who passed away in January of this year. There has been something of a break in publishing but as you will see there has been no break in recording and we have some very exciting guests coming up in Season 2. 

Fiona:

Welcome to Open POD pod,

Amanda:

This is season two of our podcast, so I'm Amanda Bueno, and I'm the practice development lead at CNWL to embed open dialogue across our team. So that's the idea, to make sure that There is a joining up between the theory and the practice. That's my aim.

Fiona:

I'm Fiona Eastmond and I'm a deeply creative and very easily distracted person who loves helping people.

Gareth:

So hello everyone, I'm Gareth Jarvis, and a consultant psychiatrist by background. I'm the medical director of the adult mental health services at Central and Northwest London, and I've been interested in open dialogue since I trained in it just over seven years ago, and have been looking. To find ways to bring this to the NHS and broader practice wherever I can ever since.

Amanda 2:

We started these podcasts with Billy Hardy, because at the beginning, when I knew that Billy wasn't well, I wanted to capture his wisdom. It's really difficult because we had some beautiful conversations, the three of us, and Billy was so many things, I can't even believe I'm talking about him in the past because he died January of this year, he was so many things in his career, you know, trainer, examiner, committee member, I mean, you name it, family institute chair, panel member, tutor, cetera, et cetera, but he was so much more than that and he would always weave in to whatever he was doing, who he was as a person, you know, father, husband, musician, poet, author.

Fiona:

Grandfather.

Amanda 2:

Grandfather just before he died, yeah. All of the other parts of him, of course, made him whole. Billy and I started everything in the middle Cause what is a beginning and what is an end? And if you're a circular and a system thinker, you're in the middle. And I think in some ways we started these podcasts in the middle, as is true to Billy. And to recognize that the first section of them, we dived in and I want to leave them just like that. Because they're a tribute to Billy they're perfect as they are, so I would just hope that anybody listening would allow us now to spring back a little bit and just recognize that Billy did something, you know that poem, If I think I'm probably quoting it wrong, but if you can feel the unforgiving minute With 60 seconds worth of distance run, yours is the earth and everything that's in it, and what is more, you'll be a man, my son. And I always was wondering, what is 60? What is the unforgiving minute? And I think the unforgiving minute is the last minute of your life, the last 60 seconds of your life.

Fiona:

We're never truly gone until the ripples that we have made in our lives have faded away. And I think that will be quite a while for someone like Billy.

Amanda 2:

Hmm, well I think I'm very aware of that actually, I love the of ripples. It's something that Irvin Yalom talks a lot about, about death not really being a death because you're leaving ripples. And, of course, he caused a tsunami in me, and then I'm creating ripples and maybe lots more people will have dialogue based on some of Billy Hardy's ripples. I am sort of becoming progressively more aware that I'm probably not going to sit under the tree that I plant, but I sit under Billy's tree, and maybe others will sit under my tree. I think it's interesting that you mentioned ripples Fiona because, um, towards, The end of Billy's life. We got into this little to and fro of sending each other a haku I wrote, I am a ripple in your ocean of wisdom causing tsunami.

Fiona:

I love that.

Amanda 2:

The other haiku I wrote Billy was, we used to talk a lot about, in between the gaps, the beats, the ands, and I wrote him a Haku saying, and, and actually the truth is, is I started to send him Haku's because I didn't know what to say, you know, and I, I wanted him to know what I was feeling in the spaces. And it's interesting dialogically, how to find words at the end of a life or when words are so difficult. What do you, how do you capture the space and the love? And so Billy and I captured them with, with sending each other little poetry. Um, and I wrote to him, in between words and lying still in the spaces, feelings do their dance.

Fiona:

It's lovely.

Amanda 2:

And, uh, I miss him very much.

Fiona:

I hope we can do him proud in our second series.

Amanda 2:

It will feel differently to people listening because the flow will be different. And it's different to us too. And, maybe that's okay. I mean, we've got Yako Sikula coming up. That one was very different. And Harleen Anderson. We've got Gareth Jarvis speaking a lot. It's finding each person's got their own rhythm.

