- Good evening everyone.
We're gonna get started.
As you all know, I'm Marianne Yoshioka,
the new dean of the School for Social Work.
Yay!
I could not, I have had the most amazing first week
on the job, and
it is in no small part because of the incredible pleasure
I have gotten from meeting many of you.
I've not met all of you yet, but it really truly is
my personal goal to meet each and every one of you.
An amazing time because of this extraordinary event today.
And having the opportunity to meet our partners
in field education, for whom we are very very grateful
for all that we have done.
And so much of the importance of this clinical training
that you are receiving is in part because of the work
and dedication of those individuals
at our many field partner agencies and organizations
around the country.
So thank you again to everyone in field education.
And in particular, thank you to our field work
education department here at Smith,
who does pretty well an amazing job.
To Carolyn and Kaitlyn, and Maria,
a big heartfelt thank you.
I could not be more delighted to preside over tonight
and to welcome you all to this important event.
It's important to celebrate the amazing work
and the great opportunities we have here at Smith College.
And it's important to celebrate it and to take moments
to acknowledge both what this experience here
in the School of Social Work has given people,
and the many many ways that people give back.
Not only to the School of Social Work,
but really to our profession and the advancement
of clinical practice.
And it's important to take this moment,
and I am happy to welcome our new provost
for the university, as well, to our proceedings tonight.
And I will be welcoming her to the podium in a moment.
And then Carolyn du Bois will be coming back
to the podium to help us through our program
for the evening.
Provost Katherine Rowe has also started
her position here at the college
along the same lines as I have,
so it's been a marvelous chance for me to get to know her,
and I am greatly looking forward
to a productive relationship as we move forward.
Provost Rowe holds degrees in English
and American Literature from Carleton College
at the Bachelor's level, and from Harvard University
at the Master's and PhD levels.
She is well-regarded and well-known nationally
and around the world as a scholar of Shakespeare.
And over recent years has studied the role and impact
of digital media on the transformation of literature.
She comes to us from Bryn Mawr where she was the co-founder
of Luminary Digital Media, which is a reading platform
that brings the works of Shakespeare to our mobile devices.
She brings a wealth of experience in faculty development,
academic priorities, institutional governance,
international initiatives, and the effect of pedagogy
for non-native English speakers.
In addition, she's contributed
to the college's visibility and positions initiative,
a depth of experience that can only do us well.
I think that many of you may have heard, as well,
that she brings another very unique skill set
that she probably does not promote nearly as much,
but she is a skilled ultimate frisbee competitor and coach.
I'm thinking there's ultimate frisbee in our future.
So without further ado, I'd like to welcome Provost Rowe
to the podium.
(applause)
- Thank you so much Dean Yoshioka,
for that lovely, lovely introduction.
I'm so thrilled to be here tonight.
This is my first ceremonial duty at Smith,
and it's very special that it's one that celebrates,
as this important event tonight does,
Smith's long history of commitment to service
and excellence in service.
I'm gonna begin by welcoming to the stage
each of our awardees, and then I'm gonna give them a moment
to say a few words of their own.
And I hope you will hold your applause,
well you can do it at the beginning,
but I hope you will give them a moment
to stand up and collect themselves to speak to you,
'cause we really want to hear from them.
It is my honor to welcome to the stage tonight
Josephine Tervalon.
(applause)
(laughter)
I had that impression.
I'll take a moment to be serious in this honor, though.
As an MSW graduate of Smith College School for Social Work,
an esteemed clinical social work professional,
you are a source of great pride for the school.
You are a gifted clinician, teacher, and consultant.
In a career that spans 50 years, you have made significant
contributions to the field of social work practice
and clinical social work education.
You graduated with honors from Tuskegee University in 1961
and headed north to continue your education here
at Smith College School of Social Work,
earning your MSW in 1963.
In the years that followed, you worked in private practice
both overseas in Italy and Texas,
providing clinical services to individuals,
families, and groups.
A consumate teacher and mentor,
you have provided astute social work supervision
to generations of MSW students,
and have served as a member of the clinical
and adjunct faculties at Baylor College of Medicine,
the University of Texas School of Social Work at Austin,
the Washington School of Psychiatry in Washington DC,
and here at your alma mater
Smith College School for Social Work.
Smith College is particularly grateful to you
for your work as a faculty field advisor for students
in the Texas area from 1985 to 2007.
Over the course of those 22 years,
you provided students with an outstanding level
of educational support that advisees
have described as a gift.
You are known, respected, and loved for your clear,
concise feedback, your guidance around complex
clinical issues, and your unwavering support
of the educational and professional development
of your students and advisees.
In addition, you've provided skilled consultation
to agency-based supervisors and have been a valued member
of the field faculty, providing wise and often witty
counsel to your fellow FFAs around the joys
and the challenges of clinical social work education.
You are a role model, mentor, teacher, supervisor,
and leader who has inspired the development
of many colleagues, particularly women in the practice
of group psychotherapy.
You've contributed to the social work profession
in so many ways, including, but not limited to,
your contributions as a longstanding member and leader
in the National Association of Social Workers,
Texas Society for Clinical Social Work,
American Group Psychotherapy Society,
and Houston Group Psychotherapy Society.
You were nominated by the YMCA of Houston Texas
as one of the outstanding women in the mental health field.
In addition to your clinical practice,
teaching, and supervisory work,
you've conducted research, written papers,
and presented extensively on mothers and daughters
and women in the profession.
Josephine Tervalon, throughout the course
of your extraordinary career, you've contributed deeply
to the lives of many, just has Smith College has,
in the words of Sophia Smith, become a perennial blessing
for the world, so too have your good works
become a perennial blessing for Smith College
School for Social Work and the profession.
It is with great pride that we present to you
the Day-Garrett Award.
I'd love to welcome you to the podium here
for a few words.
(applause)
(sighs)
- Provost Rowe.
Dean Yoshioka.
Carolyn du Bois.
And Josh Miller.
I have to recognize all of these people
for not only their positions, but what it means for me today
to be standing here before you.
I was going to write a few words,
and then I did write a few and I didn't write any more.
So I'd like to share a bit of what this means to me.
It is awesome.
Overwhelming.
A joy.
To have your peers honor you in this way.
There is nothing better.
What's difficult is sitting in the chair
while they're talking about you.
I think there's more anxiety in being seated there
than if you're looking to get the Oscar
and don't know if your name is going to be called.
To hear part of your life being
repeated back to you and how others have seen it
and appreciated it.
When I received the call from Josh in March,
I was in the kitchen with my husband cooking soup
for a small dinner party.
And having a ball, heard Josh's voice and I said,
oh Josh, it's wonderful to hear your voice.
