【翻譯練習】「開放式對話」之對話式作法要點：真實性準則
THE KEY ELEMENTS OF DIALOGIC PRACTICE IN OPEN DIALOGUE: FIDELITY CRITERIA
日期：September 2, 2014
作者：Olson, M., Seikkula, J., & Ziedonis, D.
來源： http://umassmed.edu/psychiatry/globalinitiatives/opendialogue/
瑪莉．奧森(Mary Olson)博士*
亞科．塞庫拉(Jaakko Seikkula)博士#
道格拉斯．齊多尼斯(Douglas Ziedonis)醫學博士／公共衛生碩士(M.D., MPH)*
* 美國，麻省大學醫學院(University of Massachusetts Medical School)
# 芬蘭，於韋斯屈萊大學(University of Jyväskylä)
This work has been supported by a grant from the Foundation for Excellence in Mental Health Care awarded to Dr. Ziedonis at the University of Massachusetts Medical School.
本研究由麻大醫學院齊多尼斯教授所獲之卓越心理健康照護基金會(Foundation for Excellence in Mental Health Care)獎助金支持。
The intent of this document is to support the development of an Open Dialogue practice for whole teams participating in Open Dialogue meetings, for supervision and training purposes, and for helping in systematic research. These teams can also be used for “self-reflection” by an individual practitioner.
本文之目的為支持開放式對話之實務發展，參與開放式對話會談之整體團隊可蒙獲益處，達成督導與訓練的目的，並協助系統性研究。團隊亦能以個人為單位，進行「自我反思」(self-reflection)實務。
The authors share the copyright of this work. The material may be distributed in whole with the authors’ permission. Please contact Dr. Ziedonis if you are interested in translating this work to another language. Douglas.Ziedonis@umassmemorial.org
作者分享本文之著作權。全文得經作者同意方可傳布。如欲將本文翻譯為其他語言，請聯絡齊多尼斯教授：Douglas.Ziedonis@umassmemorial.org。
This work should be cited as follows:
本文需以如下形式引用：
Olson, M, Seikkula, J. & Ziedonis, D. (2014). The key elements of dialogic practice in Open Dialogue. The University of Massachusetts Medical School. Worcester, MA.
“Dialogic Practice” arose from “Open Dialogue” as an approach to help persons and their families feel heard, respected, and validated. Starting in 1984, at Keropudas Hospital in Tornio, Finland, staff already trained in family therapy decided to change the way inpatient admissions were handled. Following the work of Yrjö Alanen (1997), they altered their response to acute crises by having a network meeting, bringing together the person in distress, their family, other natural supports, and any professionals involved, in advance of any decision about hospitalization. This was the birth of a new, open practice that evolved—in tandem with continued clinical innovation, organizational change, and research--into what has come to be known as “Open Dialogue,” first described as such in 1995 (Aaltonen Seikkula, & Lehtinen,2011; Seikkula et al., 1995). The “openness” of Open Dialogue refers to the transparency of the therapy planning and decision-making processes, which take place while everyone is present. (It does not mean that families are forced to talk about issues therapists think they should be open about.) From the outset, this network approach was for all treatment situations. Over a ten-year period, this formerly traditional inpatient facility in Tornio was transformed into a comprehensive psychiatric system with continuity of care across community, outpatient, and inpatient settings.
「對話式作法」(Dialogic Practice)源自「開放式對話」(Open Dialogue)之實務進行方法，以協助當事人及其家庭成員感覺受到傾聽、尊重、與認同。芬蘭托爾尼奧市之柯洛普達醫院(Keropudas Hospital)自1984年起採用此法後，曾受家庭治療訓練之醫療人員便決定改變住院許可之核發方式。尤利歐．阿拉寧(Yrjö Alanen)於1997年出版關於精神分裂症之研究著作，此後醫療人員對於急性心理危機之反應，改為舉辦多方會談，將身感痛苦者、痛苦者之家庭成員、其他自然支持、以及任何相關專業人士，聚集一堂共同討論，再決定是否需住院治療，由此誕生出一種全新的開放式療法，演進成為目前所熟知的「開放式對話」；確切而言，此名詞於1995年率先提出(Aaltonen Seikkula, & Lehtinen, 2011; Seikkula et al., 1995)。至於臨床改革、組織變革、以及相關研究，亦隨著開放式對話之產生而持續進行。
開放式對話之「開放性」，意為療程規劃及決策過程為透明公開，每人皆在場進行，但不代表家庭成員被迫對於治療師認為應公開談論的話題發表意見。起初，此種網絡連結方式用於各種治療情形；10年內，開放式對話從芬蘭托爾尼奧市住院對象原本之慣用療法，搖身一變成為精神科之綜合系統，對於群體成員、門診對象、以及住院對象，皆提供持續性照護。
The practice of Open Dialogue thus has two fundamental features: (1), a community-based, integrated treatment system that engages families and social networks from the very beginning of their seeking help; and (2), a “Dialogic Practice,” or distinct form of therapeutic conversation within the “treatment meeting.” This current document divides Dialogic Practice into twelve elements that describe the approach of the therapist(s) in the treatment meeting to the person, their network, and all the helpers.
因此，開放式對話具有二項基本特徵：(1)以群體為基礎的整合治療系統，自家庭成員及社群網絡於最初尋求協助之始，便將其納入參與對象；(2)使用「對話式作法」，或可稱為「治療會談」當中的另一種治療交談形式。本文列舉對話式作法之12項要點，敘述治療師於治療會談中，與會談當事人、社群網絡、及所有協助人員之對話方式。
The treatment meeting constitutes the key therapeutic context of Open Dialogue by unifying the professionals and the network into a collaborative enterprise. Thus, Dialogic Practice is embedded in a larger psychiatric service that shares its premises, because it is essential to have both aspects. The Open Dialogue approach is an integrative one in which other therapeutic modalities (Ziedonis, Fulwiler, Tonelli, 2014; Ziedonis et al, 2005; Ziedonis 2004) can be added, adapted to the needs of the person and family, as part of an unfolding and flexible “treatment web” (Hald, 2013; Seikkula & Arnkil 2014).
治療會談集結專業人士及網絡成員，形成一種協力企業，以此方式建構開放式對話之主要治療情境。由於層面較廣大之精神健康服務，亦擁有上述二項開放式對話之特徵，對話式作法與精神健康服務共享場域，並於其中具體呈現。開放式對話屬於綜合型態，可加入其他類型的物理療法(Ziedonis, Fulwiler, Tonelli, 2014; Ziedonis et al, 2005; Ziedonis 2004)，並進行調整，以符合當事人與家庭成員需求，成為開展且具有彈性之「治療網絡」一部分。
There are seven basic principles of Open Dialogue, which are the overarching guidelines that the Finnish team originally proposed (Seikkula et al., 1995). The principles are listed in the Table below:
開放式對話有7項基本原則，此原先為芬蘭治療團隊所規劃之通用指南(Seikkula et al., 1995)，如表一所示：
Relevant both to Open Dialogue as a form of therapy and a system of care, these seven principles represent the broad set of values, on which the more finely focused twelve fidelity elements of Dialogic Practice are based. For the purposes of this discussion on Dialogic Practice, the two principles of “dialogue (polyphony)” and “tolerance of uncertainty” will be given special attention as the foundation of therapeutic conversation within the treatment meeting. The other five of the seven principles, which emphasize the organizational features of the system, will be explicated in another document on organizational change and the system fidelity characteristics (Ziedonis, Seikkula, & Olson, in preparation). This companion document on organizational change will describe different ways that the Open Dialogue principles and the treatment meeting have been integrated into clinical practice, treatment programs, agencies, and systems of care.
此7項原則皆可作為開放式對話之治療形式或是照護體系而觀，表現出寬廣的價值組合；至於對話式作法更為確切的12項真實性要點，便是以此7項原則為基礎。為了討論對話式作法，本文焦點將著重於「容忍不確定性」與「對話(及複調)」此2項原則，將其視為治療會談當中的治療交談基礎；另外5項原則較強調系統的組織特性，將於另一探討組織變革與系統真實性特徵之文章中，再行闡釋(Ziedonis, Seikkula, & Olson, 文章準備中)。該份協作文章將描述開放式對話原則與治療會談，於臨床實務、治療計畫、機構、照護系統之中的不同整合方式。
In the current document on Dialogic Practice, the seven basic principles of Open Dialogue are not all covered in full detail; however they are elaborated in other readily accessible source documents (Seikkula & Arnkil, 2006; Seikkula & Arnkil, 2014). The following discussion will focus on the twelve, key elements of fidelity to Dialogic Practice that characterize the therapeutic, interactive style of Open Dialogue in face-to-face encounters within the treatment meeting.
本文探討對話式作法，並未逐一詳細說明開放式對話的7項原則；然而其他原始文件已有詳述(Seikkula & Arnkil, 2006; Seikkula & Arnkil, 2014)。以下討論將聚焦於對話式作法之12項真實性要點，利用治療會談中的面對面接觸，呈現開放式對話之治療與互動特性。
DIALOGIC PRACTICE: AN OVERVIEW
對話式作法之概述
To be in a transformative dialogue with people requires presence, an attention to the living moment without a preconceived hypothesis or specific agenda. The art and skill of Dialogic Practice means that the therapists’ communications are not formulaic. Open Dialogue involves being able to listen and adapt to the particular context and language of every exchange. For this reason, it is not possible here to make specific recommendations for sessions in advance, or for invariant phases in the treatment process. Prescribing this form of detailed structure could actually work against the process of Open Dialogue. It is the unique interaction among the unique group of participants engaging in an inevitably idiosyncratic therapeutic conversation that provides the possibilities for positive change.
為使對話更富變化性，治療師需親自參與會談，並專注當前情形，切莫心存假設偏見或預擬特定議題。對話式作法之所以具有藝術與技巧，原因在於治療師並非採取一成不變的溝通模式。開放式對話包含傾聽的能力，並能適應每場意見交流中的特殊情境及語言。因此，我們無法預先為會談提供相關建議，或於對話治療過程中設置固定語句。若每個流程架構皆明確建立，則違反了開放式對話的初衷。開放式對話具有正向改變的可能性，正因其屬於獨特的群組參與必然獨特的治療對話，所呈現出的獨特互動形式。
At the same time, there are systematic elements of Dialogic Practice. In this way, there is a paradox. While every dialogue is unique, there are distinct elements, or conversational actions on the part of the therapists, that generate and promote the flow of dialogue and, in turn, help mobilize the resources of the person at the center of concern and the network. This is what we mean by the key elements. They will be defined and described below.
對話式作法具備獨特性的同時，也擁有系統性要點。如此似成矛盾的悖論。每場對話皆獨一無二，治療師有其明顯不同的參與要素(或稱交談行為)可產生或促進對話流程，進而協助當事人及其社群網絡能夠活用現有對策。此即我們所稱的系統性要素，底下篇幅將再詳述。
Dialogic Practice is based on a special kind of interaction, in which the basic feature is that each participant feels heard and responded to. With an emphasis on listening and responding, Open Dialogue fosters the co-existence of multiple, separate, and equally valid “voices,” or points of view, within the treatment meeting. This multiplicity of voices within the network is what Bakhtin calls “polyphony.” In the context of a tense and severe crisis, this process can be complex, requiring sensitivity in bringing forth the voices of those who are silent, less vocal, hesitant, bewildered, or difficult to understand. Within a “polyphonic conversation,” there is space for each voice, thus reducing the gap between the so-called “sick” and “well.” The collaborative exchange among all the different voices weaves new, more shared understandings to which everyone contributes an important thread. This results in a common experience which Bakhtin describes as “without rank.”
對話式作法基於一種特殊的互動形式，基本特徵為每位參與者皆感覺受到傾聽與回應。藉由強調傾聽與回應的重要性，開放式對話於治療會談當中，促進了各種意見或觀點的多元、個別、以及同等有效之共存性。此種網絡內的意見多元性，是為俄國哲學家巴赫京(Bakhtin)所稱之「複調」(polyphony)。處於緊張且劇烈的危機時，此種多元意見的過程可能將顯複雜，因此需具備敏感度，以鼓勵沉默寡言、言詞謹慎、猶豫不決、混沌困惑、或難以理解之人，發表各種意見，暢言各種觀點。「複調式交談」當中，每個意見都有立足之地，而能拉近所謂「生病者」與「健康者」之間的差距。各種不同意見的協作交流，開創出嶄新而共享的理解，且每個人都是開創者，感到與有榮焉；由此帶來的共同經驗，是為巴赫京所稱之「打破階級」(without rank)。
As stated above, by calling a sequence “dialogical,” we mean specifically that the sequence has the potential for a person to feel heard, which is the beginning of any change. Evaluating the dialogical quality of a conversation means, first and foremost, evaluating the responsiveness of the therapists. Among the first steps is often for one of the therapists to engage with the person at the center of the crisis in a careful, detailed, back-and-forth interchange. The purpose is to listen and, as necessary, assist in finding words for the person’s distress,otherwise embodied in symptoms, and evolve toward a common language. As illustrated below, having input from the network assists in shedding further light on the nature of the crisis. The dialogical therapist invites each person in the meeting to share their perspective and the various, related issues that come up during the conversation. Instead of looking at therapists’ skills in terms of the way they conduct a structured interviewing methodology, the principal criterion is the often personal way the therapists respond to the afflicted person’s utterances and those of others present in the meeting.