Fiona:

Part of dialogue is bringing in different voices.

Amanda 2:

Polyphony of voices.

Fiona:

Maybe this is the uh, polyphony that we've been looking for. Maybe sometimes polyphony feels uncomfortable to start with.

Amanda 2:

It's funny because we often say, I often say with circular questioning that, you know, you can bring somebody in that's dead. You know, if your mother, if your father, if whatever was here at the moment, what do you think they would say? I think it's a very lovely position to think about what would their voices say?

Fiona:

Yeah.

Amanda 2:

I wonder if Billy was here now, what he'd say to us sort of recording a little snippet about him. I can just see him, he would, he would be roaring with all his Scottishness.

Fiona:

I can just imagine him flicking through a book and saying, Oh, that reminds me of, of this bit.

Amanda 2:

Yeah, exactly, he'd come up with something that he's read or he's thought about or that's passed him in some way, wouldn't he?

Fiona:

Yeah,

Amanda:

these podcasts are really around us thinking about using them as A learning tool, using them as a sort of conversation about conversation, dialogue about dialogue so that after people who are training in open dialogue, which we're doing at the moment in the trust, they can listen to them. And then we can build a polyphony of voices. And of course, each one can be used in a multitude of ways.

Fiona:

I guess a really good podcast question, actually, would be, What is Open Dialogue?

Gareth:

It's an approach to mental health care that was developed in Tornio in, Finland, they had, a real crisis on their hands back in the early 1980s, that their mental health hospital, which was called Keropudas, Which actually means little river, it was really struggling to have, availability for people who were in mental health crisis because all their beds were full. And they couldn't, people were staying very long lengths of time, they couldn't move them on, they weren't getting well. They were giving them huge doses of psychotropic medications. And they just said, this isn't working for us, we need to do something different. And They got together and said, what's the best idea we can have for doing something differently? And, they had these two ideas they were going to follow. One was, don't do anything or talk about the person unless they're present. And the second was include the family.

Amanda:

I'm a systemic psychotherapist, so for me Open Dialogue, and I learned about Jaako Seikkula in my training, falls as part of one of the theories of systemic, um, psychotherapy. But I also think it falls to me under the kind of guise of good humanitarian care. And, and, and so even though it's got it's principles or it's layers, I mean to me, to have immediate response, well yes, if you're hurting, you don't want to wait ages. To have psychological continuity, well yes, you don't want to be speaking to loads of different people, you want to speak to one person. To have uncertainty, well yeah, I mean who has certainty about your own life, let alone about someone else's life, it's just immoral to feel certain about someone else's life. Actually, ludicrous. Really, you know, and, and so, you know, to keep responsibility and actually to have a social network is just part of systemic thinking, you know, I, we don't live in isolation, even people who live in isolation don't live in isolation, they live in a context. So, thinking about somebody as having something wrong inside them, their own body, as opposed to them having a totally rational understandable response to their environment. is something that feels very, comfortable and moral to me. So having a set of principles around it, that make it easier to, to, have a domino effect through to teams, to lots of people who aren't systemic psychotherapists, makes sense. And I would say the most beautiful part, And the part that's very similar to Systemics, like there were lots of parts are, but the part that I love is the reflection in the room. The fact that you don't talk about someone and that you have trans, I mean, nobody wants to be talked about. I remember that feeling of walking into the playground thinking, you know, like, oh my God, they're talking about me or into the common room. We can all feel it. and I think we do that a lot about our clients. So I think that talking in front of people creates a much more respectful conversation that you have to really think, like you said earlier on, you have to think about the language you're using. and when somebody can hear that they've been truly heard, that's when magic happens. It, it, it's like when you are feeding back that you've, I mean we all want that in our relationships to be truly heard and understood. so I think it's it feels to me moral and ethical and translatable and Doable. And when I have worked in crisis teams, one of the things that often was said to me, but nobody listened to me. And I'm thinking, they must have done. You've been with the team for years. Someone must have listened to you, but they didn't feel listened to. And that's different.