What's up?
And he says, well, I have some news for you.
And he said that, I thought, oh, maybe you guys
want me to come up
and do a little workshop or something, right?
In my head.
And then when he told me, you have been one
of the selected nominees, one of the selected people
for the Day-Garrett Award this year
and I said, What?
Oh my God.
Are you serious?
He said, of course I'm serious.
And then Albert stops what he was doing
when I said oh my God.
It is such an honor to know that you see my work
and know me in that way.
It's been a blessing.
This is also a significant year for me in many other ways
because you heard how many years I've been graduated.
And Smith gave me many gifts before this.
This is the ultimate, but the first one was the classmates
and people that have been in my life
since I came to Smith.
And the fact that I came on a scholarship.
I was ready to tell them, I can't come because I only have
$1000, which was a gift
when I graduated undergraduate school.
And they said, come, we'll take care of the rest.
In those days, that was truly a blessing and I was here.
I met a dear friend who is here.
When I got the call, I thought, how do I tell my friends?
And who do I tell first that I want to hear it from me?
One is Zora Lusick, who's here with me
and was my classmate.
We have been friends all these years.
In fact, we have many things alike.
Like sons born on the same day a year apart.
That kind of thing.
Cats that are named the same.
Okay?
I also met dear friends and made dear friends
in my second year placement,
met a woman in Detroit who has become a sister.
She is here tonight from Detroit,
and she was in social work and in early child development.
And her husband.
And all my family, that not all of them are here
because they're seven grandkids
and we're an abundant family and there are lots of things
always going on and they all split between the coasts,
but they are here in the front row.
Our first granddaughter, who is wonderful
and had to, had to practice
because she does theater and is well known
in Melrose, Massachusetts.
But these are the people,
and I have, oh, Shiva, okay?
And my other daughter that I,
who adopted me, and my other two granddaughters,
whom I'm very dear to are here,
Helen Chung.
And I've known her for years.
And for your family, for your friends
to be in awe with you when you tell them what's happening,
and immediately say, I'm coming,
I'm going to be there.
It doesn't get any better than that in life.
I truly love you all, I'm so appreciative of this award.
I'm so appreciative of the school maintaining this award
and honoring those of us who have worked
not because we looked for an award,
but because we truly believe in the work
and give it our best, and it's been my life work.
Thank you so much for this and keeping it going.
(applause)
(laughter)
- It's my great honor to invite to the stage now
our second recipient of the Day-Garrett Award,
Chester Villalba, please join me.
(applause)
(laughter)
This award was established in 1967
to honor Florence Day and Annette Garrett,
exceptional educators, who personified
in their personal lives and service to their communities
the high purpose of professional service
that has long distinguished the Smith College
School for Social Work.
As a graduate of Smith College School for Social Work
and a distinguished social work professional with 40 plus
years of experience as a clinician, scholar,
educator, and leader in the field of clinical social work,
you are a source of great pride to this school.
Chester Villalba, you have a Master's degree
from Smith College School for Social Work
and an honorary doctorate degree
from the Sanville Institute.
You are a member emeritus of the National Academy
of Practice in Washington DC,
and for more than 30 years, you have participated
as a peer reviewer for the Council of Accreditation
for Social Service and Mental Health Centers,
and served as commissioner to the National Council
of Accreditation of Children and Family Services.
You have distinguished yourself through your dedicated
service to children and families in the Bay area,
working for 20 years as the CEO
of Family Service Mid-Peninsula.
Over those 20 years, you expanded family services programs
to include group therapy, counseling for older adults,
crisis hotlines for parents and teens,
and public education workshops while maintaining
a private practice in Los Altos.
You are a longstanding and honored member
of the Board of Trustees at the Sanville Institute,
as well as chairman of the Acknowledge Alliance,
formerly the Cleo Eulau Center, Board of Directors.
At Acknowledge Alliance, you have promoted the well-being
and education of children by helping to promote,
support, and provide validation for teachers
and their good work.
Your work with the agency has helped to build more resilient
and connected youth educators, and school communities.
You are co-founder of the Palo Alto-based Adolescent
Counseling Services, an agency that provides
three main counseling programs
in Santa Clara and San Mateo counties.
The bilingual On-site Individual
and Family Counseling Program
at eight public middle and high schools,
the Adolescent Substance Abuse Treatment Program,
and the Affordable After School Counseling Program,
which offers assessment, treatment, and education
for the entire community.
In addition, we are so grateful
for your service at Smith College School for Social Work.
You served as an agency-based supervisor
and then as a field advisor for many years.
Students described you as clinically knowledgable,
respectful, and understanding.
A strong advocate for students' learning
and "an enthusiastic and spirited faculty field advisor."
Furthermore, your work in our field office
was instrumental in the development of an expansion
of our network of field agencies in the Bay Area.
Through your direct service and leadership,
you've touched the lives of tens of thousands
of teens and their families, helping them find a way through
and beyond the challenging adolescent years.
You've made exceptional contributions to Smith,
to the field of social work practice,
and to the high purpose of professional service,
to which this school,
for which this school is renowned.
You are a blessing to the school and the profession.
It is with great pleasure that we bestow upon you
the Day-Garrett Award.
Please come join me.
(applause)
- She knew more about myself than I do.
(laughter)
I really am in awe, as Josh phoned,
when he phoned me,
I said, there may be a mistake here.
But I tell you, I'm just so grateful
and honored to receive this award,
particularly because two of my mentors
in my professional life received this award
and they were Jean Sanville,
who created her own school
for doctoral MSWs
in Berkeley, California,
and Cleo Eulau was my mentor in Palo Alto,
and she received this award some years ago.
To be in that company, I tell you,
it fills my heart.
I would like to tell you a story about
my son, who graduated from Smith.
But first, it's a story of how social work
is in our family's DNA.
My wife was a social worker when I met her,
and when I came to Smith, I was placed in Rochester,
and then, there we got pregnant and we came back
for the summer.
Our son Greg was born.
And one day he phoned me and said,
Dad, you know, I'm not, I don't wanna be
in political science anymore.
And I've been doing some community work
with Joan Baez Center for Humanitas,
and I've been a case worker for Tom Lantos,
who is, was a congressman
from San Mateo county district
and was in Washington, and Greg did an intern there.
And he said, but I was a migrant case worker
for that office in San Mateo,
and I really like talking to people.
And, you know, I said, he says over the phone,
Dad, I said I might think about getting a PhD
in psychology, but you know, I did send for the catalogue
for the Smith School for Social Work for where you went.
For social work where you went.
I'm thinking of becoming a social worker.
And he said, but Dad, I have a question to ask you.
