Open dialogue across cultures: Establishing a therapeutic relationship with the refugee family

Guregård, Suzanne (2009) Open dialogue across cultures: Establishing a therapeutic relationship with the refugee family. DSysPsych thesis, Tavistock and Portman NHS Foundation Trust.

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The thesis describes a detailed investigation into the quality of meetings between Swedish therapists and refugee families, and how this is affected by language and culture differences. In a series of books and papers under the heading, "OpenDialogue", the Finnish psychologist Jaakko Seikkula and his colleague have written about the importance ofdialogical quality in meetings with psychiatric patients. This Open Dialogue perspective was adopted in the research, particularly by using Dialogical Sequence Analysis (DSA), the method of text analysis as developed by Seikkula and his colleagues. The Thesis examines the first two or three meetings (but in one case, the eighth) between six refugee families from different homelands and three sets of experienced therapists, asking whether the talk was dialogical and led to some form of new understanding. It also asks whether DSA is an appropriate method of text analysis for such meetings, and by extension, how far the Open Dialogue (OD) approach is appropriate. A multi-perspective methodology was used, combining DSA, video-reflections - the interactive use of video-recordings, and interviews with the families concerned. Graphic display of DSA outputs turned out to be a valuable method for comparing meeting quality. The display showed that "new understanding" developed in these meetings under similar conditions predicted by DSA for psychotic patients. Statistical analysis also showed substantial agreement between DSA assessments of meeting quality and those made by the participating therapists. Thematic analysis of the video-reflections complemented the DSA by revealing more about the non-verbal aspects of the meetings, embodying the feelings of the participants. Interviews with the families gave their feedback on the meetings. The conclusions of the research are that the OD approach is highly appropriate, although therapists sometimes need to use more initiative than OD would suggest. The cross-cultural obstacles to dialogue were seldom the obvious ones of misunderstanding, but inhibitions on both sides and difficulties of achieving spontaneity through an interpreter. Given these obstacles, the dialogical quality turned out to be high though uneven, whether assessed by DSA or by the therapists concerned. Most families were also positive about the meetings. Guidelines emerge from the research that should improve the quality of meetings with refugee families, and strengthen the development of a therapeutic alliance.

Item Type: Thesis (DSysPsych)
Additional Information: Thesis submitted in partial fulfilment to the Tavistock and Portman NHS Foundation Trust and the University of East London for the Professional Doctorate in Systemic Psychotherapy. Click on 'Other' in Related URLs below to download from the British Library.
Uncontrolled Keywords: Professional Doctorate in Systemic Psychotherapy, Refugee, Trauma, Dialogue, Open Dialogue, Interpreter, Therapeutic Alliance
Subjects: Couple & Family Therapies > Systemic Family Therapy
Race and Culture > Refugees
Department/People: Children, Young Adult and Family Services
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