Gareth:

That, that, that feeling bit of it is, you know, you feel heard.

Amanda:

Yes.

Gareth:

There's a difference between feeling heard and being listened to.

Amanda:

Yes. Yes.

Gareth:

that's visceral. You actually feel it in your body,

Amanda:

Yes. Yes. And it's very difficult to translate that into a model, you know, or into something measurable because we're now moving into, how do you measure that you felt connect? It's like, it's one of, what is love to you? I mean, it's just so difficult. It's so difficult to make it tangible, but in the room, when you're working with a, in an open dialogical way, The whole room feels different. In fact, I had that today. So I've started to work with the home treatment team and we did a session with a lady last week and in the week she reported back to the team that she felt really different and she really liked the session but she's no idea why. And I thought, I love that. She felt, she felt the difference.

Gareth:

It's perhaps just sort of building on some of that. It's worth saying a few other things about it. There's, there's no Diagnostic exclusion to open dialogue is an approach where they use it up in Tornio, everyone gets it. It's, just the approach that everyone comes there so that they don't get hung up on diagnostic coding and trying to figure out which is the right team for this person. It's just everyone comes towards them and they all get this approach as the organizing, way of working. never work on their own, they always work in at least pairs, if not more, so that there always are teams when they go to work with someone. Because if you're going to work with a social network, it's complicated. there's no treatments that we could use within a treatment as usual system that are excluded from this approach. They're all available, they're all there on the menu, we take time within those network meetings to go at their own pace, allowing them their own time to get to the working out what's going to be right for this situation. And if any of those other things that are on the menu are worth trying, they're there and they can be used.

Amanda:

I think it's not just about them being on the menu. I think something struck me today, at work it's about the prioritizing of the relationship with the other things coming along. one of the, my team colleagues came up and was talking to me about, a person and she went through. The, the medication he's on, he's on this, and he's on this, and he's on this, and it was quite matter of fact, and he's blah, blah, blah, blah, blah, blah. I said, okay, thank you. So you've told me what drugs he's on, but what's he like? And she lit up, and she went, oh, he's really nice, actually, and the whole team really like him, and he's really good when he's at home, and he'll talk to us, and blah, blah, blah. And I said to her. And that's, what this is. That's about you switching. The priority of the conversation that you're sharing with your colleagues and That you go, we go to visit this client with the perspective of who you are, rather than what you're swallowing. Because that isn't who you are. What's happened? What's going on with you? You know, I think it's about how you weight it, so it's not to say all the other treatments that are available are not available. It's actually, can we prioritise the person and the relationship and the human?

Gareth:

yeah, and that's actually the theory being that if we prioritize that, there's a much better outcome for the person and those around them at the end of the day. That's actually, that's the, that's the, if there's something within it, it's the honoring of that relationship, the prioritizing of it, that, that is the sort of magic that sits in the middle of this approach that really. Draws out the best possible outcomes. I, from my perspective as a clinician, I find that new solutions are found that wouldn't have, I know, wouldn't have come onto the table otherwise. I find that people trust me more and they share more than they would normally have shared with me before. I come away feeling lighter. I can feel it in my body that it's been a more helpful session.

Amanda:

mm. And you've shared the responsibility with a colleague

Gareth:

Yes. well. not only with the colleague but with the network. Because actually they are co producers in the true sense. We constantly knock around this word in the NHS all the time. Co production. We're going to do co production. And we sort of do it in this slightly tokenistic way of, well, we invited a service user along to one of our management meetings, and when we told them the ideas we had already had. This is co production in every single clinical contact. This is, you are equal partners in this. We're going to build this, this, episode of care together. And we will find solutions together.