This was over the phone.
And I said, sure, Greg.
I said, that's wonderful that you'd consider that.
I'm really pleased, if that's your decision.
He said, but Dad, I wanna ask you,
why did you complain so much?
Did you like social work?
And I said, I complained?
I can't believe I would complain.
I love this field.
You know, social work is so amazing
in that you can be a counselor,
you can be a psychotherapist, you can be
a community organizer.
You can even be a CEO of an agency,
and you can, like I was, or you can have a private practice.
And you can do anything you want and you can move
from medical social work to group social work,
and it's a field that you can do so many different things
and be a professional social worker.
And I said, but I don't, can't imagine complaining.
And I said, but I'll think about it and let you know.
So I thought about it and I thought,
I never complain, I love this field.
It really, you really feel like you're making a contribution
and to work with people and groups
on a one to one basis and see communities change.
I mean, it's a, it just does something to the spirit
and makes you feel whole.
So I didn't understand it,
and then I thought, ah, I know what I was complaining about.
So I phoned him up and I said, Greg,
I never complained about the field.
The only thing that I complained about
was the money.
There wasn't much money in it.
But that didn't stop him.
He came to Smith.
In fact, he was born, as I said, Carla was pregnant
when we were in placement, and I think he was
the first baby on campus in 1968,
and he's been a social worker ever since his birth.
Thank you very much for the award.
It's really, I'm honored.
(applause)
- I feel like Vanna.
So it's wonderful wonderful to see you all here,
and to welcome you to this lecture
and to the annual conference.
I want to thank, add my thanks
to those that Marianne shared,
as did the Provost, to all of our field affiliates
who are here, supervisors, directors of training,
faculty field advisors.
I say it every single year, I mean it every single year.
We could not do this work without you.
I also wanna add my thanks to my field team,
my administrative support, and my very able
associate and assistant directors of field,
Katelin Lewis-Kulin and Maria Del Mar Farina.
I'm also incredibly touched to see
two of our long-time field faculty receive this award.
I think it's very fitting and it's a great pleasure.
It's also my pleasure to introduce to you tonight
Mary Olson, who is our keynote speaker for this evening.
Dr. Olson received her B.A. from Wellesley College,
an M.S., a Master's Degree in English and Comp. Lit.
from Columbia, then came here and did
an MSW degree at the School for Social Work
and then got a PhD from the Department of Communication
at UMass in Amherst.
She's a gifted clinician who has over 30 years
of clinical experience with children, adults, and families.
She maintains a private practice,
and currently serves as the executive director
of the Institute for Dialogic Practice,
which is work that we're gonna have the privilege
of hearing much more about this evening.
She's wonderfully gifted teacher.
She's taught clinical practice, theory, and research
at a number of institutions, including Smith College
School for Social Work, the UMass School of Medicine
and the Department of Psychiatry,
the Family Institute of Cambridge,
the University of Helsinki,
and Jyväskylä, did I, I didn't say it right, did I?
Did I nail it?
Jyväskylä University in Finland,
where she served as a Fulbright Professor
in the Department of Psychology.
She's currently the co-principal investigator
for a project funded by the Foundation for Excellence
in Mental Health Care on adapting
the Open Dialogue model in the US.
And has served as co-principal investigator
on a number of other major grant-funded projects
including one from the National Science Foundation
on empowerment for the elderly
through assisted technology.
She's the author of numerous articles and book chapters
on family therapy, anorexia, feminist practice,
managed care, and of course Open Dialogue.
She's a highly sought after speaker,
both here in the States and internationally,
and we're delighted that she's joining us here this evening.
So please join me in welcoming Dr. Mary Olson.
(applause)
- Well, it's a great honor and privilege to be here.
Can you hear me?
Oh, I gotta stay by the mic, okay.
It's a great honor and privilege to be here,
and I'm really delighted to be able to talk to you tonight
about Open Dialogue and my experience in Finland.
I really appreciate the invitation from the faculty
to do so.
I graduated from this program many years ago
and it has provided a wonderful foundation,
which it continues to do as I am able to wtiness,
with my current students and also graduates
of this program who I continue to work with
in the field.
So.
Let me start by asking how many of you
know something about Open Dialogue,
are familiar with it.
Okay, that's quite a bit.
All right.
Okay, Open Dialogue is an innovative,
social network approach to
the most severe psychiatric crises
and conditions.
It was developed by a team led by Jaakko Seikkula,
Birgittu Alakare, and Uka Altenin,
at Keropudas Hospital in Tornio, Finland,
which is in western Lapland,
which is in the northwest corner of Finland.
It's a province of about 70,000 people
on the Swedish border.
Open Dialogue is both a system,
a way of organizing a treatment system,
and it's a form of therapy in that system.
It has garnered international attention
for its outcomes for first-time psychosis.
There were two five-year studies,
and 80% of Open Dialogue patients
were working, studying, or looking for a job
at the five year marker.
Integrating key insights from psychoanalytic
and psychodynamic approaches to trauma and psychosis,
Open Dialogue is rooted in, nevertheless,
in the systemic family therapy tradition
that descended from the work of Gregory Bateson
and made language and communication central.
It also benefits from the influence on this tradition
of the writings of Mikhail Bakhtin,
who is mostly an incomprehensible Russian philosopher,
but nevertheless.
But particularly his concept of dialogue
as a model of the living world.
Open Dialogue pioneer Jaakko Seikkula
was the first to conceptualize therapeutic conversation
as dialogic in Bakhtin's sense.
And we'll be, I'll be trying to clarify
what that means.
The unique geography of Finland,
its position between Russia
and the West has allowed for this
idiosyncratic cross-fertilization
of ideas and practices from Russia, Europe,
and the United States.
So, here's a map.
You can see that Tornio is right beneath
the Arctic Circle.
And there's been a lot of cross-fertilization
between the group in Tornio
and one in Tromso,
which is the northern rim of Norway.
And the work of a person named Tom Andersen
who invented something called the reflecting team
and reflecting process work.
But I'm really gonna start,
the first part of this talk,
by describing my own connection to this work.
As Gregory Bateson said, epistemology, or,
which is a fancy work for the way
that we think, our style of thinking,
our rules for thinking,
is always personal.
The point of the probe is always in the heart
of the explorer.
So I'm gonna tell how I discovered Open Dialogue
and the ways in which I think it altered my practice
starting 15 years ago
when I encountered this radically different
kind of work.
And then I'm gonna go on, the second part
of the talk, I'm gonna talk about why now.
Why is there a growing interest in the United States
in Open Dialogue.
Project directors at Samsa and NIMH,
these are the two major federal funding agencies
in the United States, have expressed great interest
in supporting an Open Dialogue initiative,
hopefully they're gonna support ours,
at UMass Medical School.