上述「對話式」流程，特別意指該流程可令對象感覺受到傾聽，而傾聽正是改變的起點。至於對話品質之評估，首重治療師的回應程度。第一步通常為治療師之其中一人，採取謹慎、詳盡、以及互相往來之形式，與危機當事人進行對話。對話目的在於傾聽；如有必要，需協助替危機當事人可能以症狀顯現之苦痛，找到話語的出口，並成為共通語言。網絡中的訊息輸入，有助釐清危機的本質。對話治療師邀請每位會談人員分享各自觀點，以及交談中陸續浮現的各種相關議題。會談的主要準則並非注意治療師是否精於執行有條理的訪談方法論，而應注重治療師本身對於苦痛當事人及其他在場會談人員的回應方式。
Responding and Reflecting
回應與反思
There are two fundamental skills required for clinicians to do Dialogic Practice: the skill of responding and the skill of reflecting (Rober, 2005). The skill of responding is a three-part process that applies to the way all the fidelity elements are employed. This process must be present to call an exchange dialogical. While defining the quality of the therapist’s action, one has to look at the (1) client’s initial utterance; (2) the therapist’s response to that utterance; and (3) the response to the response given. How does the therapist’s response further the experience of each participant in being heard, understood, and acknowledged? How do these three steps generate dialogically responsive interaction?
臨床人員實務進行對話式作法時，需謹記「回應」與「反思」此二項基本技巧。回應技巧是一種三階段步驟，適用於所有採用真實性要點的方式。具有回應之意見交流型態，方可稱為對話。除了治療師於對話過程的品質應受界定，我們尚須注意：(1)當事人的起始語句；(2)治療師對於該起始語句的回應；(3)對於治療師回應的又一回應。治療師的回應如何促進每位參與者能夠受到傾聽、理解、以及認同之感受？此三步驟如何帶來對話式的回應互動？
The other basic skill of Dialogic Practice—the skill of reflecting--is the ability to engage in an open, participatory, transparent, and jargon-free conversation with the network and other professionals in the meeting. The skill of reflecting builds on the skill of responding.
「反思」是對話式作法的另一項基本技巧，意指能夠與會談中的網絡成員及其他專業人士，置身於一個開放、參與、透明、避免專業術語的對話。回應技巧是反思技巧之基礎。
Parenthetically, “reflecting” is different than how this same term is used in other forms of therapy. For example, in motivational interviewing, “reflecting” refers to how the therapist actively listens to what the client says. In Dialogic Practice, this term refers instead to the way the professionals talk about their own ideas in front of the family. We have learned from others that this can be confusing since many therapists interested in Dialogic Practice have also been trained in motivational interviewing.
附帶說明，此「反思」有別於其他治療形式之反思。舉例而言，動機式會談當中的「反思」，所指為治療師如何主動傾聽當事人之話語；至於對話式作法的「反思」，則為專業人士於家庭成員面前談論其自身觀點的方式。我們曾聽他人表示對於反思感到困惑，是由於許多治療師有意研究對話式作法，但先前曾受過動機式會談的訓練。
Monologue and Dialogue
個人獨白與多方對話
The Open Dialogue treatment meeting includes both monological and dialogical communication. So-called “monological” sequences in dialogue are necessary to make practical agreements, or to gain new information that can assist in a more complete understanding of the situation. By monological communication, we mean there are sequences in which the therapists themselves introduce conversational topics. Such sequences can comprise information gathering, providing advice, treatment planning, or otherwise initiating new subjects for discussion that did not build on what the client or another participant previously had said (Seikkula, 2002). In an Open Dialogue treatment meeting, up to one third (1/3) of the conversation can be monological, to stay consistent with the approach and conduct an effective meeting. Monologue can refer to the nature of communication either within the social network or that between the experts and the network.
開放式對話的治療會談，溝通模式包含個人獨白與多方對話。對話流程需有「個人獨白」(monological)，以達成實際協議，或取得更有助於完整理解情況的新資訊。所謂個人獨白，代表的是治療師本身於對話流程中引導話題，此流程可包含資訊蒐集、建議提供、治療規劃，或是發起當事人或其他與會者尚未談論過的新話題(Seikkula, 2002)。開放式對話的治療會談中，個人獨白式對話所占比例，達三分之一，有助與研究方法維持一致性，並使會談更具成效。個人獨白可指社群網絡內部、或專業人士與網絡之間的溝通模式。開放式對話的治療會談，包含個人獨白與多方對話之溝通模式。對話流程需有「個人獨白」，以達成實際的協議，或取得可助更完整理解情況的新資訊。所謂個人獨白，代表的是治療師本身於對話流程中引導話題。如此流程可包含資訊蒐集、建議提供、治療規劃，或可發起治療對象或其他參與者尚未談論過的新話題(Seikkula, 2002)。在開放式對話的治療會談中，比例達三分之一的個人獨白式對話，有助維持與研究方法的一致性，並使會談具有效用。個人獨白可指社群網絡內在、或專家與網絡之間的溝通型態。
That said, there is a difference between monological communication described above and what is meant by the term, “monological discourse.” The latter refers to an institutional way of talking, in which there is a privileged, top-down expert without a contributing listener. Instead of sustaining a dialogue among the various participants, all of whom are regarded as legitimate and equal, an entirely monological approach works against a more collaborative process that can lead to new ideas and creativity. In explaining this contrast further, it is helpful to refer to John Shotter’s (2004) translation of “dialogical” versus “monological” discourse into the more accessible terms of “withness thinking” versus “aboutness thinking” (Hoffman, 2007). In our clinical experience, this former way of thinking and practice has tended to open up more possibilities in psychiatric crises and to help unfreeze situations away from chronicity.
然而，上述之個人獨白式溝通模式，有別於此詞「獨白論述」(monological discourse)。獨白論述意指一種制式的談話方式，由一位獨擅全場的專業人士，進行由上而下的講話，其他聽者無法加入話語。至於完整的獨白溝通模式，是以更為協力合作的方式進行，有助激發新想法與創意，而非單純維持各個正當且平等的與會者之間的對話。為更進一步解釋此種對比，可參考約翰．書特(John Shotter, 2004)的論點，將「對話」與「獨白」之對比，轉化為更易懂的「由內思考」與「相關思考」之對比(Hoffman, 2007)。臨床經驗中，由內思考之方式及其實務運用，能於處理精神危機方面開啟更多可能性，並有機會脫離長期苦痛的宰制。
In what follows, we will describe each of the fidelity elements of Dialogic Practice in Open Dialogue and give clinical examples to illustrate them. The examples are drawn from the therapy sessions of the first and second authors, working together and separately. While every session incorporates these elements, we have chosen to include illustrations from different families. The reason for this is to give a sense of the different kinds of problems and situations we have addressed. There are also additional, supplemental definitions and examples of important concepts in the Glossary. These twelve fidelity elements are not separate but often overlap and occur simultaneously in actual practice.
以下篇幅將敘述開放式對話之對話式作法的各個真實性要點，以及舉證相關臨床實例。實例取自第一位、第二位作者所共同或分別舉辦之治療會談。儘管每場會談皆有融入這些要點，但為了列舉所因應的不同難題及個別情況，我們仍選擇不同家庭作為範例。本文之用語附錄，亦將列舉重要概念之定義與範例，屬於附加補充性質。12個真實性要點並非各自為政，而是整體疊合，同時出現於實務進行之中。
THE TWELVE KEY ELEMENTS OF FIDELITY TO DIALOGIC PRACTICE
對話式作法之12項真實性要點
1. Two (or More) Therapists
二位以上的治療師
The Open Dialogue approach emphasizes the importance of multiple therapists meeting as a team with the social network. There should be at least two therapists in the meeting. The teamwork is essential to responding effectively to severe, acute crises and chronic psychiatric conditions. One therapist can be interviewing the client(s), while the other takes a listening and reflecting position. Or, it can be the case that both therapists are asking questions and engaging in reflections. The “reflecting process” of Tom Andersen (1991) and the “reflective talk” of Seikkula & Arnkil (2006) are both acceptable formats and will be described in greater detail under Item #10 below. Further, it is important to differentiate Open Dialogue practice from elective, non-crisis-service, outpatient therapy. Over the past decade, Dialogic Practice has been adapted to more ordinary couple and family therapy (Olson, 2012; Seikkula, 2014), in which it is possible to conduct Dialogic Practice as a solo therapist. Of note, we are writing a summary of our experience on how to conduct Dialogic Practice as a solo therapist that we will reference here when completed.
開放式對話強調多位治療師以團隊方式與社群網絡進行會談的重要性，至少需有二位治療師參與會談。團隊合作對於嚴重急性危機及慢性精神症狀方面之有效回應，是不可或缺的一環。一位治療師可負責與當事人進行訪談，另一位治療師則著重傾聽與反思；亦可二位治療師皆加入提問與反思。湯姆．安德森(Tom Andersen)於1991年提出之「反思過程」(reflecting process)，以及亞科．塞科羅(Jaakko Seikkula)、湯姆．艾瑞克．昂吉爾(Tom Erik Arnkil)於2006年發表之「反思對談」(reflective talk)，皆可作為對話模式，第10項要點將再詳述。
尚有一點需注意者為，開放式對話作法為非選擇式、非危機服務、非門診式之療法。近10年來，對話式作法已改良至更貼近伴侶治療與家庭治療之方法 (Olson, 2012; Seikkula, 2014)，單一治療師亦可執行對話式作法。在此一提，文末之結論將述及單一治療師如何執行對話式作法之經驗，以作為此段落之參考。
2. Participation of Family and/or Network Members
家庭成員及/或社群網絡之參與
The engagement with the network begins on the phone with the clinician asking the caller such questions as, for instance: “Who is concerned about the situation or who has been involved?” “Who could be of help and is able to participate in the first meeting?” “Who would be the best person to invite them, you or the treatment team?” These questions both facilitate network participation and help to organize the meeting in a nonhierarchical way, that is, with input from the client(s).
社群網絡之參與，始於臨床人員詢問諮詢者相關問題，例如「何人關心此情況，或與此情況有關」、「何人可提供協助，並能參加初次會談」、「應由何人邀請相關人員最為適當，您、或是治療團隊」。以上問題可促進社群網絡之參與，且因提問內容之資訊由當事人提供，有助於會談不受層級制度的影響。
By valuing the inclusion of the family and other members of the social network from the very beginning, they typically become important partners in the treatment process throughout. At the same time, there is flexibility based on the willingness of the person at the center to have their relatives present. The team can meet separately with different family and network members when conjoint meetings are not possible, as in many instances of violence and abuse.
若一開始即能重視家庭成員及其他社群網絡成員之參與，他們在往後常能成為療程中的重要夥伴。同時，當事人亦可自主決定是否希望相關人員在場，例如暴力與虐待案件中，相關人員無法共同在場，治療團隊便需分別與不同的家庭成員及社群成員舉行會談。
As we will describe below (under Element #6), meetings without family or network members involved can also occur in which the therapist will then ask questions inviting the person to comment on what they think an absent member would say if they were present.
第6項要點亦將述及，家庭成員及社群網絡成員缺席之會談中，治療師亦可鼓勵當事人發表意見，詢問當事人：若缺席者在場時，該人可能訴說何種話語。
3. Use of Open-Ended Questions
使用開放式問題
The actual treatment meeting itself begins with open-ended questions asked by the clinicians. After introductions, an opening thus could be formulated by simply asking, “Who would like to start?” Or, “what would be best way to begin?” Once this kind of collaborative process becomes established and expected, it is naturally carried forward into subsequent meetings as a taken-for-granted element. In the very first appointment, it is important to emphasize the two questions that routinely commence an Open Dialogue meeting and were proposed by Tom Andersen (1991). They are: (1) “what is the history of the idea of coming here today?” And, (2) “how would you like to use this meeting?”
治療會談實務進行，始於臨床人員詢問之開放式問題。簡單介紹後，可使用二則提問作為會談開場：「哪一位有意先開始」或是「會談該怎麼開始比較恰當」。一旦確立此種協作過程，往後之會談將能自然而然採用，作為必備要素。不過在開放式對話的首場會談中，仍需先強調此二則由湯姆．安德森(Tom Andersen)規劃之提問：(1)可否談談今日之所以來此參加會談的來龍去脈；(2)您希望如何運用此番會談。
In this way, there are three subcategories of open-ended questions that we would like to address. First, there is the use of the “two questions” in the very first meeting; second, there is the use of the second of those questions in every meeting, and third, the ongoing practice of open-ended questions throughout the treatment process.
如此一來，我們將面對開放式問題的三種次分類：一、首場會談所使用的「二則提問」；二、往後的會談中，將針對第二則提問「您希望如何運用此番會談」繼續開展；三、療程中持續使用的開放式問題。
A.The History of the Idea to Have the Meeting?
今日之所以來此參加會談的來龍去脈？
“What is the history of the idea of the meeting? This question usually occurs only in the initial meeting and comes at the beginning. But, depending on the nature of the intake, it can also come later in the first meeting. It can be phrased in various ways and is addressed initially to the whole assembly, not just one person. “How did you have the idea to have this meeting?” Alternately, it is possible to start by asking, “Who first thought of having this meeting?” There is also a range of possible follow-up questions meant to engage everyone present: “How did others learn about this idea? What did you think of coming here today? Who agreed the most and least with the idea of contacting the team? What would you like to accomplish?