Amanda:

Me think, because I love a stupid analogy, me, and I was thinking about a meal. You know, when we're saying business as usual, we can do a treatment as usual. I was thinking the food can be the same, right? But the meal is enjoyed or experienced really differently when you're with people that you get along with, that you're having an interesting time with, where the relationship is taking precedence to the food. You can have great food served, but actually not enjoy it or even taste it because you're not having the conversation and relationship around it and who's around your table. So, even though it's a, sort of, one of my bonkers analogies, it just crossed my mind that how you have your meal is as important as the food that's cooked.

Gareth:

And maybe that gets the essence of, this thing that this, this term that I hear often sort of used in all these, a lot of these conversations. I've heard yourself and Fiona and Billy talk about at times the medical model. and I, I often sort of, sort of slightly sort of have a little flinch in my body when it comes up. I think, Oh, that's me. I'm part of the medical model. I'm a doctor.

Amanda:

know we're aiming it at you, Gareth, when we say it. glad it's landed. Well,

Gareth:

that, if we're trying to get to the essence of what, what do we mean by the medical model? Maybe it's that divorcing of emotion from the work to try and be utterly scientific and sterile. In the approach. Is that, is that perhaps the essence of what we're trying to

Amanda:

yes, I think we're challenging, we're challenging all sorts of things. We're challenging. We're challenging the absolute of what a diagnostic label may mean instead of the nuances of, and we're challenging the fact that what people call, you know, our symptoms are also understandable responses to what's going on. When is a symptom a symptom and when is it a response? I don't know the answers to all that, but I do think that there's nuance in there.

Gareth:

Yeah.

Amanda:

and of course, like you said earlier on, if you come with your psychiatrist lens and hat, how do you also self reflect on that nuance and

Gareth:

you see, as a psychiatrist, I know that I was trained to hold that nuance. So it says my psychiatry training didn't involve me sitting down with a map of the brain and, a list and a drug formulary. it, it involved training as a psychotherapist. It involved learning about social models. It involved learning alongside multiple assuming team members of all different professions and types. It involved learning about anti psychiatry. Yeah, you can't pass your psychiatry exams without having this incredibly broad, multifaceted, I, I was blown away by the sort of sheer range of fields of thinking I had to assimilate to become a psychiatrist. And so, so, so, that's one of those little flinches, those cringes that are in me when someone says, Oh, it's the medical model. I'm thinking, well, as the representative of the medical model within the mental health fields, that's not the way I was trained. I'm not.

Amanda:

unjust to you then,

Gareth:

Yeah, slightly. It does. But, at the same time, having gone down this journey that I've gone on, I do think there's a rebalancing that needs to take place. There's the bio, the biological, so you get your medication. Then it's the psychological, you might get your sessions of psychotherapy. Social. Oh, forget it. By we, we were bored already by the time we got to biopsychosocial you. We've run active ideas by this point, tag on at the end. Maybe they need to be connected into a club or something. you know, the, the social, open dialogue for me is almost flipping that we're going for a social psycho bio model. It's,

Amanda:

I think, and also, I mean, I think, you know, communicating properly, communication can actually avoid medication. I mean, we don't, I don't think, I think that when medication is assumed the only treatment or the primary treatment. It doesn't leave room. And as I've understood from, the beginning of Open Dialogue, there was room to have some conversations first. I think that that's where uncertainty might sit, that's where fear might sit for what's happened with our very pressurised NHS service. It's, there's no, it feels, whether it's true or not, is another 7 million podcasts, but it feels like there's no room for stopping and feeling and looking and talking and all collectively deciding.

Gareth:

Mm-Hmm.

Amanda:

It doesn't feel like there is. It doesn't. I think that's where it becomes so very, very difficult.

Gareth:

yeah, yeah, yeah, yeah. Yeah. Because it really blew me away, turned my world upside down, and I feel like I kind of went down a rabbit hole I can never come back from. And,

Amanda:

did it turn your world upside down? Because you say that, but can you elaborate on it?