I co-lead a research project there
on the adaptation of Open Dialogue to the US.
But the question is why now is there this keen interest,
whereas several years ago, we were told
that our work was just too different
and that we would never get funding for it.
So, talking about this growing interest
is gonna require my sketching
the historical and cultural forces
that are shaping the introduction of Open Dialogue
into the United States.
Just briefly, let me say that,
as you may well know,
in the last two decades,
the dominant discourse of psychiatry
has been something called biological determinism.
That sees symptoms as biochemical processes
to be treated primarily with medication.
In contrast to this perspective,
Open Dialogue believes in responding
to the whole person in a context.
Now what's happening at the various highest levels
of academic research is that there is recognition
that biological determinism, that this linear,
decontextualized, simplified view
of the brain as a thing
has very many,
has a great variety of problems.
And what I'm sensing is that there's a paradigm shift
underway.
And the interest in Open Dialogue is reflecting that.
I think that there is a shift toward
reestablishing psycho-social care
in the treatment of the most severely troubled
and distressed and disenfranchised people.
So.
And thirdly, at the same time that I wanna describe
this approach and why I'm interested in it,
I also want to state
that there is a need for caution
in bringing a method and a system from another place,
and that for this to really be viable in the United States,
there has to be extensive adaptation.
Particularly because of our diversity of population.
So let me start with my own history.
My discovery of Open Dialogue was serendipitous.
Now, people who know me know that I love language
and I love words, so,
in preparation for this talk I looked up serendipity,
and Wikipedia says that serendipity is the accident
of finding something good and useful
without specifically searching for it.
It was coined by an art historian named Horace Walpole
who in 1754
wrote a letter using this word for the first time,
basing it on a Persian fairy tale,
the Three Princes of Serendip,
whose heroes, he said, were always making discoveries
by accident or sagacity,
of things they were not in quest of.
Serendipity is based on the Sanskrit serendip,
which means golden island.
Now, I think what I wanna make clear
is not only was my discovery of Open Dialogue
marked by serendipity, but Open Dialogue itself,
by fostering a context for listening,
emphasizes a more collaborative, open-ended,
and yes, serendipitous conversation,
in which the aim is to generate a common language,
or dialogical dialogue,
in contrast to trying to
simply immediately eradicate
symptoms based on an expert-driven
or "monological" discourse.
It was Foucault who best
identified the political nature of not having
a common language in psychiatry.
Foucault said that the absence of a common language
in psychiatry, in other words,
a shared language,
is a formula of social exclusion.
He also said,
and he wrote in Madness and Civilization,
as for a common language,
now he's talking about in psychiatry,
there is no such thing any longer.
The constitution of madness as mental illness
at the end of the 18th century
affords evidence of a broken dialogue.
The language of psychiatry, which is a monologue
of reason about madness, has been established
only on the basis of such silence,
meaning the silence of the voice of madness,
the silencing of the voice of suffering
from the perspective of the person suffering.
So.
And by common language, I wanna add something else,
which is that we don't just mean words.
I was really delighted to
be and to hear the panel on Monday night
talking about their work,
and I thought to myself when I heard about hip hop therapy,
which uses rap music to engage urban youth
who are turned off by talk therapy,
as an example of a very creative dialogic practice.
So dialogue and engaging dialogue
can take many many forms.
So, my journey into Open Dialogue
was through an unlikely door.
About 15 years ago, I was invited
by the then dean for social work
at Smith College, Anita Lightburn,
to participate in a research study
on the effects of managed care
on children and families.
I was part of a group that included Phoebe Sessions
and Allen Coffee Pulleyblank,
and I was interested in this because of what
I was experiencing professionally at the time.
In the mid-90s, in the Pioneer Valley,
there was a sea change when managed care
started to come in and shape the mental health field.
Up until that point, family therapy had flourished
and there had been family therapy teams
and family therapy training programs.
After the arrival of managed care,
family therapy teams started disappearing
from ordinary clinics and agencies,
and family therapy training programs
started to shut down.
The program that I had spent five years building
at Berkshire Medical Center
was dismantled in five weeks when we merged
with another agency under the new,
restrictive economic context.
So, at that point I thought that family therapy
was facing extinction and I was wondering,
are these just bad ideas?
We were just mistaken?
They don't make any sense, you know?
What had drawn me to family therapy in the first place
with the idea of trying to understand an individual
in a context.
So when Anita Lightburn invited me to join this study,
I leaped at the chance,
and what I found was that it began to shape an answer
to what was happening and why systemic practices
were disappearing from public settings.
We interviewed stakeholders
in the northeast and
we interviewed people in community mental health,
we interviewed administrators, front line people,
psychologists, social workers,
insurance companies.
And what we found was a virtual consensus.
At that point, there was an ascendancy
of psycho-pharmacology,
and a downplaying of all relational therapies,
including family therapy.
And in looking back,
what we discovered was a very important trend,
which is that the insurance practices
were the way that the new biological determinism
was established and became routine
in ordinary clinics and practices.
So not only was,
were the insurance companies
shaping reimbursement structures,
they were shaping clinical practice itself.
The subtrends that we found.
Now I also wanna say that the managed care initiative
was propelled by very legitimate aims
and managed care is not a monolith
and there were better managed care companies than others.
But in general, this was the effect on public settings.
Now the reason I'm gonna go over these trends
a little bit more is because
they remain highly relevant today.
There's a new book by a woman, Sandra Bloom,
called, a relatively new book called Destroying Sanctuary
in which she documents that not only do these trends
still operate, they've become amplified.
So, what we found in addition were these subtrends.
There was an erosion of clinical practices
and an emphasis instead on productivity and procedures.
There was the idea that medication is really
the only real thing that you can do.
There is an emphasis on the individual
and reinscribing the individual as the locus of pathology
even if that individual is a child.
There was increased professional isolation
and an absence of collaborative arrangements.
A flattening out of opportunities
for training and supervision.
And so there were reduced contexts for creativity
and innovation.
And finally, the most important trend,
which is kind of a trend about all the other trends,
is that there was a loss of language of the living world.
Dialogue, stories, metaphor, ambiguity, mystery.
Did I say dialogue?
History, stories.
Instead, there was this idea that all human suffering
could be comprehensively,
there was an increasing disposition
to see all human suffering as comprehensively
explained by
a chemical imbalance.
So this was pretty discouraging.
I also wanna say that even though
there were these trends, there were and continue to be
many people, many social workers, particularly,
doing wonderful wonderful work
and helping people despite these
less than optimal circumstances.