「可否談談今日之所以來此參加會談的來龍去脈？」此提問通常出現於首場會談的開場白，不過亦可依照實際情形，稍晚再使用於首場會談的對話中。提問有多種形式，一開始是對全體參與者發問，而非針對單一個人，例如「大家是怎麼知道可以來參加會談的」或是「哪一位最先想到要來舉辦會談的呢」。尚有許多後續問題，可使與會者皆融入會談：「其他人怎麼知道這件事的？今日來此會談，您覺得如何？提出要聯絡治療團隊時，哪一位最表同意，又是哪一位最持反對意見？您們希望可以達成什麼事？」
It is important to give everyone a chance to discuss their ideas about the meeting. At the same time, if, at any time, someone does not wish to speak, it is equally important not to force them to do so.
重要的是，會談的各個成員皆需有機會表達意見。同時亦須謹記，若其中有人無意發言，不可迫使其開口說話。
This type of question invites people to speak in a reflective voice. By reflective, we mean asking people to discuss their own purposes, intentions, and aims with regard to the decision of seeking help. Beginning in this way, this first question addresses the immediate context and is neutral toward any definition of a problem or symptom. It encourages people to describe the situation leading up to the meeting and the important people involved. Despite the emphasis on history, the question gives immediate multiple entrees into the present moment.
此類提問可使回答者產生反思，反思意指要求與會者針對其決定尋求幫助之舉，討論他們的目的、意向、以及目標。以反思為前提而開始會談，第一則提問即可立刻切入情境，且對於當事人之難題或症狀，不產生偏頗的指涉。此提問鼓勵與會者敘述會談舉行之前因，以及重要相關人員。雖此提問討論的是來龍去脈，但仍可提供諸多方式引導進入當下的會談。
Andersen (1991) writes, “The idea behind this question is to reach an understanding about how much those who are present are committed to the idea of being present (p. 159).” Often when asked, different participants express different viewpoints on their commitments to being present, which is important to know, especially when the idea of therapy itself may be contested terrain. At other times, this question can locate a potential resource by identifying people not present who could be helpful. This question does not have just one meaning or effect, and sometimes something completely unexpected happens.
安德森寫道：「此提問的用意，是希望在場與會者了解自身對於現前舉行的會談，將能帶來多少貢獻」。問及此，各個與會者通常會針對自身貢獻為何，表達不同觀點，此方面在治療本身具有爭議時，尤顯重要。有時，此提問亦可藉由指明當時未在場但或可帶來幫助之人，協助找出其他可能的資源。此提問不會僅具有單一意義或成效，甚至會出現完全意料以外之成果。
B. How Would You Like To Use this Meeting?
您希望如何運用此番會談
The second question is “How would you like to use this meeting?” The question can be phrased in different ways. As with the earlier question, the second question is addressed to the whole assembly, not to one person. At the same time, it is important to give everyone a chance to respond to this question.
第二則提問為「您希望如何運用此番會談」，此提問亦可使用不同形式的問句，且如同第一則提問之原則，需對全體參與者發問，而非針對單一個人；同時，每個人皆需有機會回應此則提問。
This second question is asked in the first meeting and, with some variation, in all subsequent meetings. Usually this question occurs at the beginning of a meeting. There are instances where it comes later, so the timing depends on the therapist being sensitive to the particular nuances of how a particular meeting is unfolding.
第二則提問將於首次會談中提出，而往後的會談亦可採用不同方式，加入此提問。此提問通常出現於會談之初，有時也可能在會談稍後，提問的時間點，決定於治療師對於會談展開過程的細微差別所抱持之敏銳度。
The rationale behind this question is that in Dialogic Practice, it is the clients rather than the professionals, who principally determine the content of the meeting, That is, we talk about what the clients want to talk about. For this reason, in every meeting, the therapist asks the client how they wish to use the meeting. Over time, with such repetition, the second question may become more implied, rather than directly stated.
之所以採用此提問，基本原因為對話式作法的過程中，會談內容的主要決定權，在於當事人而非專業人士；也就是說，我們討論的是當事人有意討論的話題。因此在每個會談中，治療師皆詢問當事人希望如何運用此番會談。經過多次會談後，此提問因重複提出，其問句方式可能變得較為隱藏本意，而非開門見山道出。
These two questions let the therapists know that the parents both were committed to the idea of doing Open Dialogue, rather than in conflict about it, and had a shared motivation to help their son. There was evidence that Jack was not opposed to the idea, since he willingly came with them. These questions created a window on the parents’ joint perception that there was “more to Jack,” whom, as they explained, had been defined as chronic and hopeless by the mental health system. This excerpt also provides an illustration of making contact with each person early in the meeting and allowing each person to have a voice in relation to the theme being discussed, namely, the nature of the meeting.
此二則提問令治療師得知，開放式對話的進行，是經過父母雙方的同意，而非對此意見不合。二人也有共同的動機，也就是希望能幫助兒子。且能明顯看出傑克並不反對參加會談，因為傑克自願與父母一起前來。此二則提問也使父母了解，開放式對話能夠「給傑克更多幫助」，畢竟如同父母所言，傑克在心理健康系統中，以往總是被冠上長期慢性疾患以及無法醫治的診斷結果。此則對話節錄同時也示範了如何在會談之初接觸每位與會者，並使每個人都有機會針對討論主題發聲，這也正是會談的本意。
After beginning with above-mentioned questions, it is important throughout the meeting to have in mind formulating the questions in an open-ended way, so that clients can take the initiative both to speak about what they see as important and in the way that they would like to discuss it. For therapists, this means that they guide the dialogical process by neither determining nor selecting topics, but by their way of responding to clients’ utterances. In the next section, and throughout this document, there will be examples of this kind of open-ended inquiry.
以此二則提問作為會談開端之後，切記必須在會談過程中，以開放的角度，有條理地闡述此二則提問，如此當事人方能主動道出認為重要之處，並以自身慣用的方式進行討論。對於治療師而言，則代表不必由治療師本身來決定或選擇對談主題，而是以回應當事人話語的對談方式，來主導整個對談過程。下個篇幅當中，以及本文各處，皆有此種開放式問題的範例。
4. Responding To Clients' Utterances
回應治療對象的話語
The therapist promotes dialogue by responding to the client’s utterances commonly in three ways that invite a further response. This includes (A) using the client’s own words; (B) engaging in responsive listening; and (C) sustaining attunement to nonverbal utterances, including silences.
治療師可藉由以下三種方式來回應治療對象的話語，以期展開更多回應，提升對話作用：(A)使用治療對象本身的語句；(B)投入回應式的傾聽；(C)維持非口語形式話語之協調，包含對話中的沉默不語。
A. Use of the Client’s Words
使用當事人本身的語句
The clinician actively follows what the client says and integrates the client’s very same words and phrases into their responses. The above example shows how the therapists do this, closely listening to what clients say and repeating the client’s own words in asking questions or making other comments. What the client has previously said is incorporated—with their very same words-- into the therapists’ responses. Here is a brief vignette from the L. family of David, Tracy, and Jack that took place in the initial meeting described above.
臨床人員積極注意當事人所說的話語，並且將當事人使用的語句，一字不漏地放入自己的回應之中。上述案例已顯示治療師仔細傾聽當事人話語，並在回答問題或作出其他評論時，重複使用相同語句，當事人曾說過的話語，完整使用於治療師的回應。以下為上述L家庭在首次會談過程的小插曲：
B. Responsive Listening To Make Space for Stories That Are Not Yet Told
投入回應式的傾聽，以引發更多尚未講述的故事
The practice of repeating words leads naturally into “responsive listening,” or listening without a specific agenda. Responsive listening often creates an atmosphere in which the clients’ begin to tell important personal stories that they have not shared--or do not share easily--with others, especially professionals. There is evidence that the therapist’s responses are effective when, for instance, there is change experienced during a meeting in the direction of a calmer atmosphere. The conversation has pauses, silences, and more shared exploration of--reflection about—issues and concerns in a dialogical ebb and flow.
重複語句的作法，將自然而然形成「回應式的傾聽」，或是不存在特定議題的傾聽。回應式的傾聽經常能夠塑造一種氛圍，對象在此氛圍之中，娓娓道出先前未曾與他人分享、或不輕易與他人分享的個人重要故事，尤其是共同談話者為專業人士的情況下。證據顯示，會談當中若感受到氣氛趨向緩和平靜，此時治療師的回應更起成效。對話過程的起伏消長之中，包含了暫停、沉默、以及對於議題與關注層面的深入探討或反思。
In the meeting with the L. family of David, Tracy, and Jack, the therapists listened responsively. They repeated words, or, with small questions, invited alternate and more hopeful perspectives (together with a lot of “Mhms”). In response, the parents expanded on the qualities of their son that gave them hope. They told several pivotal and unexpected stories that the therapists never could have anticipated. For example, his parents described how Jack saved a woman’s life in the residential community he was living in by notifying staff that she was suicidal. This and other affirming stories told during the session characterized Jack as a person capable of acting to help and protect others, rather than only as a person in need of help and protection himself. As these stories were told and heard by the Open Dialogue clinicians, a more positive identity was constituted and new possibilities were reviewed for Jack’s recovery that had not been captured by his diagnoses.
L家庭的會談當中，治療師使用回應式的傾聽，重複當事人的語句，或者利用小問題讓當事人帶出其他更具希望的觀點(也使用許多「嗯哼」)；父母則是詳細描述兒子所具有讓他們感到希望的特質，作為回應。父母說出了好幾個出乎治療師意料之外的重要故事，例如傑克曾通報警方他所住的社區有一位女性企圖自殺，而救了她一命。此則故事和其他在會談中言之鑿鑿的故事，將傑克形容為一位有能力採取行動以幫助與保護他人的人，而非只會單方面索求來自他人的幫助與保護。這些故事打造了傑克的正面特質，而傑克在以往診斷之中遭到忽略的康復機會，亦透過這些故事，使得開放式對話的臨床人員，得以重新審視傑克復原的可能性。
C. Nonverbal Attunement, Including to Silences
維持非口語形式話語之協調，包含對話中的沉默不語
The therapist shows attunement to the client’s analogic (nonverbal) communications. Importantly, this also includes allowing for and tolerating silences in the conversation.
治療師需協助維持類比形式(非口語形式)話語之協調，重要之處也包含了允許並容忍對話中的沉默不語。
It is crucial to pay close attention to what is being communicated through body-based channels as well as words. Here is an example from the above meeting when the therapist returns at a later point in the meeting to address his initial encounter with Jack:
溝通行為中的肢體表達和口語傳達，二者皆須密切注意。以下案例延續上述會談，治療師在會談稍後的某一時間點，提及與傑克的初次見面：
In the above example, this exchange elicited from Jack a clearly verbalized preference, in contrast to expressing his voice in the meeting principally through physical gestures such as sitting outside the circle or leaving the room when sensitive issues came up. At the same time, while such analogic (nonverbal) behaviors might be viewed as symptoms, they are respected as important communications within the meeting.
上述案例中，意見交流引起傑克以言語明確告知自身偏好，而非僅以肢體動作表達意見，例如坐於圓圈外圍，或是在敏感話題出現時設法離開房間。另外，此種類比形式(非口語形式)話語雖可能被當成症狀，但我們的會談中極為重視此種表達，視為一種重要的溝通作法。
In this way, therapists notice clients’ gestures and movements, their breathing, change in their tone of voice, their vocal pitch, their facial expressions, and the rhythm of their utterances and changes in that rhythm. If a therapist’s question produces a pause in the client’s breathing, this is meaningful. It may be a sign that the question was too difficult or challenging and thus blocking the possibility of new meanings arising.
治療師將注意當事人之姿勢、動作、呼吸、語氣改變、聲調、臉部表情、話語節奏及其他改變等。若治療師的提問造成當事人出現屏息的動作，則別有含意，可能代表該提問過於困難或咄咄逼人，反而阻擋了出現新資訊的機會。
Allowing for silences in the therapeutic conversation can be another important form of therapeutic attunement, since silence often offers a creative prelude for untold stories and the emergence of new voices. The allowable period of silence cannot be quantified, but has to be felt from within the shared context. Such indices are essential for the therapists to notice and know how to respond to, with the hope of understanding as much as possible the meaning of what the client utters.
允許治療對談中的沉默片段，亦是維持治療協調的重要形式，其原因在於，沉默的下一階段經常能夠開啟尚未道出的故事，或是帶來新加入對話的與會者。至於受允許的沉默期間，無法量化定之，而需視當時情境而定。
這些基本指標能夠幫助治療師察覺及得知回應方式，以期更為了解當事人所說話語的意義。
5. Emphasizing the Present Moment
強調當前時刻
The clinician emphasizes the present moment of meeting. There are two, interrelated parts to this: (A) responding to the immediate reactions that occur in the conversation; and (B) allowing for the emotions that arise.
臨床人員重視會談中的當前時刻，此原則包含二個互有關聯的部份：(A)回應對談中出現的直接反應；(B)允許情緒湧現。
A. Responding to Immediate Reactions
回應直接反應
This means a preference for responding to the client’s immediate reactions that occur in the here-and-now therapeutic interaction, rather than on their reports on what has happened outside the therapy room. A simple example of this in the meeting described above with Jack and his family is the interchange about shaking hands.