Gareth:

yeah, I, I think I didn't realise how many fixed ideas I already had about psychiatry myself prior to going to that training. I thought I came along thinking I'm, I mean, I was fairly junior consultant at that point, I was fairly early in my career, I was thinking, ah, I'm quite young, groovy, I'm up to date with all the most modern ideas and practices that I could have, and to then have a mirror held up to me and my practice and some of the much less pleasant aspects of the mental health care system, the failings that we've got around there, you. was really hard, actually. so that first week I went on the training felt really difficult to swallow because it actually felt like, oh, am I part of the problem? so there was a lot more to come after that and it bit by bit by bit got, reconstructed from there and saw that all the different options, and actually I didn't have to abandon everything I'd learnt and everything that I was. I just had to. Reintegrate it into a new way of thinking. and there was plenty of resources I could fall back on, but it was, it was a journey. It took me a while to, to, to, to, to move along it. But the moment it really clicked for me was when I started changing my practice for service users and carers. And I just got such amazing feedback from them. And they said, wow, what was that? We loved that. Can we have some more? That's when I thought, okay, the practice based evidence is there for me.

Amanda:

hmm. That's really interesting because, you know, I often think about how open dialogue sits alongside psychiatry and how psychiatrists might feel with us coming along with this model. And how that self reflection, I think when you said, am I part of the problem requires a real raw self reflection I mean, And then I think about people at the end of their careers who've been doing things a certain way for 40 odd years or whatever it might be. You mentioned that it was early in your career or early ish. And I wonder whether that made it. Not easier, because I don't want to diminish what you went through, but the, the reflection on it, am I part of the problem, maybe sits differently according to how long you've been part of the problem, dare I say it. It's just really hard.

Gareth:

I've really noticed ever since I went on Open Dialogue Training I've noticed the words that come out of my mouth, and I've immediately framed it as a problem. And I think a lot of people listening who, have really committed their lives to trying to help people, And to really working in some exceptionally challenging situations with very little resource and they've always done their very best with the best knowledge they had available to them at that time. We've really got to do honor to that. Because actually to then frame them as a problem could really be quite alienating for a lot of people, I'd imagine. for staff who have been. Trying to do their best with what they had available to them.

Amanda:

A psychiatrist or a doctor, psychologist, etc, psychotherapist, we're doing it for the right reasons. I know that. There are some very, very beautiful and good people that we work alongside in our trust. But I'm just thinking of, as a human, self reflection means that I often have what I still call at nearly 62 growing pains, dare I say it, where I reflect on something and I think, oh that hurt, you know, that, oh, oh my goodness, do I do that or do I do that? And I think this requires that and it's really difficult and yet at the same time, what's wrong with growing as a human? Our bodies grow and change, our bodies change shape. Our bones hurt. I know I'm speaking for myself now because you two are much younger than me, but they do. What's wrong with you emotionally growing too, all the time? Why, why, why do you think you finished your training and then you're cooked?

Gareth:

Yeah, yeah. Yeah.

Amanda:

Hmm. I mean, we do that. And I think the other thing I also like about, open dialogue is not only what we do with clients, but what we do with each other. How we have organizational open dialogue

Gareth:

Hmm.

Amanda:

and have these tricky conversations with each other and growth areas. You know, what is an appraisal anyway? Is it one person telling another person how they're doing in their job because they've got a higher banding? Or is it a conversation between human beings that can share their thoughts? I don't know the answer. I'm just thinking out loud as we're speaking about this.

