Dialogical Meetings in Social Networks

Tom Erik Arnkil, Jaakko Seikkula

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781855754102
• eBook ISBN:
  9780429912689
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book describes and analyses two dialogic network practices: 'Open Dialogues' - developed for use in psychiatric crisis situations - and 'Anticipation Dialogues' - used in less acute situations such as multi-agency muddles where the helper systems are stuck. The book is both theoretical and detailed enough for practitioners who wish to apply the approaches to their work. It is meant for professionals in the fields of psycho-social work - including therapists to day care personnel, social workers to school teachers, - researchers, and academics. As the book touches upon dialogues with and within private networks, the book reaches out to clients, too.

PART I

CHAPTER ONE

Dialogues at the boundaries between and within professional and personal networks

We have primarily sought practical solutions. Jaakko worked right from the beginning “within” the practices he was researching, being a member of a psychiatric treatment team. For Jaakko, practical developments have most often preceded theoretical analysis of the experiences. For Tom, developing concepts has been central, albeit in close contact with practice. He was not a member of the open-care teams he has researched, which work with children, adolescents, and families. However, network-dialogical practices were developed in close cooperation with the grass-root practitioners.

Although we describe in detail the dialogical practices we have been involved with, our aim is also to discuss the more general dimensions of dialogism. After all, technical skill is not sufficient. Attitude, outlook, and one’s way of thinking are equally if not more important. Neither is networking simply a series of network methods; it is, rather, an understanding of the significance of relationships for an individual—an orientation towards networks. Of course, therapeutic tools are not unimportant. Some ways of discussion are more favourable than others in generating dialogues. The guidelines for Open Dialogues and Anticipation Dialogues took shape over a long period. The course was not straight, however. We have had to totally retrace our thoughts a couple of times. Below, we describe those twists and turns in the development path, to highlight how the central ideas were arrived at.

No common definitions of the problem, after all

Anticipation Dialogues were developed in complex multi-professional situations where the helping process seemed to be leading nowhere, in spite of attempts by a number of helpers to do the professionally right thing. Tom was studying encounters between the compartmentalized professional system and the comprehensive everyday life of the citizens. Anticipation Dialogues were developed in a series of projects in several municipalities in Finland conducted by Tom’s team at the National Research and Development Centre for Welfare and Health (STAKES). Tom’s point of departure was in social sciences: social policy and sociology. Tom is not a clinician. His colleague through the years was Esa Eriksson, a psychologist and family therapist.

“Multi-problem situations” create client relationships with several agencies. Multi-agency contexts are complex, and such complexity certainly does not reflect on the family alone. The effective combination of different agencies may get hindered even when the work of the individual professionals is sound and good. In a way, the outwardly well-organized professional system gets into disorder when it encounters phenomena that cannot be compartmentalized in a way that parallels how the expert system is divided. Such disorders are not infrequent. Cases can revolve around repeated attempts to try to control others and to make them do what is seen as necessary. Anticipation Dialogues were developed to revitalize such situations. Together with the front-line professionals, Tom and Esa and their team tried to develop methods that would be helpful in situations where the parties seemed to be repeating unsuccessful patterns of activity. Professional work with children, adolescents, and families afforded plenty of such material.

Tom and Esa conducted a series of projects together with frontline professionals from the mid-1980s on. The first project was with three social welfare offices and an clinic for substance abusers. The next partnership involved the personnel of two social welfare offices and a psychiatric clinic for adolescents. The third development community to become involved was extensive: all the professionals—from antenatal clinics to psychotherapy, from day care to family counselling clinics, from schools to child protection—working with children, adolescents, and families in two municipalities. The next community was somewhat larger again: the equivalent professionals plus the police force in fourteen municipalities and rural districts. Finally, the Anticipation Dialogues’ set of practices are being used in a training programme being carried out in various parts of the country.

At first, dialogism was not at the forefront. It became central, however, through experience. In the beginning, the focus was on the means for changing one’s own activity, instead of trying to change others directly. The main method for this was through anticipating the outcomes of one’s own acts and reflecting together upon the actual outcomes—and trying to learn the lessons. The aim was to find a means that, on the one hand, would not repeat recurrent patterns but would, on the other, likewise not be so exceptional as to break the contacts with the client. The idea was to find appropriately different ways through anticipations.

Tom and Esa sought a new approach through varying their own patterns of activity with the help of anticipation, facing intended and unintended consequences, gaining surprises, and reflecting on their own positions in the network of relationships. This development was a merger of at least three strands of previous thought: (1) In the work of analysts of first- and second-order change, such as Paul Watzlawick (Watzlawick, Weakland, & Fisch, 1974), we can see the idea that more of the same problematic attempt to solve a problem is itself problematic. The problem is, in part, the problematic problem-solving. Thus, the problem-solving efforts need to be changed. (2) Tom Andersen’s work (1991) was also a source of inspiration: the idea of finding ways that are appropriately unusual for the client. More of the “usual” does not bring about change, while attempts that are too unusual can break off the contacts or make the client feel defensive. Tom and Esa sought an “area” in between. (3) The idea of using anticipation for probing what is appropriately different or unusual came from the work of two Finnish psychologists, Johan Weckroth (1986) and Totte Vadén (1985).