回應對談中出現的直接反應，意指在治療過程時，需能即時回應治療對象當下所出現的直接反應，而非僅參照對象所述有關其在會談室以外發生的情形。上述L家庭案例中，與傑克討論交換關於握手的看法，即為回應直接反應之一例。
B. Allowing Emotions to Arise
允許情緒湧現
A more complex dimension of emphasizing the present moment unfolds if the client becomes emotionally moved while speaking about a sensitive issue. When emotions arise such as sadness, anger, or joy, the task of therapists is to make space for their emotions in a safe way, but not to give an immediate interpretation of such emotional, embodied reactions. Here is an example of the latter:
當事人談及敏感話題而觸發情緒，是強調當前時刻要點當中，較為複雜的面向。當事人若有悲傷、憤怒、喜悅等情緒浮現時，治療師的任務是為他們找到安全的情緒出口，而不應立即詮釋此種外顯的情緒反應。相關案例如下：
6. Eliciting Multiple Viewpoints: Polyphony
引發多元觀點：複調
Open Dialogue does not strive for a consensus, but for the juxtaposition and creative exchange of multiple viewpoints and voices, even if they are in tension between people or within a person. There are two dimensions to the multiplicity of viewpoints and voices, or polyphony: (A) outer and (B) inner. In outer polyphony, the therapist engages everyone in the conversation, encouraging all voices to be heard and respected, while, integrating incongruent language, and managing a dialogue instead of a monologue. In inner polyphony, the therapist listens for and encourages each person to speak about their own point of view and experiences in complex ways.
開放式對話的目的，並非致力達成共識，而是多元觀點及意見的並行共存與交換，即使與會者之間或個人本身的觀點或意見處於緊繃態勢時，也不例外。觀點及意見的多元性，或稱複調，分別表現於外在與內在二個面向。外在複調當中，治療師讓每位與會者加入對話，鼓勵所有意見皆能表達及受尊重，並整合相歧的語言，維持對話而非獨白的進行。至於內在複調，則是治療師留神傾聽每位與會者，並以各種方式鼓勵所有人道出個人觀點及經驗。
A. Outer Polyphony
外在複調
Everyone should be listened to and given the possibility of speaking, not just the person identified as having problems or symptoms. Experiencing, or “living in,” the polyphony of voices within the meeting, a multiplicity of voices, the clinician should be sensitive to everyone present and hear from everyone about the important themes under discussion. In both the first example of the L. family of David, Tracy, and Jack and the second example of the couple, Margaret and Henry, the therapists made sure that each person was given the chance to speak. With Jack’s family, there was an interweaving of their different voices into a common understanding of their collective isolation, not just focusing on Jack’s predicament. Here is a further example from the therapy of Margaret and Henry.
所有人皆應受到傾聽，且擁有發言機會。對話並非侷限於面臨難題或遭診斷有疾患的單一個人身上。臨床人員在會談當中，體驗(或「實際處於」)意見複調，也就是意見的多元性，應能敏銳感受在場各個與會者，並傾聽各人對於討論的重要主題所持之不同意見。在L家庭及V夫妻的案例中，治療師確認每個與會者皆有機會發言，L家庭更是交織結合不同意見，進而對於他們的集體隔絕情形產生了共同的理解，而非只關注傑克的病情。以下為V夫妻的延伸治療案例：
Another key dimension of the principle of polyphony is the clinician’s ability to integrate language by other professionals and members of the social network that is jarringly incongruent with the dialogical way of working. The occurrence of such incongruent comments does not occur in every session, but handling such remarks is such an important element of sustaining a polyphonic conversation that we are including it here. Here is an example from a third family, the P. Family.
複調原則的另一重要面向，是臨床人員統整不合對話常理語句的能力，這些語句可能出自其他專業人士及社群網絡成員。雖然並非每場會談皆會出現不合對話常理的語句，但處理此種語句是維持複調對話的一項重要因素，故而在此述之。
B. Engage the Multiple Inner Polyphony, or Voices, of the Client
內在複調(意見多元性)
The therapist listens and engages the multiple views and voices of the client. These may be possibly conflicting viewpoints or voices expressed by the same person. The above example of the primary care physician is actually also an example of accessing an “inner polyphony.” At first, the doctor spoke in his professional role as a knowledgeable expert, in which he inadvertently produced a breach of empathy with Christopher. He then repaired the breach by expressing his sensitivity to Christopher’s discomfort. In this way, the doctor himself spoke in more than one voice: first, as an expert using general knowledge, and second, as an empathetic clinician responding to the present interaction. This kind of movement is key to Dialogic Practice.
治療師傾聽並融入當事人的多元觀點與意見。有時，同一個人所表達的觀點或意見，可能彼此衝突。上述案例之家庭醫師，即是「內在複調」之明顯例證：該醫師起初以專家角色自居，自詡博學多聞，卻無意間糟蹋了對於克里斯多福的同理心；之後因感受到克里斯多福的不安，向其表示歉意，以挽回自身言詞造成的損害。此案例中，醫師說出了一種以上的意見：一個是大談常識的專家，另一個是能夠感同身受的臨床人員，回應當前的互動。內在複調在對話式作法之中，居有重要地位。
While interviewing clients, dialogical therapists ask about absent members. This is another way to evoke the expression of inner polyphony. A usual question is: “If X had been here, what would they have said about the issues discussed?” This is an example of a hypothetical question. The idea of such a question is for the client(s) to imagine a conversation with an important and relevant person in their life who could not be present in the meeting. In this way, the voices of important others becomes part of the outer conversation, and the client’s inner dialogue becomes subject to new examination and reflection. At times, the question itself provokes a spontaneous shift in a dilemma posed by a client in relation to an absent other. A powerful example, which comes from the L. family, occurred not in the first meeting but later on in the treatment process.
對話治療師與當事人進行訪談時，常會問及不在場的人員，這是另一種引起內在複調表達的作法。通常以如此假設語氣詢問：「如果某人在這裡，他對我們討論的議題可能會有什麼看法？」，用意在於使當事人(們)設想與一位當時不在場的重要相關人物對話。在此作法之下，其他重要人物的意見將成為外在談話的一部分，而對象自身的內在對話又可帶來新的檢視與反思。當事人有時給不在場人員設下的兩難情境中，提問本身將同時引發此種情境的轉變。L家庭的案例是個有力證明，不過這次並非發生在初次會談中，而是稍後的治療過程。
7. Creating a Relational Focus in the Dialogue
對話中「關係聚焦」(relational-focus)之運用
While interviewing clients, dialogical therapists are interested in working with the themes and issues within a relational frame. For instance, when a family member is angry and critical toward a professional, it is not framed as manifestation of a “personality disorder,” but as their response to an actual relationship and specific interaction with that professional, thus making their anger one voice within a polyphonic conversation.
對話治療師與當事人進行訪談時，有意採取「關係」的框架，在此框架中討論主題和各種議題。舉例而言，若一位家庭成員對一名專業人士感到憤怒並批評，此並非「人格障礙」的表現，而是一種與該名專業人士的實際關係及特定互動的回應，可看作是複調談話的多元意見中的其中一個憤怒意見。
Relational questions are an offshoot of this relational way of thinking and are asked in order to bring greater clarity to the situation. This can be achieved by, for example, asking questions that address more than one person, define the relationships in the family, and express an interest in the relational context of the problem or symptom. In the meeting with Jack’s family previously discussed, one of the therapists asked Jack’s parents to define what percentage of the time they spent caring for Jack as opposed to focusing on their own relationship and their own lives. This question is relational in the sense that it draws several participants into a discussion in which relationships can become more clearly defined and differentiated, instead of more confused.
關係問句是關係思維模式的一種衍生方式；關係問句的運用，目的是希望更清楚了解情況，例如可向一人以上的當事人提出問題，定義他們在家庭中的關係，並表達自身有意探討當事人之難題或症狀的關係情境。前述L家庭之案例中，一位治療師詢問傑克的父母，他們花費在照顧傑克的時間，以及他們關注自身關係與生活的時間，二者比例如何。此提問可使多名與會者加入討論，並在討論之中，對於彼此關係愈能得到清晰的了解與辨別，而非混淆不明，因此可視為關係問句之一例。
In Open Dialogue, there are many variations of relationally oriented questions that draw on systemic, solution-focused, narrative, and psychodynamic styles of inquiry. For instance, we can ask the kind of so-called “circular” questions that were first invented by the Milan systemic team (Boscolo, Ceechin, Hoffman, & Penn, 1987). Such questions highlight a difference or address relationships in the family. (For a more in-depth discussion of circular questions, please see the Chapter X: Open Dialogue and Family Therapy).
開放式對話中，關係導向問句有許多不同形式，但皆屬於系統性、焦點解決性、敘述性、以及精神動力學方面的問句，例如可使用米蘭系統性家族治療(Milan Systemic Family Therapy)團隊所謂之「循環提問」方法(Boscolo, Ceechin, Hoffman, & Penn, 1987)。此類提問能夠標示出家庭成員中的差異性，或者探討家庭成員關係。(關於循環提問的深入討論，請見第十章：開放式對話與家族治療)。
In Open Dialogue, we do not ask these or any questions as part of a structured interviewing methodology or a preplanned sequence of questions that will lead toward crafting an intervention. Such structured methods tend to constitute monological sequences, rather than dialogically structured interactions. Instead, in Dialogic Practice, questions are put forward as responses that it is hoped, resonate with the unique opportunities within the conversation, thus used in a creative, improvisational, and sparing way to open up new pathways for voice and expression. We have coined the term “relational questioning” to signify this kind of dialogical inquiry.
開放式對話中，此類提問或其他任何提問，皆不應作為組織條理形式的訪談方法、或是預先規劃而成的提問串列，以致於造成刻意干預。使用具有組織條理形式的訪談方法，將可能演變為獨白談話，而喪失了自然成形的對話互動。恰當的對話式作法應為：提問之運用，需作為一種回應，期望能夠捕捉到談話中的獨特細節，與對方產生共鳴；提問應以更具創造力與即興風格的方式，適度運用不浮濫，以此開啟意見與表達的新窗口。我們創造「關係問句」一詞，以明確指出此種對話提問方式。
8. Responding to Problem Discourse or Behavior as Meaningful
對於論述或行為的回應，注重意義
There is an emphasis in Dialogic Practice on “normalizing discourse” in contrast to speaking about issues as pathological, which often is where things start. The therapist listens for the meaningful and “logical” aspects of each person’s response. What this means in practice is that the therapist strives to comment and respond to what was said in a way that sees symptoms or problem behavior as making sense, or “natural” responses to a difficult situation. This shift to normalizing discourse affirms people by emphasizing how problem behavior is meaningful within a particular context, rather than how it is “wrong” or “crazy.” Normalizing talk has an affinity with the Milan systemic therapy technique of “positive or logical connotation,” although the latter technique is given as an intervention in the form of an explanation to the family. “Normalizing talk” is a much more subtle process of understanding and responding woven into the conversational back-and-forth exchange. It also can occur by means of locating unique outcomes, or exceptions, in “problem-saturated stories” (Olson, 2006; White, 2007). (Please also see Chapter X that compares Open Dialogue and family therapy and further describes the differences between normalizing talk and family therapy interventions such as “reframing” and “positive or logical connotation.”).
一般情況常以病理觀點作為議題討論開端，但對話式作法著重於「論述正常化」(normalizing discourse)。治療師傾聽各人回應之中，有意義以及「符合邏輯」的層面，也就是在實務作法上，治療師致力將症狀或問題行為，視為用來對付難題的有意義或「自然」反應，以此方式來評論或回應當事人所說話語。論述正常化之作法，強調問題行為在特殊情境中的意義性，而非批判其「錯誤」或「瘋狂」，藉此給予認同。論述正常化與米蘭系統性家族治療之「正面或邏輯性內涵」方式，二者有密切關聯，不過後者是作為對於家庭成員提供解釋的干預形式，至於「論述正常化」則是更為細膩的理解與回應過程，巧妙安排於對話交流之中，亦可透過「充滿問題的故事」(problem-saturated stories)方式，安插獨特的結局或例外情形，以實現論述正常化(Olson, 2006; White, 2007)。(亦請參見第十章，將開放式對話與家族治療二者進行比較，並深入敘述論述正常化與家族治療干預形式如「重組」、「正面或邏輯性內涵」等之差異)
For instance, in the earlier excerpts of the L. family and the V. couple, a normalized discourse replaced a pathological one in the collaborative emergence of meaning. The very first session described above allowed a discourse to evolve that embedded the experience of Jack and his family in a history of isolation and estrangement from their families of origin, a normalized context in which their experience became more understandable. Similarly, in the session with Margaret and Henry, Margaret’s symptoms became connected through the discourse to the normalized context of a young couple being “between two families,” with a particular focus on the loyalty bind of the husband in relation to his mother.
舉例而言，前述L家庭與V夫妻之會談節錄中，便使用正常化論述取代病理學論述，共同發掘意義的存在。本文所舉之第一個案例中，正常化論述方式得以呈現傑克及其家人受到原生家庭隔絕與疏遠的往事，處於此般正常化的情境之下，也更能夠理解他們的經歷。同樣地，在與瑪格麗特及亨利的會談中，透過正常化論述，將瑪格麗特的症狀連結至一對年輕夫妻「介於二個家族之間」的情境，並特別關注亨利與亨利母親的親情束縛。
9. Emphasizing the Clients’ Own Words and Stories - Not Symptoms
強調當事人的話語及故事，而非症狀
Dialogic Practice invites the telling of what has happened in a person’s life, their experiences, thoughts, and feelings, instead of reporting on symptoms. Telling stories may happen easily or may require a more deliberate search for language. Openings in the form of one word or sub-sentences may be key words with highly relevant associations to the problem situation. The therapist zeroes in on these words that can give access to a narrative of a person’s suffering. This is part of a larger process of evolving a common language, and larger story.