Around this time when we were doing this study,
I happened to go hear Carlos Sluzki talk
at the American Family Therapy Academy.
He'd also been my boss for about seven years.
But he was one of the few psychiatrists
and family therapists at the time
who began to speak out about what was happening.
And he talked about the powerful economic
and political interests that were embedded in the decade
of the brain.
The interests of the pharmaceutical companies
and the insurance companies.
And he also pointed out that the idea
of reducing symptoms to biochemical events
allows for the selective inattention to inequality,
poverty, racism, social injustices,
as we look for
the universal brain causes
rather than looking at social and political contexts.
Now, I also wanna say that I am not anti-medication.
Medication is sometimes essential.
But I think we need a much more subtle
and integrative approach.
That medication is not the only real thing you can do.
It's one thing you can do.
But there are other things that are helpful as well.
So he also said, despite his scathing critique,
that in the midst of all this grim picture,
like in one of those doom and gloom science fiction stories
in which, to our relief, in some remote crevices
of the scorched earth, patches of flowers
begin to bloom again.
A variety of systemic practices inspired
by the powerful ideas of the field of family therapy
were still growing here and there,
posing new challenges,
pushing new envelopes.
So.
The next leap in my life I really can't explain.
It's easier for me to say that I had a fairy godmother
that waved a magic wand than to explain
how I got a Fulbright to go to Finland
to study Open Dialogue.
But, I came across Open Dialogue
when I was doing this research on managed care.
And the contrast was astonishing to me.
So in this remote corner of western Lapland,
they had a family-centered,
network-centered approach that was delivering care
in the community and achieving impressive outcomes
with the severest problems.
In contrast to the United States where systemic thinking
was vanishing, in Finland it was being regarded
as a serious agent in the treatment
of the most severe conditions.
And so I became very very interested in this
and when I had a chance to go to Finland,
I leapt at that chance.
So I went to the University of Jyväskylä
Department of Psychology and that's the beautiful bridge
and river.
It's a little murky, the photograph,
but that's the psychology building, there.
And I went there in 2001.
And I was invited there, actually, to talk about research
I had done on anorexia.
And I had done a series of case studies
with women who had recovered at a time
when recovery was a disputed concept
in the eating disorders field,
and it may be still today.
But using a phenomenological approach,
I came to understand anorexia,
at least in the beginning phases,
as something in which women
draw on the language of food and body
to express a dilemma that's unspeakable.
In other words, food and body is a territory
that the culture gives to women,
and women use that territory, that symbolic language
to convey unspeakable dilemmas,
or inexpressible dilemmas that are felt to be,
that they otherwise can't express.
So what struck me about what was happening in Finland
is that the Finnish team also
conceptualized psychosis as a crisis of inexpressibility.
As also stemming from an inexpressible
or unspeakable dilemma.
And they were evoking a similar interplay
of body, voice, and communication.
So, what happened is that these two research areas,
one on larger systems and the other
on embodied communication came together.
Because as I said, Open Dialogue
has this double helix structure.
It's both a system and it's a dialogical practice
in open psychiatric meetings.
So it has these two levels.
So I decided that I wanted to learn more about it
and I arranged to go to Keropudas Hospital,
which is a six hour train ride from the university
where I was teaching, so that I could learn
more about it and I could give a kind of living form
to these statistics.
So I went to Keropudas Hospital,
and I went there in December.
So this is the dark time.
Below the Arctic Circle,
where there was no sun, but there was light.
And I wanna tell you about that experience.
So here's the,
a photograph from outside of my hotel.
That's 8:30 in the morning.
And I left that hotel
and that's what it looked like.
It looked like evening, and it was quite lovely
but nothing I'd ever experienced before.
And I was picked, so I was picked up
by the chief psychologist at Keropudas Hospital,
Kauko Haarakangas.
And we were driving out to the hospital.
And we tried to do small talk,
although that wasn't working because small talk
is not a cultural practice in Finland.
So even though we were both trying,
Finnish silence quickly descended on our conversation.
And so I started looking out the window
and looking at this winter landscape.
And it was one monochromatic field of whiteness.
There were very few buildings.
The river was frozen on our left.
There was a cloudy overhang
that fused the sky and the earth.
And I thought about something that Tom Andersen,
this Norwegian psychiatrist I mentioned earlier
had said in a seminar that had been given
earlier that summer in Sollejellen, Norway,
and I also had the privilege of going to that.
And Sollegjellen, Norway is a desperately beautiful
and barren mining town in northern Norway.
And he started the conference by saying
go to the margins
if you wanna be creative.
So, he said that,
or maybe he said go to the margins
and I added the part about creativity.
But anyway, I was thinking, this is where we must be.
I am on the margins.
So, this is also, kind of what it looked like there.
And so we got to the hospital and I got out of the car
and I really appreciated the no holds barred effect
of winter near the Arctic Circle.
There was a dry and absolute cold.
And we went into the hospital and the morning was spent
learning about Open Dialogue,
Kauko did a PowerPoint presentation
and talked about this work.
But I was about to see it in action
because the head psychiatrist Birgittu Alakara
had gotten a call from a therapist that morning
about a woman who was saying that she was suicidal.
And so Birgittu invited the woman,
I mean, the therapist called about this woman,
invited the therapist, the woman,
an outpatient nurse, and this woman's partner
to what's called a treatment meeting
and I was offered a chance to participate
in that meeting.
So the treatment meeting is the main therapeutic forum
of Open Dialogue.
Within 24 hours of the initial call,
there is a meeting that's called,
in advance of any hospitalization,
that brings together the person at the center of concern,
any family members, any professionals,
and anybody else closely involved in the situation.
The treatment meeting then, thus
brings together the family.
The family is involved from the very beginning of treatment.
And not only did this treatment meeting
reorganize the hospital admission process,
it also changed the therapeutic enterprise itself.
Because professionals were thrown in together
with families and people in trouble
from the very beginning.
And they began to change their clinical philosophy.
Instead of thinking as old-style,
systemic family therapists that they
have to initiate change and make interventions,
they shift it
to a very different kind of practice
influenced by the ideas of Bakhtin,
that their goal was simply
to foster dialogue and make sure
all voices were heard,
and to try to come up with a more shared understanding
of the crisis, to try to help the person
at the center of concern find words
for what was frightening and distressing them,
and that this social weaving
of this assembly of voices,
this polyphonic conversation, to use Bakhtin's word,
became the basis of care.
So, when I walked into the meeting after lunch,
there was a young woman sitting there,
and she was sitting next to the door,
and she was
not making eye contact.
She still had her white puffy parka
with its snowflake pattern on it zipped up.