Gareth:

definitely think that's something that we've yet to fully understand in trying to implement this way of working. Is that there are all those questions. an interesting sort of phenomenon I think that I see happen time and again with open dialogue once you get into the training. There can be all sorts of things that come out of the woodwork. And, people can say, oh, what is this training? What's it doing to us? what's all these sort of conflicts that are coming out within the team now? They were always there. All that stuff is there beneath the surface, we sort of ignore it. We, we move past it all the time I, I think within open dialogue there's, an understanding of. Equality of voice, of lifting all voices, of valuing all voices, and in doing so, you then have to confront the difficult stuff, and, and, and, as you're saying, coming into that organizational conversation, there's so much stuff that happens every day that is just fast and furious to try and get the business done, and doesn't honour Slow thinking and talking and making sense of and understanding and emotion and Yeah,

Amanda:

And of course the learning and the change happens in a relationship. I mean we know that, having worked personally with each other for many years, we've reached a point where we can have difficult conversations, I think. Self reflecting ones. Sometimes they hurt. Sometimes we're both furious. Sometimes we're not. But the growth and the changes and the ideas happen in relationship. They happen. It's tricky. I mean, I, I thought about it, you know, in my training as a psychotherapist, the first couple of years were theory and then the last couple of years were very theory and action. So you then went into jumping in and learning alongside your clients, learning alongside your colleagues, but only when you had a kind of little sprinkling and foundation of the theory. And maybe that's where we sit at the moment to sort of, navigate it. But to me, it's also all about, failing. I mean, I, I don't have a problem with failing ever. I mean, I don't even care about the word because to me that's learning. it's just whether it's useful or it's not useful. And, and so what if something isn't useful? I think that doesn't mean you don't do it. You just go, okay, that bit didn't work. How do we find a bit that works for you? In your situation, in your context, and think around things together. I think together, that's the key. With practitioners, with each other, with our clients. Instead of having one sort of model that is meant to fit.

Gareth:

and I guess that's where sort of organically we've evolved towards trying to throw many different approaches at this. Conundrum of how do we move things forward and that, that was one of the ideas behind starting up this series of podcasts was about the idea of giving people lots of different resources so that they can turn to because it's going to, it's a journey, they're going to have to take time to digest the ideas and integrate them and play with them and return to them at their own pace and so the idea of having a number of conversations Playing with the ideas ourselves is get them to reflect on the conversation we're having and does it fit with them what they're learning from it. We're going to try and talk to some of the real key thinkers in this field what will be their, understanding of practice going forward when it's taken to other places. Draw in new voices into this space so people can listen to them and reflect on them and think about what fits for them. I

Amanda:

I think you're absolutely right, Gareth, and I think also if we're thinking about feedback loops for anybody listening, if there are conversations or there are people that they feel are important to join this space, then do reach out to us because you'll then, because then you're, we're creating a proper reflection with you, the listeners but I think that would be the idea behind it, wouldn't it?

Gareth:

Yeah. I mean, one voice we haven't brought into our conversation yet is Fiona. And I love hearing Fiona's voice. I, I, I wondered if there was anything that you were wanting to, that was occurring to you at this point, Fiona.

Fiona:

well, I was just wondering, we could give a little teaser of who's coming up. couldn't we? and a little bit about how those conversations went and then you can wait for those episodes to come. It's always a joy to listen to the dialogue of what people are saying in this podcast. But I try not to guide or shape it too much. And I take a little phrase from each one and make it into the title, and it's really interesting how throughout the, the dialogue, the title, I think it might have changes and then it changes again when I edit it. and each one, I think, especially in season two is going to be really different, and provide a really good space for learning a bit more about open dialogue Any suggestions, any. Any burning questions, actually? Feel free to get in touch.

Amanda:

You just made me really think of something, Fiona, because when we're operating an open dialogue session, we're often told to use the client's utterances.

Gareth:

Hmm.

Amanda:

Now, I often think in that never use them literally. Sometimes I do, sometimes I don't, but what I do use is kind of like the emotional flavor that comes out so that the clients truly know that I've heard Or more importantly, felt them. And I just thought, you're almost doing that with your title. The bit that jumps out, that emotionally resonates with you, is actually very open dialogue in and of itself. Because it's like, which bit have I really heard? And which bit strings this together? And, you know, there will often be a word in a session that it's felt in your body and it sometimes takes you by chance. Then it's what's so beautiful about it is you get the opportunity to speak to it.