對話式作法不報告當事人症狀，而是鼓勵當事人訴說生命中所發生的事情、經驗、思想、以及感受。故事可能容易敘述，也可能需要精準搜尋用詞。以單一字詞或是子句作為開端時，該字詞或子句或許即為與問題情況具有高度關聯的關鍵詞。此類詞句往往能夠通往當事人的痛苦回憶，因此治療師將特別注意，這也是開展共通語言以及進入層面更廣大的故事時，所需歷經的龐大過程之一部份。
In this way, severe symptoms may be understood as embodying inexpressible or unspeakable dilemmas. They are often rooted in terrible, often traumatic, experiences that resist ordinary language and the ordinary capacity to express experience in narrative terms. For instance, hallucinations may be signs of such otherwise inexpressible experiences. The person who exhibits the most severe symptoms may also have the least access to language. More time may be devoted to exchanges with the most acutely symptomatic person whose voice may be the most incoherent, and thus, the weakest. Further, in meetings that take place during crises, the most difficult, and consequently the most important, issues are often indicated by a single, key word a person says, rather than expressed as a full story. This type of one-word utterance that may sound strange, may be repeated and turned over, slightly altered by the therapist until a more mutual wording evolves. The aim is to arrive at shared understandings that give voice to the person’s experience, making it more understandable and thus, fostering new possibilities for everyone. This often means focusing on the small details of the person’s description of what happened, or what actually happens in the room while the person is telling their story.
在此原則之下，當事人的嚴重症狀，或許可理解為對於無法形容或言說之兩難困境的一種呈現方式，此種兩難困境往往根源於令人感到恐怖的經驗，且常為創傷回憶，因此當事人抗拒以一般的語言或敘述性形容方式來表達。例如，幻覺可視為一種徵兆，顯現出無法形容的經驗。症狀最為嚴重的當事人，可能也最無法運用語言，意見雜亂無章，論點不足，因此需花費更多心思與此種當事人溝通往來。此外，在危機之間舉辦的會談，常可透過當事人所說出的單一關鍵詞語，探知最困難且亦為最重點的問題所在，而非透過長篇大論方能描述。此類單一詞語之敘述方式，聽似怪異，當事人可能一再重複拋出話語，治療師也會在對話中將此種話語作出些許轉換，直到最終出現一個共通的措辭。此種作法透過針對當事人的經驗提供意見，使其更易理解，並對於每個人皆產生新的可能性，期能達成共同理解之目標。這也通常意味著，必須注意當事人描述之中的微小細節，無論是描述已發生的事件，或是描述自身講述故事時所處之會談現場情形。
10. Conversation Among Professionals in the Treatment Meeting: The reflecting process, making treatment decisions, and asking for feedback
治療會談當中，專業人士之間的交談：反思的過程，作出治療決策，以及詢問回饋意見
In every meeting, the professionals’ conversation with each other should be emphasized.
When doing so, they are advised to look at and talk to each other and not at the family or any other participant.
每場會談中，必須重視專業人士之間的交談；而專業人士們注視及交談的對象，建議應為其他專業人士，而非家庭成員或其他與會者。
There are three parts to having a conversation in front of the family. The first two are interchangeable; but the third one always comes after the professionals’ dialogue. First, there is the reflecting process, in which the therapists engage in reflections that center upon their own ideas/images/associations, with the client and family present. Second, the therapists converse with the other professionals during the meeting on planning the treatment, analyzing the problem, and openly discussing the recommendations for medication and hospitalization. And, third, the family comments on the professionals’ talk. That is, after the reflections, one of the therapists invites the family and other network members for their responses to what they heard.
專業人士在家庭成員面前的交談，分為三個階段，前二階段可互相調換順序，但第三階段一向出現在專業人士對話結束之後。第一階段是反思的過程，治療師在反思過程當中，集中精神在治療師本身對於當事人及在場家庭成員的想法／形象／聯想。第二階段中，治療師在會談期間與其他專業人士交談時，一併規劃治療方式、分析問題，並且公開討論用藥及住院方面的建議。第三階段則是家庭成員對於專業人士談話的評論，也就是治療師在反思之後，其中一名治療師邀請家庭成員及其他網絡成員，針對所聽見的談話內容，請他們給予回饋意見。
A. & B. Reflections as Ideas/Images/Associations and Planning
想法／形象／聯想之反思，以及決策規劃
“Reflecting talks” among professionals in a treatment meeting and in front of the family was pioneered by Tom Andersen in (1991). Another version is the “reflective talk” of Seikkula & Arnkil (2006). Both types of reflections are acceptable formats in Dialogic Practice during team meetings. The reflecting process (or talk) occurs among the professionals in the presence of the family. Andersen originally proposed well-defined alterations of talking and listening in the therapeutic conversation with a “reflecting team” (usually 3 professionals) sitting separately, though in the same room as the family, or behind a one-way screen. Making this process more interspersed and spontaneous, Tom Andersen and the Finnish team eventually started to apply the idea of the reflecting process in a less structured way as part of the ongoing flow of the meeting.
早在1991年，湯姆．安德森(Tom Andersen)已率先提出治療會談中，專業人士之間在家庭成員面前的「反思對談」，另一版本則為塞科羅(Seikkula)及昂吉爾(Arnkil)於2006年所發表，二者皆可用於團體會談之對話式作法的對話模式。專業人士之間的反思過程(或對談)，於家庭成員面前進行。安德森一開始在治療對話中的對談及傾聽過程上，作了精心變改，其中的「反思團隊」(常為3名專業人士)坐在房間一頭，家庭成員則位於房間另一頭、或是坐在一面單向透視屏風之後。安德森及芬蘭團隊為了讓過程顯得更為隨性自然，最終採用了反思的過程，此種反思過程並未事先規劃，而是會談流程本身持續進行的一部分。
As indicated, the talk among the professionals ranges from reflecting upon the ideas, images, feelings, and associations that have arisen in their own minds and hearts while listening to planning the treatment. The purpose is to create a place in the meeting where the therapists can listen to themselves and thus have access to their own inner dialogues. It also allows the clients’ to listen without being under pressure to respond to what the professionals are saying.
如同先前所述，專業人士在規劃治療決策時，彼此之間的對談包含了內心浮現的想法、形象、感受、以及聯想，目的是希望在會談當中創造一個空間，治療師可在其中傾聽自身聲音，通往內在對話。此過程也使當事人能夠在無壓力的情況下，聆聽專業人士對談，並給予回應。
Following Tom Andersen (1991), the helpers use ordinary language, not jargon, and should be speculative based on the themes introduced by the family. This is called “speaking as a listener rather than as an author” (Lyotard, cited in Seikkula and Olson, 2003).
遵循湯姆．安德森的建議，專業人士將使用一般交談會出現的語言，而非賣弄專業術語，且對於家庭成員帶出的主題，需保持思索臆測，此過程稱之為「以傾聽者的身份發言，而非以作者的身份大放厥詞」(Lyotard, cited in Seikkula and Olson, 2003)。
C. The Family Comments on the Reflections
家庭成員對於反思的回饋意見
After the therapists give their reflections, the family should have a place to say what they think about their discussion. Asking the family to comment on the professionals’ talk gives them a voice in their own future. So Therapist 2 asked the L. family: “I am wondering if you have any thoughts about our comments? What struck you? What did you agree with? Is there anything you disagreed with? Tracy responded by saying: “I think you hit the nail on head. Him (Jack), looking after us. I didn’t realize we felt so positively about Jack. (Jack laughs). But, we do.” Jack and Tracy both exchanged glances and laughed. David responded to the word “mixed” used previously byTherapist 1, and discussed the various practical options with the therapists.
治療師提出反思後，家庭成員應有機會說出他們對於治療師討論內容的意見。邀請家庭成員對於專業人士對談提出回饋意見，可讓家庭成員得以評論自身未來走向。因此，治療師乙詢問L家庭：「我想了解你們對於我們的意見是否有任何想法？你們在哪方面感到驚訝？你們在哪方面深表同意？是否有不同意之處？」
崔西回答：「我覺得你們真是一針見血。他(傑克)，照顧著我們。我們從來就不知道自己對於傑克的看法是這麼正面積極。(傑克笑了)。但是，我們真的就是如此。」傑克和崔西眼神交流，會心一笑。大衛回應了治療師甲所使用的「茫然困惑」這個字，與治療師討論各種實務治療選項。
11. Being Transparent
透明公開
All treatment talk is shared with all participants. Everyone in the network meeting is equally privy to all discussions and information shared. This means that all discussion of hospitalization, medication, and treatment alternatives occurs with everyone present. Often transparency occurs as a feature of the reflections. As seen above in the session with the L. family, the treatment decisions were initially addressed as part of the dialogue between the therapists. For instance, as already indicated, the therapist reflected on what he saw as various options in planning the treatment, making his ideas open for discussion, rather than giving an expert recommendation.
所有的治療交談應與每位與會者共同分享，網絡會談的每名成員皆應同等了解所有的討論內容及資訊。此原則代表了關於住院、用藥、治療替代方案的所有討論，需要在每個人都在場的情況下進行。反思過程常有透明公開之特點，例如上述L家庭的會談中，起初由治療師內部對話討論治療決策，接著治療師反思他所認為的各種治療規劃選項，將自身想法開誠布公討論，而非以專家之姿下達建議。
At the close of first and often subsequent meetings, dialogical therapists engage the participants in planning the structure of the next meeting. There will usually be such open-ended questions such as: Would you like to meet again? Do you have an idea when? Do you know who might come next time? If the family seems hesitant, the therapists might ask, “Would you prefer to think it over and call us? Of course, if the membership and frequency of the meetings has become established, these questions may be unnecessary.
第一場會談及後續會談之結束時，對話治療師將和與會者一同計畫安排下一場會談，且經常使用開放式問句，例如：還想再會面嗎？大概想要什麼時候再碰面嗎？你知道下次可能有誰會來嗎？若家庭成員似乎猶豫不決，治療師可詢問「還是你要不要回去想想看，再打電話給我們呢」當然，若是會談的成員及次數皆固定，可不必使用這些問句。
12. Tolerating Uncertainty
容忍不確定性
Tolerating uncertainty is one of the seven basic principles of Open Dialogue and one of the key elements of Dialogic Practice. Tolerating uncertainty is at the heart of dialogue. It is thus a specific element and an element that defines the other elements.
容忍不確定性是開放性對話的7項基本原則之一，以及對話式作法的12項要素之一，這是對話的核心所在；因此，容忍不確定性是一個特定的對話要點，並且由此要點再定義出其他對話要點。
In Open Dialogue, there is the fundamental orientation of creating an organic understanding of the crisis with everyone’s input (polyphony). This stance is based on the assumption, as well as our experience, that every crisis has unique features. Hasty decisions and rapid conclusions about the nature of the crisis, diagnosis, medication, and the organization of the therapy are avoided. Further, we do not give ready-made solutions such as specific, preplanned therapeutic interventions to the family or the single person in crisis.
開放式對話的主要導向，是透過每個人輸入的訊息(複調)，建構出對於危機的基本理解。此種立場所根據的假設為每個危機皆有不同特點，而我們實際的危機經驗也是如此。因此對於危機本質、診斷、用藥、治療架構等，必須避免急於作出決策或快速下定論。此外，針對處於危機狀態的家庭成員或是單一個人，我們不會給予現成的解決方案，例如已規劃而成的特定治療干預。
The primary idea that professionals should keep in mind in crises is to behave in a way that increases safety among the family and the rest of the social network. Among the specific practices associated with this, it is important to make contact with each person early in the meeting and thus, acknowledge and legitimize their participation. Such acknowledgment reduces anxiety and increases connection and thus, a sense of safety. The availability of the immediate meetings with the team and the frequency of meeting in a crisis also helps the network tolerate the uncertainty of the crisis as the ensemble works toward their own shared understanding of what is frightening and distressing people. Such shared understanding can launch new forms of agency.
關於危機中的處理方式，專業人士首先必須增加家庭成員及其他社群網絡成員之間的安全感，這是專業人士應謹記之主要原則。與此有關之特殊作法中，重點在於專業人士在會談初期便需接觸各個與會者，如此可認同並接受他們的參與。此種認同將減輕焦慮，增進連結，並因此促進安全感。若能在危機中立即並頻繁與治療團隊進行會談，令網絡成員能夠共同理解造成驚嚇及憂慮的原因，亦有助網絡成員容忍危機的不確定性。此種共同的理解，可產生新的自主形式。
In the same spirit, the starting point of a dialogical meeting is that the perspective of every participant is important and accepted without conditions. This means that the therapists refrain from conveying any notion that our clients should think or feel other than they do. Nor do we suggest that we know better than the speakers themselves what they mean by their utterances. This therapeutic position forms a basic shift for many professionals, because we are so accustomed to thinking that we should interpret the problem and come up with an intervention that counteracts the symptoms by inducing change in the person or the family.
相同道理可知，對話式會談的起點，是需重視每位與會者的觀點，並且一視同仁，無條件接受。若治療師表達出當事人應該使用有別於往常的方式思考或感受，此作法實不可取。而以往我們十分慣於認為，需對難題進行詮釋分析，再透過激起當事人或其家庭的改變，以作出可對抗症狀的干預行為；但在對話式會談中，我們不可單純藉由說話者的話語，便自認為比說話者本身更了解他們。
If change does occur in the process of Open Dialogue, this may be attributed to the process of engaging everyone’s point of view within the meeting. It is therapists’ responsibility to conduct the meeting in a way that creates a space where it is safe for everyone to express themselves, in the ways we have outlined above. Finally, the therapists do not simply facilitate polyphony and erase their own voices. They also express their perspectives, but in the form of reflections that they exchange in the presence of the family. Their ideas thus are “overheard” and can be commented upon—and critiqued-- by the network, rather than being “truths” directly imposed in a top-down fashion.
