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

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.
Keywords: refugee, trauma, dialogue, open dialogue, interpreter, therapeutic alliance

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