Gareth:

I wonder, Fiona, if you had any reflections on some of our answers to your question there.

Fiona:

yeah, I think as always, and as is my habit, I'd come back to a food analogy. and I think that, that, that Amanda, your description of a meal and Gareth your discomfort around. Sort of feeling that the medical model, as it is called, is being thrown in the bin. A picture came to mind in my head, as it always does, of two restaurants next to each other. And one of them is an absolutely massive restaurant. Loads of people go to it all the time. But they all leave a bit hungry and a bit unsatisfied and that's the NHS. And there's like a small organic restaurant where only a few people go in and they spend hours eating this incredibly carefully prepared food. that seems to cost more, but doesn't actually cost more because they don't have to go in so often to be satisfied, to be full up and to be healthy when they go home. And, they both serve the same food and the food's made by the same cooks. They've just got different recipe books.

Gareth:

Yeah.

Fiona:

that's what came to me talking about the difference. and then about what is open dialogue. I think it's very important to understand where it originated from and things like that. But I don't think until you've actually witnessed some kind of network meeting that you can ever truly know the impact. And see where the strange descriptions of echoing clients utterances and things like that to understand where those because we systematize don't we as humans and we love and the NHS loves because it loves outcomes. We love a manualized therapy and to try to describe open dialogue is like manualizing a society where we listen to each other. And what, what is so impossible is that we don't even live in that society. Socially, we don't.

Gareth:

Yeah.

Fiona:

Socially, our dialogue is poor. It's not open. We don't truly listen to each other enough. so it feels like it's not really reflecting anything that we're familiar with. So we go to the small organic restaurant and we don't recognise any of the names of the dishes. We feel awkward. We leave. We go back to the big restaurant. We have the same thing we always have.

Amanda:

With self service, the small one's got a waitress that sits and chats and has a giggle with you and asks you about your wine, and the other one is 100 percent self service.

Fiona:

Oh yeah. In the small organic restaurant, you know, the name of the guy who runs it,

Amanda:

Yeah. They

Fiona:

runs it. Hi do you have you? Yeah. And yeah. And I, and I think that maybe in that reflection, there's something about, the difference between the village shop and the, and the giant supermarket. and there are advantages and disadvantages of both. You know, variety is great. The one doesn't eclipse the other, they can learn from each other.

Amanda:

But they can also have choice in there. I mean, what I would like to do is have our A& Es, have our doctor's surgery and say through this door you can have just treatment as usual and through the other door you can have open dialogue and you can choose which door you want to go through. That doesn't mean if you go through the open dialogue door you're going to not get your usual treatment as usual, just means you can choose.

Fiona:

Surely the things that we get asked for over and over again are not only I wish my family was involved, but that I wish I had some choice.

Gareth:

Yeah.

Fiona:

big things. Surely.

Gareth:

And continuity.

Fiona:

Oh yes, there we go. And continuity of care, different person answering the phone all the time. Don't like that. Yeah. Those, they're the top three things.

Gareth:

yeah.

Fiona:

What can we

Gareth:

Hmm.

Fiona:

trying?

Gareth:

Well, we are gonna try and explore that and define that, aren't we? Over this next of of conversations. got Jaako Seikkula as one of those key people who is the, the founder of the approach we're gonna talk to. We've got lovely conversation coming up with Harlene Anderson, family therapist and systemic thinker who, operates out of Texas in the USA, who was a key influence on the Tornio team and developing their approach. We've got listeners who have suggestions of who they want us to speak to. What kind of questions we want to put to some of our future guests. Get in touch with us. Let us know. We want this to be a dialogue.

Fiona:

Indeed,

Amanda:

And in fact, we can't put the change in unless everybody wants it and the community wants it as well. Because the community needs to come forward and say, I'd like open dialogue. Who's doing it? We have to have people ask for it. So I wonder what word has jumped out at Fiona from today, I'm intrigued.

Narrator:

And that's it for this episode of Open Pod Pod. Join us for the next episode.