若是開放式對話的過程中確實出現改變，或許可歸功於會談當中確實有採納每位與會者的觀點。治療師的責任是在會談中開創安全的空間，每個人皆能在此空間裡表達自我，如同前述方式。最後要注意的是，治療師並非單純運用複調，卻抹煞治療師本身的意見；治療師仍會表達觀點，不過是以反思的形式，在家庭成員面前交換意見。因此，治療師不再由上而下強制灌輸「真理」，而是網絡成員能夠「竊聽」治療師的想法，並且表達評論或批判。
All in all, in a fruitful dialogue, clinicians participate in a human way with feeling and compassion and fulfill their professional roles’ with an element of personal warmth. This promotes a therapeutic connection and avoids being too distant or giving clients the sense that they are being scrutinized or objectified.
一場成效斐然的對話，從各方面觀之，臨床人員是以人本的形式參與其中，充滿感受及憐憫之情，並散發個人溫暖，實現專業人士角色。此種作法可促進治療上的連結，避免過於疏遠，且不至於令當事人感到遭受檢視或被物化看待。
CONDUCTING THE TREATMENT MEETING: THE CONTEXT OF OPEN DIALOGUE & DIALOGICAL PRACTICE
進行治療會談：開放式對話與對話式作法的情境
In Open Dialogue, the treatment meeting is the context for Dialogic Practice. A treatment meeting should occur as an immediate response within 24-hours of the initial contact from someone seeking help with a crisis. In advance of any decisions about hospitalization or therapy, this meeting brings together the person in acute distress with all other important persons, including other professionals, family members, and anyone else closely involved. It is the responsibility of the professional who took the initial call to organize the meeting, with input from the client(s).
開放式對話中，治療會談為對話式作法的情境。當事人或相關人員初次聯繫治療單位以尋求危機協助後，治療單位必須在24小時內快速回應，舉行治療會談。決定住院或採用其他療法之前，治療會談可集中急性憂鬱之當事人及其他重要相關人員，包括專業人士、家庭成員、以及關係密切者。專業人士一旦接獲初次聯繫，得知當事人的消息資訊，便需負責安排會談。
The meeting occurs in an open forum with all participants sitting in a circle. The team members who have initiated the meeting have the responsibility for fostering the dialogue. The team may decide in advance who will conduct the interview and what role the rest of the team will have. Usually if the team is experienced, they start with no prior plan regarding who initiates the questions. All team members can participate in interviewing. The initial, “two questions” referred to earlier invite the network to talk about the issues that are most pressing for them at the present time. The team does not plan the themes of the meeting in advance. From the very beginning the therapists listen carefully and elicit all voices, words, and stories in the manner we have sketched in this document. If the person at the center of concern does not want to participate in the meeting or suddenly runs out of the meeting room, a discussion takes place with the family members about whether or not to continue the meeting. If the family wants to continue, one of the clinicians informs the person that they can return if they want to.
會談在開放空間進行，所有與會者圍成圓圈而坐。開啟此場會談的治療團隊成員，亦負責促進對話進行，治療團隊成員可事先決定由何人進行訪談，以及其他成員的角色。一般情況下，經驗豐富的治療團隊，無須事先規劃何人開始提問。所有的治療團隊成員皆可參與訪談。本文稍早述及的二則提問，可在會談之初，邀請網絡成員談論他們當前最感迫切的問題所在。團隊成員不事先規劃會談主題。治療師在一開始便需仔細傾聽並引發各種意見、字句、故事，相關方式已列於本文。若是最需受到關切者無意參與會談，或突然離開會談室，治療團隊則與家庭成員討論是否應繼續進行會談。若家庭成員希望繼續進行，臨床治療人員則告知該位當事人，待其有意重啟會談時，治療團隊及其他成員可再重返會談現場。
Everyone present has the right to comment whenever they want to. It is advisable that everyone respect and address the ongoing topic of the dialogue, unless clearly proposing an alternate. For the professionals, this means they can respond either by inquiring further about the theme under discussion, or engaging in reflecting dialogue with one another, in which they strive to be open and forthcoming. Therapists speak to –and look at--each other, use ordinary, nonpathologizing language, avoid criticizing family members, and engage in a dialogical exchange with one another. In every meeting, there should be at least some time for the professionals’ reflections with each other, because this format is central to generating bothnew words for the crisis and an open and shared process that encourages a sense of trust and safety. It is also essential that the network members have an opportunity to comment on what the professionals have said.
每位在場人員有權隨時發表意見。適當作法是，各人皆需重視及針對現前的對話主題，除非話題明確轉移；對於專業人士而言，此作法代表他們可視情況採用不同回應方式，例如針對討論中的主題提出深入詢問，或是專業人士之間彼此進行反思對話，而反思對話必須力求公開及傳遞訊息。治療師對每位在場人員說話，注意眼神接觸，使用一般日常話語，不套入病理學論述，避免批評家庭成員，並與各人皆有對話交流。每場會談中，至少需保留一小段時間作為專業人士之間的反思，因為反思是一種重要的形式，可產生描述危機的新字句，創造公開共享的流程，激發信任感及安全感。另一重點則是網絡成員需有機會可評論專業人士的話語。
Any decisions about medication and hospitalization are made with everyone’s input.
作出有關用藥及住院的決定之前，必須先廣納每個人的意見看法。
Discussion of issues related to medication and hospitalization usually occur after family members have had a chance to express their most compelling concerns. After the important issues for the meeting have been addressed, one of the team members usually makes the suggestion that the meeting be adjourned. It is important, however, to close the meeting by referring to the client's own words and by asking, for instance: “I wonder if we could take steps to close the meeting. Before doing so, however, is there anything else we should discuss?” By so doing, the clients have control over the decision to end the session. At the end of the meeting, it is helpful to summarize briefly the themes of the meeting, especially whether or not decisions have been made, and if so, what they were. It is also important to work out the structure of the next meeting if the details are unclear, such as discussing who will attend and when it should take place. The length of meetings can vary, but ninety minutes is usually enough.
對於用藥及住院議題的討論，經常出現於家庭成員表達其強烈關切之後。既已提出會談最重要的議題，一名治療團隊成員常會建議會談可中止；然而必須謹記，應使用當事人自身說出的話語以結束會談，並先行詢問，例如：「我在想是不是該結束這場會談了，不過在這之前，我們還有要討論什麼嗎？」如此一來，當事人可自行決定究竟是否應結束會談。會談之終，如能簡單總結會談主題，尤其總結是否已作出任何結論(如有結論，又為何種結論)，將可帶來幫助。若是下次會談的細節尚未明確，亦不可忽視其安排規劃，例如討論下次會談的參加人員及時間。會談時間長度並無一定標準，但通常90分鐘已足夠。
SUMMARY
結論
Open Dialogue is both a community-based treatment system and a form of therapeutic conversation that occurs within that system, specifically within the treatment meeting. These two layers of Open Dialogue are guided by the seven principles, of which “dialogue (polyphony)” and “tolerance of uncertainty” are the two fundamental coordinates of therapeutic conversation, or Dialogic Practice. Dialogic Practice in Open Dialogue is the same for both acute crises and more longstanding repetitive, so-called “chronic” situations.
開放式對話是以社群為基礎的治療系統，並且在此系統內所呈現之治療對話形式，尤其透過治療會談呈現。開放式對話的此二種層面，由7項原則導引，而其中對於治療對話(或稱對話式作法)最為重要之2項原則，分別為「對話(或複調)」以及「容忍不確定性」。急性與慢性精神危機之處理，皆可使用開放式對話中的對話式作法。
This document has focused on defining Dialogic Practice by identifying and describing twelve, key elements. In the treatment meeting, the principal aim is for the therapists to foster a dialogue in which everyone’s voice is heard and respected. The starting point is the language the family uses to describe their situation. The stance of the therapist is different from that of traditional psychotherapy, in which the therapist makes the interventions and does not disclose personal issues. While many family therapy schools concentrate on specific forms of interviewing, the dialogical therapist focuses more on listening and responding to what has touched them.
本文藉由認識與敘述對話式作法之12項要點，以辨明對話式作法之要義。治療會談中，治療師之主要目標為促進對話，令每個人的意見皆能受到傾聽及重視，並以家庭成員描述情況的字句，作為對話起點。以往在精神治療法之中，治療師進行干預，不揭露個人話題；但對話式作法的治療師，所扮演之角色有別以往。許多家庭治療學院仍注重訪談的特殊方式，但對話治療師更為強調傾聽，以及回應對話中令其感興趣之處。
It is in these moments of “aliveness” in Open Dialogue when a speaker or listener has been touched by something new in the exchange that holds the possibility for transformation. In the prior discussion, we have given examples of these “Striking Moments” (see also, Shotter & Katz, 2007) For example, when Christopher used the word “heartbrokenness,” both he and the therapists were visibly moved. Further inquiry yielded a profound shift of perspective afforded by telling a story of what happened to him that placed his experience in a context. There can be sudden revelations and positive movements toward self-healing and wholeness associated with this process that can be profoundly connecting and astonishing. This transformative possibility seems to rely on a therapeutic stance of remaining present and engaged, attuned to ones’ own inner dialogue and sensitive to the outer, shared dialogue, responding utterance by utterance as an exchange unfolds. For this reason, professionals hold their knowledge and expertise lightly as part of their repertory of responsiveness. This “Striking Moments” approach is contrasted by Roger Lowe (2005) to a “Structured Methods” approach, which refers to those stepwise and unidirectional sequences guided by external theories and hypotheses.
開放式對話正是有此種「活性」，亦即說者或聽者在對話交流中受到某種新觀點打動，而創造出改變的可能性。先前的討論篇幅中，已有數個案例出現此種「靈光乍現」(可另參考Shotter & Katz, 2007)。例如克里斯多福說出「痛心」一字之時，克里斯多福與治療師皆明顯有所感觸，進一步詢問之下，克里斯多福道出了造成他如此現況的過往經歷，帶來深入的觀點轉變。而真相突然披露，並激發出趨於自我療癒及完整性的正向力量時，可能與此種為彼此帶來連結的驚人過程有關。轉化的可能性，似乎端看治療立場是否維持在場與投入，與某人的內在對話一致，並對於外在共同對話具有敏銳度，以對方字句作為回應字句，表示展開交流。基於此原因，專業人士可將自身知識及專業，使用於回應時的詞庫。羅傑．羅伍將此種「靈光乍現」與「條理分明」作為對比(2005)，「條理分明」意指由外部理論及假說所指引的單向逐步順序。
The Dialogic Practice of Open Dialogue emphasizes “being with” rather than “doing to.” There is an open-ended inquiry that emphasizes the present moment. Clients’ words and stories are felt to be precious and are carefully attended along with their silences and the whole gamut of gestures, emotions and body-based utterances. The therapists’ respond to the clients’ expressions by repeating words and listening carefully and try to understand without imposing their own overlay of jargon, interpretation, and hasty conclusions. If someone is difficult to understand, there is an ongoing search for words to give more lucid expression to what they might be trying to say. There is the assumption that the situation is meaningful and that everyone is struggling to make sense of it. New, jointly produced possibilities emerge as new words and stories enter the common discourse. The meeting creates a context for change by generating exchange among the multiple voices all of which are valued and important. Common language and understandings can help undo the tangle of the confusion and ambiguity and produce a greater sense of orientation and agency.
開放式對話中的對話式作法，強調的重點為「陪伴對方」而非「給對方下指導棋」。使用開放式問句，著重當前時刻，當事人的字句與故事皆視如珍寶，善加吸收，允許沉默片段，並注意對方各種姿勢、情緒、及肢體語言。治療師仔細傾聽當事人話語，回應時重複其字句，並且在屏除治療師賣弄個人專業術語、作出詮釋、急於下定論等前提之下，嘗試理解當事人。若當事人不易理解，治療師可持續尋找字句，以明確表達出對方欲吐露之言語。假想情況為，情況富有意義，且每個人皆努力想了解情況。新的字句與故事進入共同論述之後，便能出現共同創造的新機會。治療會談打造各種意見的交流空間，所有意見皆受重視並具有價值，以此方式造就出改變的情境。共同的語言，共同的理解，將能幫助破除混沌狀態，產生更高的方向感與自主感。
A REQUEST FOR FEEDBACK FROM YOU THE READER
歡迎讀者提供寶貴意見
Of note, in order to continue to clarify, refine, and update the 12 key elements of fidelity to Dialogic Practice discussed in this document, we encourage readers to provide feedback on whether this text captures your experience of doing Open Dialogue and Dialogic Practice, helps in reflecting on your work, is useful in training and supervision, and assists in doing research. We see this text as a living document. Future studies of the reliability and validity of the “The Key Elements of Dialogic Practice in Open Dialogue: Fidelity Criteria” are needed and forthcoming. Please email us and share your comments at: Dialogic.Practice@umassmed.edu.