And the color was drained from her face
and her body seemed inert,
and her spirit seemed also absent.
And next to her was her partner.
So I'll call her Hannah,
and her partner, who I'll call Euke,
was the opposite.
He was dark-haired, he was wiry, he was alert,
his body was turned toward her in a protective way.
He was a social worker, he was also completely fluent
in English.
He sensed my need for a translator
and he began to translate the session.
I had the counter-impression that he was a caretaker
of the first order of magnitude.
Birgittu, the head psychiatrist began the Open Dialogue
meeting in the way we begin,
which is to ask about the history of the idea
to have the meeting.
Whose idea was it to have this meeting?
Who took the initiative?
And because the therapist is the one
who asked for the meeting, she began speaking.
And she described how Hannah
had moved here from another part of Finland.
She had grown up
in a family that had been very abusive.
She had fallen in love with this man.
He was from this area and he was coming back here
for work, and she had come with him.
She knew no one else in the area.
And she had been seeing this therapist
in individual therapy, and she had been,
for several weeks, telling this therapist
that she did not wanna live anymore,
that she wanted to kill herself,
that she had a plan.
And the therapist was becoming very very concerned.
So Birgittu listened and then asked
the fiance, what are your thoughts about
what the therapist had said.
And there was a silence.
There was a stillness, it was completely concentrated.
Although, I must say that I have never felt so calm
in any kind of meeting before.
I felt completely calm and safe.
It was really remarkable.
And I looked at Birgittu's face,
and I was really struck by how open and intent it was.
That there was no suggestion in her face
that she was assessing or scrutinizing this couple.
She was just waiting for an answer.
And the man looked at her and he said something
that stunned all of us.
He said, I get drunk and I beat her.
I then was stunned
and, but I looked over at Hannah
and all of a sudden she
came back into the room
and started to look more alert
and the color started coming back into her face.
It's as if she'd woken up from a dream.
And then, I too began to feel movement
and I turned to her and I said,
she also spoke English,
I said,
which is more dangerous to you?
Your thoughts of suicide or the beatings?
And she said instantly, the beatings.
So now it was really easy to see her position
and to comprehend
what Mary Catherine Bateson has called
the whole contextual structure.
So this man that she loved
also, and that had rescued her from her family,
also was violent and abusive at times.
And yet, she was wholly dependent on him
and knew no one else in the area
and did not have a family to go back to.
My sense was that there was something subtle and powerful
about the stance of the professionals.
John Shotter calls this withness.
As opposed to aboutness, thinking.
Being with rather than doing to.
Bakhtin has a fancy word, dialogicality,
to talk about this sense of being with.
And what happened,
even though this was about something terrible
that was happening, there was a common language forming
that gave this young woman a voice.
And so, you know,
I was really struck because I'd worked in emergency rooms
and I don't think I'd ever experienced
such a rapid shift in perspective.
So after this experience I decided to do,
to learn more about it, to do some research.
I did a very, sort of a, what could be loosely described
as an ethnographic study.
I teamed up with Jaakko Seikkula
and we did writing together.
And then I came back to the United States.
So let me just quickly kind of review
before I go on,
and just kind of speak in a little bit of a different voice
and give somewhat of a brief overview of this approach.
There are these seven principles.
These are the principles that Kauko had outlined
in his PowerPoint presentation.
Immediate help, the team meets within 24 hours.
A social network perspective.
You can distill the aim of Open Dialogue
to reducing psychic and social isolation.
So bringing everyone together
to try to figure out what's happening.
Flexibility and mobility.
There's geographical flexibility,
there's clinical flexibility.
This is not an approach that strives for theoretical
or clinical purity, so it's very integrative.
It brings in ideas and insights
from various traditions.
The responsibility of the therapist,
the therapist is responsible for organizing the services.
Psychological continuity, meaning that the team
that comes together within the first 24 hours
remains your team during the duration of the crisis.
Tolerance of uncertainty means that
it's really a relationship to time,
that to try to develop an organic understanding
of the situation, integrating the voices
of everyone present means that you have to be able
to tolerate the uncertainties so you can build
the plan and the decisions
based on an organic understanding.
So there's an avoidance of hasty decisions
and quick assessments.
And finally, dialogue, which I'm gonna say more about
a little bit later, but the aim of dialogue,
the aim of the meeting is simply to create dialogue.
I also analyzed this practice using
these two levels of the micropolitics and poetics.
The micropolitics being the institutional practices,
and the poetics being the dialogue
and the language practices.
And what's happened over the last 10 years
is that the dialogic practice has also been adapted
to more ordinary kinds of couple and family therapy
So now we talk about dialogical therapy
that shares many of the same psychotherapeutic principles,
but it's not embedded in this overarching system.
Finally, just to highlight two important key assumptions.
In contrast to traditional family therapy,
the Open Dialogue approach and dialogical therapy
does not view the person or the family
as the cause of the psychosis or the cause of the problem.
It really takes a kind of ideological agnosticism
saying we really don't know what causes
these severe crises and conditions,
but that bringing people together in a crisis,
not separating people seems to be particularly
important in these severe situations.
The other is that it's a meaning-driven,
language-driven view, say, of psychosis.
That psychosis is a terrifying, alienating,
temporary estrangement
from shared communicative practices.
It's a no-man's land where a person
has no genuine voice or agency.
So there's a great emphasis in this way of working
on constructing voice, constructing agency.
And in contrast to the way we tend to work with people
in these states, they start from the very beginning
in engaging a communicative process.
Here are the outcome studies, which is I think
the whole reason we're here,
the whole reason we're talking about it.
So, in terms of medication use,
two-thirds of their first-time psychosis people
are not put on anti-psychotic medication.
In terms of relapses, almost 70%
did not have a relapse within the five years,
and these statistics are pretty consistent for both
five year followup studies.
80% have very, have residual,
very light residual or asymptomatic at five years,
and then the functional outcomes,
80% working, studying, looking for a job
and only 20% on disability.
The best longitudinal research that we have
in the United States is Martin Harrow's work.
And he has found that a comparable statistic
in the U.S. would be 5% recovery rate.
So, for this reason, people are trying to figure out
what are they doing right.
So, coming home.
So I came home
from this experience
and I found people
at Smith College School for Social Work
who were interested in Open Dialogue.
I found like-minded people at UMass medical school.
But, as I said, we wrote grant applications,
we did our best,
and we repeatedly did not get funding for this research.
But at the same time, I began,
in my own clinical practice
to experience
startlingly positive outcomes
in working with young women and their families
with eating disorders, depression, cutting,
psychosis, and I think that,
though not in every case,
but what was different in my own practice,
I would say, is that
I started to drop the clinical gaze.