In “multi-problem situations” there are several parties trying to change the client’s or the family’s activity. The professional gaze is fixed on the client from various directions, and each of the specialized players tries to change the client according to their professional frameworks. If the whole does not progress as wished, the professionals will intensify their attempts and may also try to change not only the client but also the activity the other professionals. A pattern of activity may emerge, a recurrent figuration, that is not a single-handed “creation” of the client/family or the work of the professionals alone but something in-between: a co-creation. It does not belong to the “system-world” alone, nor only to the “life-world”, and it is—or was—very hard to put a name to it. The parties maintain a pattern of interaction together, even with many players pursuing change instead of constancy. The cooperation plan they are following may embody something quite different to what is actually realized as a figuration of reciprocal actions.

Changing multilateral interaction to one’s liking by unilateral commands or appeals is hard to achieve. However, what one does and how is of significance. Therefore, instead of focusing only on how the others should change, it is fruitful to look at one’s own attempts in the pattern. Varying one’s own activity is not as hard to achieve. The outcomes will very seldom be exactly what one anticipated. Instead, one is likely to face a mix of intended and unintended consequences. In order to learn what promotes change through being different enough while also maintaining contact by being familiar enough—in other words, is being appropriately different—it is useful to reflect upon the outcomes in the light of one’s anticipations. Controlling networks is not possible, but it is possible to learn more about how others position you. In this vein, one can become a little more aware of the anticipations one makes regardless.¹

Evan Imber-Black’s work (Imber-Black, 1988; Imber-Copper- smith, 1985) inspired Tom and Esa to combine anticipations with analysing multi-problem/multi-agency situations.

Tom and Esa tried, together with the teams in the projects, to simplify and clarify the anticipation method. Finally, it materialized as three questions for the team members to consider when trying to vary their own activity in multilateral networks. The questions were:

1. What would happen if you did nothing?

2. What could you do to help that was appropriately different?

3. What would happen if you did that?

These questions were originally for team members within an agency. They would discuss each other’s anticipations about a case so as to find a way where they would act in a way that was appropriately different—that is, was acceptable for the client/family but not a “more-of-the-same” recurrent activity pattern. Therefore, trying to anticipate “what happens if . . .” requires personal involvement, so that not only a cognitive means of orientation (general professional knowledge) but also emotional and moral means of “feeling out” the particulars of the unique situation can be made use of.

In Tom’s and Esa’s later projects, the situations were no longer approached from the direction of a particular agency or team. The hub was a multi-agency case: a “multi-problem situation” that pulled in professionals from various agencies around it. Tom and Esa acted as dialogue facilitators for professionals’ network meetings. The conveners of such sessions were professionals who felt increasingly worried about where the cooperation—or the lack of it—was leading. The professionals invited were those actually working with the client/family in question.

The three above-mentioned questions were applied. The discussions were organized with the aim of leaving plenty of room for mutual listening. The participants could only talk in turns. When one had a turn, the others listened. The idea behind this was to try to foster inner dialogues instead of commenting on each other’s utterances. The idea of separating speaking and listening came from Tom Andersen’s (1991) way of setting up reflecting teams. The anticipation method began to evolve towards a deliberate dialogism. Organizing the sessions in a way that would maximize possibilities for generating rich inner dialogues became the aim.

Earlier, in the context of team discussions, it had seemed fruitful to try to bring into focus the full spectrum of the team members’ anticipations. The new context was not a team plus its clients, but a whole professional network around a family that had simultaneous contact with a number of professional helpers. It seemed equally productive to bring to the fore the spectrum of anticipations. The sessions were organized in the no-man’s-land between the agencies, with one involved agency as the “host/hostess”. The same three-part question structure was applied. Each of the professionals answered in turn what they thought would happen if they did nothing, what could they do to be helpful, and what they thought would happen if they did that. Talking and listening were separated in the same way it was done in team reflections: each professional could talk without others interrupting to comment. At the end of the session there was a discussion on who will do what with whom next. Bringing to light the dissimilarities between each other’s anticipations was very powerful in enriching the participants’ ideas. With such experiences, enhancing the polyphony of voices became a central aim in developing the approach. It seemed that it was exactly the multi-voicedness that helped to broaden the narrowing patterns of thinking and interacting. No overall definitions of the problem were made in the sessions. Instead, the facilitators asked about the professionals’ own activity and the anticipated outcomes.