Thanks – Mary, Jaakko, and Doug September 2, 2014
本文討論對話式作法中的12項真實性準則，為了持續對其闡明、修飾、更新，我們十分歡迎讀者提供寶貴意見，無論是本文記錄您的開放式對話及對話式作法的自身經驗、協助反思您的個人作品、用於訓練及監督、以及成為研究上的輔助資料，皆誠摯邀請您給予回饋。我們將此份文件視為動態文件，需要持續進行對於本文可靠性及有效性之後續研究。請將您的寶貴意見寄至以下電子信箱：Dialogic.Practice@umassmed.edu
誠摯感謝
瑪莉／亞科／道格 敬上
2014年9月2日
ACKNOWLEDGMENTS
致謝
We would like to express our gratitude to the families from whom we have learned so much. We thank them for their permission to describe examples from our work together. We have altered theses examples to protect confidentiality and remove any identifying information. We also want to thank our colleagues for their invaluable feedback: Jukka Aaltonen, Volkmar Aderhold, Magnus Hald, Lynn Hoffman, Peter Rober, Markku Sutela, and the UMass Medical School research group, including Daniel Breuslin, Nancy Bryatt, Robert Clyman, Jon Delman, Daniel Fisher, Christopher Gordon, Stephanie Rodrigues, and Makenzie Tonelli.
在此向參與本文開放式對話治療的各個家庭，表達無限感謝，我們真正獲益良多。感謝各個家庭允許我們採用其經驗作為案例，我們對於細節進行變改，以保護當事人隱私，並移除可供辨識的資訊。此外，我們也要感謝同事們的無私奉獻：Jukka Aaltonen、Volkmar Aderhold、Magnus Hald、Lynn Hoffman、Peter Rober、Markku Sutela，以及麻大醫學院研究團隊成員Daniel Breuslin、Nancy Bryatt、Robert Clyman、Jon Delman、Daniel Fisher、Christopher Gordon、Stephanie Rodrigues、與Makenzie Tonelli
REFERENCES
參考文獻
Aaltonen, J., Seikkula, J., & Lehtinen, K. (2011). Comprehensive open-dialogue approach I: Developing a comprehensive culture of need-adapted approach in a psychiatric public health catchment area in Western Lapland Project. Psychosis, 3, 179-191.
Alanen, Y. (1997). Schizophrenia: its origins and need-adapted treatment. London: Karnac.
Andersen, T. (1991). The reflecting team: Dialogues and dialogues and dialogues. New York: Norton.
Boscolo, L., Cecchin, G., Hoffman, L., & Penn, P. (1987). Milan systemic family therapy: Conversations in theory and practice. New York: Basic Books.
Hald, M. (2013). The treatment web. Presentation at the International Meeting for the Treatment of Psychosis Network. Tromso: Norway.
Hoffman, L. (2007). The art of “withness.” In H. Andersen and D. Gehart [Eds.], Collaborative therapy: Relationships and conversations that make a difference. New York: Routledge.
Lowe, R. (2005). Structured methods and striking moments: Using question sequences in
“living” ways. Family Process, 44, 65-75.
Olson, M. (2006). Family and network therapy for a system of care: A pedagogy of hope. In A. Lightburn & P. Sessions, Handbook of community-based practice. New York, NY: Oxford University Press.
Olson, M., Laitila, A., Rober, P., & Seikkula, J. (2012). The shift from monologue to dialogue in a couple therapy session: Dialogical investigation of change from the therapists’ point of view.
Family Process. 51, 420-435.
Rober, P. (2005). The therapist’s self in dialogical family therapy. Family Process 44, 479-497.
Seikkula, J. (2002). Open dialogue with good and poor outcomes for psychotic crises. Examples from families with violence. Journal of Marital and Family Therapy 28: 263-274.
Seikkula, Aaltonen, J., Alakare, B., Haarakangas, K., Keranen, J., Sutela, M. (1995). Treating psychosis by means of open dialogue. In S. Friedman, The reflecting team in action: collaborative practice in family therapy. New York, NY: The Guilford Press.
Seikkula, J. & Arnkil, T. (2006). Dialogical meetings in social networks. London: Karnac.
Seikkula, J. & Arnkil, T. (2014). Open dialogues and anticipations: Respecting the otherness in the present moment. Helsinki: THL publications.
Seikkula, J. & Olson, M. (2003). The open dialogue approach to acute psychosis. Its poetics and micropolitics. Family Process 43, 4103-418.
Shotter, J. (2004). On the edge of social constructionism. “Withness-thinking” versus “aboutness-thinking.” London: KCC Foundation Publications.
Shotter J, & Katz, A. (2007). “Reflecting talk,” inner talk,” and “outer talk:” Tom Andersen’s way of being. In H. Andersen and D. Gehart [Eds.], Collaborative therapy: Relationships and conversations that make a difference. New York: Routledge
White, M. (2007). Maps of narrative practice. New York: Norton.
Ziedonis, D.M. (2004) Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives. CNS Spectrum 9(12):892-904, 925.
Ziedonis, D.M., Smelson, D.A., Rosenthal, R.N., Batki, S.L., Green, A.I., Henry, R.J., Montoya, I., Parks, J., Weiss, R.D. (2005). Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. J Psychiatric Practice 11(5):315-39.
Ziedonis, D.M., Fulwiler, C, Tonelli, M. (2014). Integrating mindfulness into your daily routine.
Vital signs, A publication of the Massachusetts medical society. 19:2, 6.
日期：September 2, 2014
作者：Olson, M., Seikkula, J., & Ziedonis, D.
來源： http://umassmed.edu/psychiatry/globalinitiatives/opendialogue/
瑪莉．奧森(Mary Olson)博士*
亞科．塞庫拉(Jaakko Seikkula)博士#
道格拉斯．齊多尼斯(Douglas Ziedonis)醫學博士／公共衛生碩士(M.D., MPH)*
* 美國，麻省大學醫學院(University of Massachusetts Medical School)
# 芬蘭，於韋斯屈萊大學(University of Jyväskylä)
This work has been supported by a grant from the Foundation for Excellence in Mental Health Care awarded to Dr. Ziedonis at the University of Massachusetts Medical School.
本研究由麻大醫學院齊多尼斯教授所獲之卓越心理健康照護基金會(Foundation for Excellence in Mental Health Care)獎助金支持。
The intent of this document is to support the development of an Open Dialogue practice for whole teams participating in Open Dialogue meetings, for supervision and training purposes, and for helping in systematic research. These teams can also be used for “self-reflection” by an individual practitioner.
本文之目的為支持開放式對話之實務發展，參與開放式對話會談之整體團隊可蒙獲益處，達成督導與訓練的目的，並協助系統性研究。團隊亦能以個人為單位，進行「自我反思」(self-reflection)實務。
The authors share the copyright of this work. The material may be distributed in whole with the authors’ permission. Please contact Dr. Ziedonis if you are interested in translating this work to another language. Douglas.Ziedonis@umassmemorial.org
作者分享本文之著作權。全文得經作者同意方可傳布。如欲將本文翻譯為其他語言，請聯絡齊多尼斯教授：Douglas.Ziedonis@umassmemorial.org。
This work should be cited as follows:
本文需以如下形式引用：
Olson, M, Seikkula, J. & Ziedonis, D. (2014). The key elements of dialogic practice in Open Dialogue. The University of Massachusetts Medical School. Worcester, MA.
2014年9月2日
版本1.1
| 緒論 |
“Dialogic Practice” arose from “Open Dialogue” as an approach to help persons and their families feel heard, respected, and validated. Starting in 1984, at Keropudas Hospital in Tornio, Finland, staff already trained in family therapy decided to change the way inpatient admissions were handled. Following the work of Yrjö Alanen (1997), they altered their response to acute crises by having a network meeting, bringing together the person in distress, their family, other natural supports, and any professionals involved, in advance of any decision about hospitalization. This was the birth of a new, open practice that evolved—in tandem with continued clinical innovation, organizational change, and research--into what has come to be known as “Open Dialogue,” first described as such in 1995 (Aaltonen Seikkula, & Lehtinen,2011; Seikkula et al., 1995). The “openness” of Open Dialogue refers to the transparency of the therapy planning and decision-making processes, which take place while everyone is present. (It does not mean that families are forced to talk about issues therapists think they should be open about.) From the outset, this network approach was for all treatment situations. Over a ten-year period, this formerly traditional inpatient facility in Tornio was transformed into a comprehensive psychiatric system with continuity of care across community, outpatient, and inpatient settings.
「對話式作法」(Dialogic Practice)源自「開放式對話」(Open Dialogue)之實務進行方法，以協助當事人及其家庭成員感覺受到傾聽、尊重、與認同。芬蘭托爾尼奧市之柯洛普達醫院(Keropudas Hospital)自1984年起採用此法後，曾受家庭治療訓練之醫療人員便決定改變住院許可之核發方式。尤利歐．阿拉寧(Yrjö Alanen)於1997年出版關於精神分裂症之研究著作，此後醫療人員對於急性心理危機之反應，改為舉辦多方會談，將身感痛苦者、痛苦者之家庭成員、其他自然支持、以及任何相關專業人士，聚集一堂共同討論，再決定是否需住院治療，由此誕生出一種全新的開放式療法，演進成為目前所熟知的「開放式對話」；確切而言，此名詞於1995年率先提出(Aaltonen Seikkula, & Lehtinen, 2011; Seikkula et al., 1995)。至於臨床改革、組織變革、以及相關研究，亦隨著開放式對話之產生而持續進行。
開放式對話之「開放性」，意為療程規劃及決策過程為透明公開，每人皆在場進行，但不代表家庭成員被迫對於治療師認為應公開談論的話題發表意見。起初，此種網絡連結方式用於各種治療情形；10年內，開放式對話從芬蘭托爾尼奧市住院對象原本之慣用療法，搖身一變成為精神科之綜合系統，對於群體成員、門診對象、以及住院對象，皆提供持續性照護。
The practice of Open Dialogue thus has two fundamental features: (1), a community-based, integrated treatment system that engages families and social networks from the very beginning of their seeking help; and (2), a “Dialogic Practice,” or distinct form of therapeutic conversation within the “treatment meeting.” This current document divides Dialogic Practice into twelve elements that describe the approach of the therapist(s) in the treatment meeting to the person, their network, and all the helpers.
因此，開放式對話具有二項基本特徵：(1)以群體為基礎的整合治療系統，自家庭成員及社群網絡於最初尋求協助之始，便將其納入參與對象；(2)使用「對話式作法」，或可稱為「治療會談」當中的另一種治療交談形式。本文列舉對話式作法之12項要點，敘述治療師於治療會談中，與會談當事人、社群網絡、及所有協助人員之對話方式。
The treatment meeting constitutes the key therapeutic context of Open Dialogue by unifying the professionals and the network into a collaborative enterprise. Thus, Dialogic Practice is embedded in a larger psychiatric service that shares its premises, because it is essential to have both aspects. The Open Dialogue approach is an integrative one in which other therapeutic modalities (Ziedonis, Fulwiler, Tonelli, 2014; Ziedonis et al, 2005; Ziedonis 2004) can be added, adapted to the needs of the person and family, as part of an unfolding and flexible “treatment web” (Hald, 2013; Seikkula & Arnkil 2014).
治療會談集結專業人士及網絡成員，形成一種協力企業，以此方式建構開放式對話之主要治療情境。由於層面較廣大之精神健康服務，亦擁有上述二項開放式對話之特徵，對話式作法與精神健康服務共享場域，並於其中具體呈現。開放式對話屬於綜合型態，可加入其他類型的物理療法(Ziedonis, Fulwiler, Tonelli, 2014; Ziedonis et al, 2005; Ziedonis 2004)，並進行調整，以符合當事人與家庭成員需求，成為開展且具有彈性之「治療網絡」一部分。
There are seven basic principles of Open Dialogue, which are the overarching guidelines that the Finnish team originally proposed (Seikkula et al., 1995). The principles are listed in the Table below:
開放式對話有7項基本原則，此原先為芬蘭治療團隊所規劃之通用指南(Seikkula et al., 1995)，如表一所示：
表一：開放式對話之7項基本原則
|
|
| IMMEDIATE HELP | 立即協助 |
| SOCIAL NETWORK PERSPECTIVE | 社群網絡觀點 |
| FLEXIBILITY AND MOBILITY | 靈活性及行動性 |
| RESPONSIBILITY | 責任感 |
| PSYCHOLOGICAL CONTINUITY | 心理的持續性 |
| TOLERANCE OF UNCERTAINTY | 容忍不確定性 |
| DIALOGUE (& POLYPHONY) | 對話(及複調，polyphony) |
Relevant both to Open Dialogue as a form of therapy and a system of care, these seven principles represent the broad set of values, on which the more finely focused twelve fidelity elements of Dialogic Practice are based. For the purposes of this discussion on Dialogic Practice, the two principles of “dialogue (polyphony)” and “tolerance of uncertainty” will be given special attention as the foundation of therapeutic conversation within the treatment meeting. The other five of the seven principles, which emphasize the organizational features of the system, will be explicated in another document on organizational change and the system fidelity characteristics (Ziedonis, Seikkula, & Olson, in preparation). This companion document on organizational change will describe different ways that the Open Dialogue principles and the treatment meeting have been integrated into clinical practice, treatment programs, agencies, and systems of care.
此7項原則皆可作為開放式對話之治療形式或是照護體系而觀，表現出寬廣的價值組合；至於對話式作法更為確切的12項真實性要點，便是以此7項原則為基礎。為了討論對話式作法，本文焦點將著重於「容忍不確定性」與「對話(及複調)」此2項原則，將其視為治療會談當中的治療交談基礎；另外5項原則較強調系統的組織特性，將於另一探討組織變革與系統真實性特徵之文章中，再行闡釋(Ziedonis, Seikkula, & Olson, 文章準備中)。該份協作文章將描述開放式對話原則與治療會談，於臨床實務、治療計畫、機構、照護系統之中的不同整合方式。
In the current document on Dialogic Practice, the seven basic principles of Open Dialogue are not all covered in full detail; however they are elaborated in other readily accessible source documents (Seikkula & Arnkil, 2006; Seikkula & Arnkil, 2014). The following discussion will focus on the twelve, key elements of fidelity to Dialogic Practice that characterize the therapeutic, interactive style of Open Dialogue in face-to-face encounters within the treatment meeting.