And even though I thought I didn't have a clinical gaze,
'cause, you know, I was feminist, I was systemic,
and social justice, and all this stuff,
but I did.
And I remember the moment that it was gone.
And it doesn't mean that you don't use your expertise,
you just use it much more lightly.
And instead of looking for the crazy thing
in the person and family,
I simply tried to make sure that everyone was heard.
And the difference, I think it created a kind of
openness of mind
that families, that people can sense.
And it's very subtle, but it's very powerful.
There're two quotes
that tended to capture, I think,
the effect of this work on my own practice.
One is by the architect Christopher Alexander
who talks about aliveness in architecture,
and I felt there was a new aliveness in my clinical work,
and I was struck with the idea that
the more we learn about this method,
and I would say this dialogic practice,
the more I found it doesn't so much teach us new processes,
but rather opens up a process in us
which is already part of us.
And that was my experience.
And the other is Peter Rober
talking about dialogue is a space
where life can come.
Okay, so I said that I would talk
a little bit about.
Let me just say before I go forward,
the really, the ground of my conviction about this work
is my own lived clinical experience
in tandem with what I saw in Finland.
But the shift in my own clinical practice
and the way my own clinical work started to flourish
is what has kept me going.
But let's think now,
I wanna turn now to talk about
the cultural and historical factors
that are shaping this interest in Open Dialogue
at the present time.
So as I said, you know, biological determinism
has shaped the mental health field,
but now, at the highest levels,
there's the recognition that this way of thinking
has some serious problems.
And here are, I think,
the various reasons why
this perspective is being rethought.
The first is that, as has been brought forward
by the work of Robert Whitaker,
U.S. psychiatric disabilities
have increased, actually, they've skyrocketed
for children and adults over the past 20 years.
The reasons for this are not well understood.
Whitaker's perspective is that the medications over time
tend to chronify sever difficulties.
It's probably more complex than that
because there have been profound changes in work patterns,
in welfare reform.
I think it's a much more complex picture.
But this has been well-documented,
that psychiatric disability rates
have increased exponentially in the last 20 years.
The other influence is the rise of the recovery movement
and the testimonies of psychiatric survivors
and mental health consumers
who have really formed a world wide movement
that has been propelled by the internet.
So psychiatric survivors in Germany can compare experiences
with people in the United States.
So this has become a very powerful lateral
social and political movement,
and they have testified to
what they feel are dehumanizing practices,
hasty insurance-driven treatment decisions,
and an over-reliance on medication.
Their power and their influence is important.
I think that this is probably one
of the most important things that has come out
of the mental health field in the last 20 years.
But it also means that if somebody wants
to do research,
it's now impossible to do research without including,
and I think this is a very important ethical shift,
without including the voice of the consumer,
the voice of the psychiatric survivor.
And psychiatric survivors and consumers
have embraced Open Dialogue.
They see it as the one clinical approach
that is consistent with the values and principles
of their movement.
I think the third factor is that
genetic researchers and psychiatric epidemiologists
are now inferring social factors,
say in the study of people
diagnosed with schizophrenia.
The diagnosis of schizophrenia is also being deconstructed.
Understood not as a discrete disease entity,
but as a cluster of symptoms.
But I don't wanna get into that right now.
But, for example, psychiatric epidemiologists
have shown that if you're a person of color,
your chances of being diagnosed with schizophrenia
increase greatly the whiter your neighborhood becomes.
The diagnosis of schizophrenia is also corollated with
disruption of social network and immigration.
There is an enormous literature on that.
Genetic researchers also have failed to produce
any kind of single gene for, say, schizophrenia.
Now there may well be a genetic contribution,
but there's so many genes that are involved, it's dizzying.
So the idea that it could be distilled to one gene
is really a hypothesis that has failed.
And finally, it's become clear that these medications
have very serious side effects.
They affect brain tissue, they're associated
with metabolic syndrome, and people who are longterm users
of anti-psychotic medications,
it's been shown that their life expectancy
is 25 years less than people
who do no take these medications.
So it would have been really wonderful
if we could do research and come up with medications
that could cure the human suffering.
But it's turned out to be much more complicated.
And as I said, this is well known at the highest levels
of academic research.
And the highest levels of academic research,
no one believes in the chemical imbalance theory anymore.
There's also some other troubling trends.
The use of anti-psychotics in children with Medicaid
is four times that of children in the private sector
and for less serious conditions.
13 to 15% of foster kids are prescribed psychiatric
medications compared to 4% of non-foster kids.
So these medications, the other troubling trend
is these medications are being used disproportionately
with the most vulnerable and the most disenfranchised
population, so why is that?
If this is an objective disease.
So.
The other part of this
is that neuroscience is beginning
to show that the brain
really does not operate like a thing.
Its logic is not linear, it's not cause and effect.
It's dialogical, it's systemic,
there are feedback loops.
It's much more like a network.
There's a group in Switzerland that's mapping
the architectural and functional principles
of the brain, and the metaphor that they use
is the brain is like a symphony.
Of course, it's also a chemical entity.
But its organizing logic is probably musical
and communicative.
So, and this is not to say,
at the same time, that these medications
aren't necessarily helpful.
As I said, for come people they're helpful.
Why they're helpful is not really well understood.
It's more empirical rather than theoretical.
And it also may be, like many things in medicine
and many things in the biological living world,
that these medications have time factors.
In other words, if you go on prednisone for your asthma
you can't stay on that indefinitely.
So this is being understood and there's a rethinking
of this simple idea that a severe symptom
is a biochemical event, it's a brain,
it's a chemical imbalance that can be repaired,
like insulin is to diabetes, with the right medication.
And that really, we have ben in the grip of a false idea.
So what's changing is, and I think one of the reasons.
Now again, I don't what you coming away from this
thinking Open Dialogue means no medication.
Because medication is used, but it's used
in a pragmatic way.
It's used to facilitate social participation,
rather than in a theoretical way to fix an imbalance.
I think over time, the paradigm shift
that we are going to be seeing
is a shift from biological reductionism
that treats symptoms as biochemical processes,
the brain as a thing,
to a dialogical approach that responds to a suffering person
in a context, and that the mind is a relational process.
This has enormous implications for the social work field.
Open Dialogue is a more collaborative, egalitarian,
less hierarchical way of organizing a system,
and I think clinical social workers
are poised to be leaders in bringing forward
this new way of thinking and this new practice.
I wanna just say a little bit more
just to,
so there's truth in advertising.
I, so.
So this is the project that I'm working on.
I hope I mentioned that I'm working together
Jaakko Seikkulak, who telecommutes from Finland,
Skype commutes, and also comes here
once or twice a year, and also Doug Ziedonis,
who's working with us, and he's Chairman
of Psychiatry at UMass Medical School.
