More On Open Dialog

For my original piece see here;

for Marian’s response go here

And this is my latest response:
Hi Marian — I agree with your excellent insights and cautions here about Open Dialog. As you point out, there is great peril working with families; I do believe that, sometimes but not always, the healing and recovery of survivors of abuse is better served by the survivor confronting the abuser and changing power dynamics in the family, rather than separating from the family. Often survivors need tremendous support to go up against a power structure that has silenced and discounted them, and the job of counselors in family systems is to bolster the person as an ally so they can take on that challenge. This may involve continued risk of abuse, but I think that eliminating all risk is not always the best or only approach: people sometimes need the option to take a risk as part of a larger goal. I personally wish I had some kind of support to do this with my family; without that support I did what was for me second best, separating from them for years.

Sometimes survivors of family violence themselves don’t want separation, though they do want fundamental change. Separation may also not be immediately feasible because of circumstances (which should be addressed, such as the possibility of economic independence or independent housing.) I support both paths depending on the person’s self-determination, either is not going to be right for everyone, and I think it’s crucial to recognize the power imbalance between survivor and perpetrator and give the survivor a context and means to defend themselves, assert their power, and change the relationship.

I would tend to agree that Soteria is in many ways more promising as a model, but I also, as much as I love Loren, Voyce, Alma and the rest of the Soteria people I’ve met, don’t want to idealize things. Soteria does also risk some of the same dangers of professionalization, as it was also run under clinical administration by professionals in a medical context. I would hope that Soteria counselors can help clients to work with changing family system dynamics if that is what they want to do, as well as providing a safe  sanctuary away from the family.

Family abuse and violence are complex; victimized family members are usually not just injured, but they are trained into a role of learned helplessness and traumatization. There is an ongoing relationship of disempowerment and an internalization of the oppression. This is why people sometimes leave abusive families and then suffer repeating patterns of oppression and abuse for years or even their whole lives afterwards: the abuse becomes a learned and habitual role dynamic that they carry with them. One of the terrible impacts of abuse is how the abuser can live on inside of us. Separation from the family may be a vital and necessary ingredient for recovery, but overcoming the socialized role dynamic, and unlearning those conditioned responses
can be even more important for independent lives. It may be easier to leave the family than to fight it successfully, but the rewards for fighting successfully can sometimes be greater.

I think we are all better off the more effective alternatives we can point to. My exposure to Open Dialog is more limited than Soteria but I do find its success rates without medication very inspiring.

Soteria did receive referrals through area hospitals and so did not escape the ‘patient’ terminology in its admissions.  I think the goal here is to leave the medical system behind, since social and human problems are not diseases. Every culture in history has had specialists dedicated to healing, however, and I do think that specialization is in itself not objectionable, though I’d hope that we can universalize the knowledge of wellness and caring throughout our culture. I would like to see non-medicalized, community support options for people in extreme distress that would remove the DSM and individual pathology approach completely, and instead consider community social networks in need of attention, resources, and help from the community as a whole, rather than professionalized services targeted towards pathologized individuals. Family systems approaches
avoid locating problems individuals and instead see problems in the web of relationships between people, and in an era of biomedical absurdities family system approaches can often be a step in the right direction.

As we learn about alternatives like Open Dialog I do feel they need to be scrutinized with great vigilance, especially by survivors, to keep them honest and open to feedback, rather than see them as monolithic solutions beyond criticism.
– Will Hall

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