The professionals seemed be curious to hear each other’s anticipations and were interested in what each specialist thought would be the consequences in other parts of the network if she/he did this or that, or nothing. Each participant was equal regardless of her/his status in the professional hierarchy in the sense that no one, no matter what her/his speciality, could say with certainty “what would happen if . . .”. Tom and Esa also observed that most of them knew very little about the non-professional resources—the private networks—of the clients and that the discussions raised curiosity towards these possibilities. The only summaries at the end of the discussion were expressed in activity-language—that is, a braid of actions took shape: who does what with whom next.

Finally, when everything was “ready”, in the sense that the anticipation procedure for the sessions was tested and streamlined, clients entered the sessions and everything had to be reappraised.

Everything has to be changed when clients are present

The professionals had been encouraged to bring along clients. When, without warning, this actually happened in one particular meeting, Tom and Esa were faced with the realization that the situation was different with the client present. Thorough revisions of previous thinking had to happen almost instantaneously. They realized that the set of anticipation questions would not be appropriate for an encounter between the client’s network and the professional network, so they had to make revisions in the short timeframe before the session began. A meeting between clients and professionals is a direct intervention into the lives of the clients, and the minimum requirement for such an encounter is that the clients leave the session more empowered than they entered it. The carefully prepared set of anticipation questions did not seem appropriate for this. Even the opening question—what would happen if nothing was done?—could be offensive. In a case where there was a risk of suicide or some other great danger, the question would be absolutely inappropriate. The model had to be revised thoroughly—in some twenty minutes. Tom and Esa discussed all the resource-oriented work models they knew and weighed their personal experience in ways that could arouse credible hopefulness in those present. Making use of means they had developed for in-organization consultation and supervision and combining ideas from client work, they made a plan for interviewing the client, the family, and the professionals from a future perspective. The set of questions now called “Recalling the future” was outlined. The anticipation structure was turned around: instead of starting from one’s actions and anticipating what may happen, the starting point was to be in desired outcomes, and actions were to be “derived” from these.²

In the first-ever meeting having the client present, the mother of a client family had arrived all by herself. Five or six professional helpers of her family were also present. Two adjoining round tables were organized, and Tom and Esa announced the following rules. Talking and listening are separated; one is to refrain from commenting, so that each and every person has room for listening to the impressions generated in her/his inner dialogues; everybody will be interviewed in turn; each will be asked to think aloud. The client will be interviewed first, then the professionals. Moreover, the questions will approach the present from the near future, as if we were already there. This way a plan for cooperation will be outlined, and it will be put together at the end. To help this, everybody’s views will be recorded on a flip chart, for all to see.

Tom started interviewing the client at one table, while the professionals listened from the other table. After a joining conversation, he asked the client the first of three questions: “A year has passed and things are quite well in your family. How are they from your point of view?” Tom helped the client with concrete questions about her everyday life. The second question was: “Who helped you to carry out these good developments?” At times he repeated word-for-word what the client had said and inquired “did I hear you correctly when I heard you say . . .”. He tried to help the client to catch her thoughts and also to signal that she was listened to attentively. Tom and the client were in eye contact; others were not looked at, nor were they spoken to directly. The third question was: “Were you worried about something ‘a year ago’, and what lessened your worries?” The question aimed at charting present worries from a perspective of relief. While Tom interviewed, Esa took notes on the flip chart. The client’s words were used. The sentences were shortened, but trying not to alter the idea. After the client had had the chance to think aloud, Esa started to interview the professionals. The client listened. Tom took notes. The first question to the professionals, each in turn, was: “As you heard, things are quite well in the family now that a year has passed. What did you do to support the good developments—and who helped you and how?” The second question was: “Were you worried about something ‘a year ago’, and what lessened your worries?” The flip chart gradually filled up with notes about the good year, its support, and its worries, plus the matters that lessened them. Finally, no longer now assuming a year had passed, a discussion took place on making a plan of cooperation. The notes on the flip chart were used as guidelines. Discussed were whether everyone felt they could actually be involved as outlined, who does what with whom next, who coordinates the cooperation, and whether it is necessary to meet again and when. The flip charts were signed with the future and present dates and handed to the client.

Tom and Esa were amazed how well the session went. The plan was down-to-earth and concrete. The client left smiling happily, and the professionals radiated satisfaction. Dozens of similar dialogues were then carried out, modifying the method. Instead of single clients, families arrived, and many families brought people from their personal networks—children, parents, grandparents, significant friends, and so on. What made the sessions run in such an interested atmosphere, one after another? The dilemmas in question had been entrenched for quite a while in most cases. Something a client once said gave a clue: Tom and Esa were near the clients during a break, when the wife took a long draw on her cigarette and said to her husband: “Isn’t it strange that we are talking with those there [pointing in the direction of the professionals] about how ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Series Editors’ Foreword
• About the Authors
• Foreword
• Preface
• Introduction: on networks and dialogues
• Part I
• Part II
• Part III
• Epilogue: on power and empowerment
• References
• Index