So this is really remarkable that a Chairman of Psychiatry
of a major medical school would be working with us
to try to bring forward this Open Dialogue approach.
And one of the things that we've done so far
is we have done what you need to do
in order to do research.
we got funded by the Foundation for Excellence
in Mental Health Care and we spent the last two years
doing the preliminary work, developing
the research protocols and materials you need to do
for clinical study.
We have, if you're interested, I'm not gonna go over this
right now, but if you're interested, there is something
that we've, we have a finished product that you can download
from our website called the 12 elements
of dialogic practice.
Like, 12 is I guess a mystical number.
I don't know why we came up with 12, but.
But this will soon be available on our website.
I call it, it's an anti-manual manual,
because I couldn't tolerate, as an English major,
the idea of writing a manual about something.
So instead of writing a manual,
we tried to distill what the elements were
and then give examples from our own practice.
It's not a cookbook, it's not a how-to.
Finally, though, I said that I wanted to also
give a word of caution.
And that is to say that
I think, despite the great appeal of Open Dialogue,
the promise of Open Dialogue,
that
it's an idea that we really need to understand more deeply
and how it would actually work
in our own context, in our own society.
You know, for example, I think one of the things
that has allowed Keropudas Hospital
to achieve the outcomes it has achieved
is that it has a very good relationship
with the Rural County Employment Office.
So they're able, because of this relationship,
to get people back to work.
Now,
how can that be replicated.
If you get people back to work,
that's a self esteem issue,
you're gonna manage your symptoms,
you got a job, you're in a natural network,
so there're all these benefits.
So I think we really have to think carefully
and think about how we're gonna adapt this
and be cautious about the claims we make.
I think there's a danger, also,
in saying, you know, Open Dialogue is this new,
magical, miracle cure,
because everything is contextually shaped.
You know, maybe the outcomes that they got,
you know, sometimes they use the analogies,
like the Beatles, you know.
You had this particular idiosyncratic group
of therapists working together,
and how do you replicate that?
So I wanna quote Gregory Bateson and say
behind every scientific advance,
there's always a matrix, a mother load of unknowns
out of which the new partial answers have been chiseled.
He advises us to be careful, not to rush in
where angels fear to tread.
So with that,
I'll end my talk.
(applause)
Should we take a few questions?
Yeah?
- [Voiceover] We have time for a few.
- Okay.
Yeah.
- [Voiceover] It's an observation.
So I was just struck in your case example,
when you spoke of speaking to the fiance
and you said that in reference to the woman,
but my reaction was to the man,
before the woman, the man had spoken,
and when I think about it, I think
it's a tribute to the approach being
not just a focus on prior expectations.
But this then allowed him, also,
to think about where he was going wrong.
- Absolutely, I couldn't agree with you more,
I couldn't agree with you more.
Absolutely, absolutely.
He spoke the unspeakable, and then that allowed
for her to acquire a voice.
So even though he was doing something terrible,
he also had the humanity to throw her a lifeline.
- [Voiceover] He needed help as well.
- And to find him,
yeah and so, and so
they define, so instead of being alone,
he was defining himself now
as somebody who was in need of help.
And I don't know if I mentioned this,
I meant to, but I may have forgotten it,
being a little nervous.
They referred him to a program,
they have very good programs,
they were starting to have good programs then
for men who are violent toward their partners,
so he accepted that referral.
So it really made the situation much less dangerous.
Yeah.
- [Voiceover] Can you say a little bit more about
the way that you can see adaptations to the model
(mumbles)
- Well, I mean, I think that
the next step is that we are gonna see
and this is, we just wrote another grant
in which we're gonna try to see if we can,
there isn't a lot of money,
but we're gonna try to see if we can
organize treatment meetings in the UMass
Emergency Room.
And to see if we can have three meetings.
We have two people in the Emergency Room.
We also, Peter Rober and I and Jaakko Seikkula
have been running training seminars
and we have people come from different agencies
to train with us and to learn this approach.
And we have two people in the Emergency Room now
who have been through two years of our training program.
And so we're very fortunate to have a nurse practitioner
and a clinical social worker who
now are two of the 50 people in the country
who are trained in this way of working.
And so we're gonna see if we can launch this
with 10 families and see,
see if it's feasible.
You know, can we do it?
Do the families accept it?
Do they come back?
Is it possible within the Emergency Room?
Yeah.
- [Voiceover] In some ways, the model,
the very systems are not foreign,
it seems to me, in terms of social work.
- Absolutely, absolutely.
- [Voiceover] We're probably one of the professional groups
that has looked at the total arena of the individual.
- Absolutely.
I feel that and I also feel that the curriculum
at the Smith College School for Social Work,
this, you know, the excellent clinical training,
the ability to zoom in on the individual,
but also to look at the wider environment,
I mean, this is exactly the curriculum,
exactly the training that prepares people
to do this kind of work.
And we've had extraordinary graduates
in our program come through our training program
and they're like ducks to water.
And I think you need both,
you know, one of the things about Finland,
it hasn't kind of divided the psychoanalytic
and the systemic in the way that it's been divided here,
so they draw fluidly form both sides of that.
And I think it's very important to be able
to do that and to have as broad a perspective as possible
when you're confronting these great challenges.
Yeah.
- [Voiceover] I've come to be inspired by your vision
of a coming paradigm shift away from the biochemical model.
At the same time, I wonder what it will take
for these dialogic concepts to take purchase
in the minds of big pharma or insurance company executives.
- Well, you know, I just was in Nashville, Tennessee,
I've never been there before, talking to
managed care executives,
many of whom are also fundamentalist Christians.
And a couple of 'em said, you're doing the Lord's work.
So maybe, who knows?
Okay, one more.
- [Voiceover] Yes I'm also cautious
with the paradigm shift that you had mentioned.
Would you say in juxtaposition to this
that there's also a paradigm shift
that at least we feel this in Canada
where people are wont to do more natural things,
looking at all the things that new immigrants
things that they used in their country,
and so this then, in essence, will be helpful
to you to make this shift.
- Absolutely, absolutely.
Absolutely.
Yes, I think it resonates with something,
I think people feel, it's not that,
you know, again, it's not to be anti-medication.
It's just, it's not sufficient to address
these problems and difficulties,
and I think people intuitively know that.
Yeah.
Okay, well you've been a wonderful group
and thank you for coming.
(applause)
- Thank you all so very much.
Mary, that was an absolutely wonderful,
wonderful presentation.
Thank you.
And I have someone's cell phone from the dinner.
If anybody's missing one.
Thank you.