本文探討對話式作法，並未逐一詳細說明開放式對話的7項原則；然而其他原始文件已有詳述(Seikkula & Arnkil, 2006; Seikkula & Arnkil, 2014)。以下討論將聚焦於對話式作法之12項真實性要點，利用治療會談中的面對面接觸，呈現開放式對話之治療與互動特性。
DIALOGIC PRACTICE: AN OVERVIEW
對話式作法之概述
To be in a transformative dialogue with people requires presence, an attention to the living moment without a preconceived hypothesis or specific agenda. The art and skill of Dialogic Practice means that the therapists’ communications are not formulaic. Open Dialogue involves being able to listen and adapt to the particular context and language of every exchange. For this reason, it is not possible here to make specific recommendations for sessions in advance, or for invariant phases in the treatment process. Prescribing this form of detailed structure could actually work against the process of Open Dialogue. It is the unique interaction among the unique group of participants engaging in an inevitably idiosyncratic therapeutic conversation that provides the possibilities for positive change.
為使對話更富變化性，治療師需親自參與會談，並專注當前情形，切莫心存假設偏見或預擬特定議題。對話式作法之所以具有藝術與技巧，原因在於治療師並非採取一成不變的溝通模式。開放式對話包含傾聽的能力，並能適應每場意見交流中的特殊情境及語言。因此，我們無法預先為會談提供相關建議，或於對話治療過程中設置固定語句。若每個流程架構皆明確建立，則違反了開放式對話的初衷。開放式對話具有正向改變的可能性，正因其屬於獨特的群組參與必然獨特的治療對話，所呈現出的獨特互動形式。
At the same time, there are systematic elements of Dialogic Practice. In this way, there is a paradox. While every dialogue is unique, there are distinct elements, or conversational actions on the part of the therapists, that generate and promote the flow of dialogue and, in turn, help mobilize the resources of the person at the center of concern and the network. This is what we mean by the key elements. They will be defined and described below.
對話式作法具備獨特性的同時，也擁有系統性要點。如此似成矛盾的悖論。每場對話皆獨一無二，治療師有其明顯不同的參與要素(或稱交談行為)可產生或促進對話流程，進而協助當事人及其社群網絡能夠活用現有對策。此即我們所稱的系統性要素，底下篇幅將再詳述。
Dialogic Practice is based on a special kind of interaction, in which the basic feature is that each participant feels heard and responded to. With an emphasis on listening and responding, Open Dialogue fosters the co-existence of multiple, separate, and equally valid “voices,” or points of view, within the treatment meeting. This multiplicity of voices within the network is what Bakhtin calls “polyphony.” In the context of a tense and severe crisis, this process can be complex, requiring sensitivity in bringing forth the voices of those who are silent, less vocal, hesitant, bewildered, or difficult to understand. Within a “polyphonic conversation,” there is space for each voice, thus reducing the gap between the so-called “sick” and “well.” The collaborative exchange among all the different voices weaves new, more shared understandings to which everyone contributes an important thread. This results in a common experience which Bakhtin describes as “without rank.”
對話式作法基於一種特殊的互動形式，基本特徵為每位參與者皆感覺受到傾聽與回應。藉由強調傾聽與回應的重要性，開放式對話於治療會談當中，促進了各種意見或觀點的多元、個別、以及同等有效之共存性。此種網絡內的意見多元性，是為俄國哲學家巴赫京(Bakhtin)所稱之「複調」(polyphony)。處於緊張且劇烈的危機時，此種多元意見的過程可能將顯複雜，因此需具備敏感度，以鼓勵沉默寡言、言詞謹慎、猶豫不決、混沌困惑、或難以理解之人，發表各種意見，暢言各種觀點。「複調式交談」當中，每個意見都有立足之地，而能拉近所謂「生病者」與「健康者」之間的差距。各種不同意見的協作交流，開創出嶄新而共享的理解，且每個人都是開創者，感到與有榮焉；由此帶來的共同經驗，是為巴赫京所稱之「打破階級」(without rank)。
As stated above, by calling a sequence “dialogical,” we mean specifically that the sequence has the potential for a person to feel heard, which is the beginning of any change. Evaluating the dialogical quality of a conversation means, first and foremost, evaluating the responsiveness of the therapists. Among the first steps is often for one of the therapists to engage with the person at the center of the crisis in a careful, detailed, back-and-forth interchange. The purpose is to listen and, as necessary, assist in finding words for the person’s distress,otherwise embodied in symptoms, and evolve toward a common language. As illustrated below, having input from the network assists in shedding further light on the nature of the crisis. The dialogical therapist invites each person in the meeting to share their perspective and the various, related issues that come up during the conversation. Instead of looking at therapists’ skills in terms of the way they conduct a structured interviewing methodology, the principal criterion is the often personal way the therapists respond to the afflicted person’s utterances and those of others present in the meeting.
上述「對話式」流程，特別意指該流程可令對象感覺受到傾聽，而傾聽正是改變的起點。至於對話品質之評估，首重治療師的回應程度。第一步通常為治療師之其中一人，採取謹慎、詳盡、以及互相往來之形式，與危機當事人進行對話。對話目的在於傾聽；如有必要，需協助替危機當事人可能以症狀顯現之苦痛，找到話語的出口，並成為共通語言。網絡中的訊息輸入，有助釐清危機的本質。對話治療師邀請每位會談人員分享各自觀點，以及交談中陸續浮現的各種相關議題。會談的主要準則並非注意治療師是否精於執行有條理的訪談方法論，而應注重治療師本身對於苦痛當事人及其他在場會談人員的回應方式。
Responding and Reflecting
回應與反思
There are two fundamental skills required for clinicians to do Dialogic Practice: the skill of responding and the skill of reflecting (Rober, 2005). The skill of responding is a three-part process that applies to the way all the fidelity elements are employed. This process must be present to call an exchange dialogical. While defining the quality of the therapist’s action, one has to look at the (1) client’s initial utterance; (2) the therapist’s response to that utterance; and (3) the response to the response given. How does the therapist’s response further the experience of each participant in being heard, understood, and acknowledged? How do these three steps generate dialogically responsive interaction?
臨床人員實務進行對話式作法時，需謹記「回應」與「反思」此二項基本技巧。回應技巧是一種三階段步驟，適用於所有採用真實性要點的方式。具有回應之意見交流型態，方可稱為對話。除了治療師於對話過程的品質應受界定，我們尚須注意：(1)當事人的起始語句；(2)治療師對於該起始語句的回應；(3)對於治療師回應的又一回應。治療師的回應如何促進每位參與者能夠受到傾聽、理解、以及認同之感受？此三步驟如何帶來對話式的回應互動？
The other basic skill of Dialogic Practice—the skill of reflecting--is the ability to engage in an open, participatory, transparent, and jargon-free conversation with the network and other professionals in the meeting. The skill of reflecting builds on the skill of responding.
「反思」是對話式作法的另一項基本技巧，意指能夠與會談中的網絡成員及其他專業人士，置身於一個開放、參與、透明、避免專業術語的對話。回應技巧是反思技巧之基礎。
Parenthetically, “reflecting” is different than how this same term is used in other forms of therapy. For example, in motivational interviewing, “reflecting” refers to how the therapist actively listens to what the client says. In Dialogic Practice, this term refers instead to the way the professionals talk about their own ideas in front of the family. We have learned from others that this can be confusing since many therapists interested in Dialogic Practice have also been trained in motivational interviewing.
附帶說明，此「反思」有別於其他治療形式之反思。舉例而言，動機式會談當中的「反思」，所指為治療師如何主動傾聽當事人之話語；至於對話式作法的「反思」，則為專業人士於家庭成員面前談論其自身觀點的方式。我們曾聽他人表示對於反思感到困惑，是由於許多治療師有意研究對話式作法，但先前曾受過動機式會談的訓練。
Monologue and Dialogue
個人獨白與多方對話
The Open Dialogue treatment meeting includes both monological and dialogical communication. So-called “monological” sequences in dialogue are necessary to make practical agreements, or to gain new information that can assist in a more complete understanding of the situation. By monological communication, we mean there are sequences in which the therapists themselves introduce conversational topics. Such sequences can comprise information gathering, providing advice, treatment planning, or otherwise initiating new subjects for discussion that did not build on what the client or another participant previously had said (Seikkula, 2002). In an Open Dialogue treatment meeting, up to one third (1/3) of the conversation can be monological, to stay consistent with the approach and conduct an effective meeting. Monologue can refer to the nature of communication either within the social network or that between the experts and the network.
開放式對話的治療會談，溝通模式包含個人獨白與多方對話。對話流程需有「個人獨白」(monological)，以達成實際協議，或取得更有助於完整理解情況的新資訊。所謂個人獨白，代表的是治療師本身於對話流程中引導話題，此流程可包含資訊蒐集、建議提供、治療規劃，或是發起當事人或其他與會者尚未談論過的新話題(Seikkula, 2002)。開放式對話的治療會談中，個人獨白式對話所占比例，達三分之一，有助與研究方法維持一致性，並使會談更具成效。個人獨白可指社群網絡內部、或專業人士與網絡之間的溝通模式。開放式對話的治療會談，包含個人獨白與多方對話之溝通模式。對話流程需有「個人獨白」，以達成實際的協議，或取得可助更完整理解情況的新資訊。所謂個人獨白，代表的是治療師本身於對話流程中引導話題。如此流程可包含資訊蒐集、建議提供、治療規劃，或可發起治療對象或其他參與者尚未談論過的新話題(Seikkula, 2002)。在開放式對話的治療會談中，比例達三分之一的個人獨白式對話，有助維持與研究方法的一致性，並使會談具有效用。個人獨白可指社群網絡內在、或專家與網絡之間的溝通型態。
That said, there is a difference between monological communication described above and what is meant by the term, “monological discourse.” The latter refers to an institutional way of talking, in which there is a privileged, top-down expert without a contributing listener. Instead of sustaining a dialogue among the various participants, all of whom are regarded as legitimate and equal, an entirely monological approach works against a more collaborative process that can lead to new ideas and creativity. In explaining this contrast further, it is helpful to refer to John Shotter’s (2004) translation of “dialogical” versus “monological” discourse into the more accessible terms of “withness thinking” versus “aboutness thinking” (Hoffman, 2007). In our clinical experience, this former way of thinking and practice has tended to open up more possibilities in psychiatric crises and to help unfreeze situations away from chronicity.
然而，上述之個人獨白式溝通模式，有別於此詞「獨白論述」(monological discourse)。獨白論述意指一種制式的談話方式，由一位獨擅全場的專業人士，進行由上而下的講話，其他聽者無法加入話語。至於完整的獨白溝通模式，是以更為協力合作的方式進行，有助激發新想法與創意，而非單純維持各個正當且平等的與會者之間的對話。為更進一步解釋此種對比，可參考約翰．書特(John Shotter, 2004)的論點，將「對話」與「獨白」之對比，轉化為更易懂的「由內思考」與「相關思考」之對比(Hoffman, 2007)。臨床經驗中，由內思考之方式及其實務運用，能於處理精神危機方面開啟更多可能性，並有機會脫離長期苦痛的宰制。
In what follows, we will describe each of the fidelity elements of Dialogic Practice in Open Dialogue and give clinical examples to illustrate them. The examples are drawn from the therapy sessions of the first and second authors, working together and separately. While every session incorporates these elements, we have chosen to include illustrations from different families. The reason for this is to give a sense of the different kinds of problems and situations we have addressed. There are also additional, supplemental definitions and examples of important concepts in the Glossary. These twelve fidelity elements are not separate but often overlap and occur simultaneously in actual practice.
以下篇幅將敘述開放式對話之對話式作法的各個真實性要點，以及舉證相關臨床實例。實例取自第一位、第二位作者所共同或分別舉辦之治療會談。儘管每場會談皆有融入這些要點，但為了列舉所因應的不同難題及個別情況，我們仍選擇不同家庭作為範例。本文之用語附錄，亦將列舉重要概念之定義與範例，屬於附加補充性質。12個真實性要點並非各自為政，而是整體疊合，同時出現於實務進行之中。
| 表二：開放式對話之對話式作法，所應具備的12項真實性要點 |
| 1. Two (or More) Therapists in the Team Meeting 團體會談需有二位以上的治療師 |
| 2. Participation of Family and Network 家庭成員及社群網絡之參與 |
| 3. Using Open-Ended Questions 使用開放式問題 |
| 4. Responding To Clients’ Utterances 回應當事人的話語 |
| 5. Emphasizing the Present Moment 強調當前時刻 |
| 6. Eliciting Multiple Viewpoints 引發多元觀點 |
| 7. Use of a Relational Focus in the Dialogue 對話中「關係聚焦」(relational-focus)之運用 |
| 8. Responding to Problem Discourse or Behavior in a Matter-of-Fact Style and Attentive to Meanings 對於論述或行為方面所遇難題的回應，需就事論事，並注重意義 |
| 9. Emphasizing the Clients’ Own Words and Stories, Not Symptoms 強調當事人的話語及故事，而非症狀 |
| 10. Conversation Amongst Professionals (Reflections) in the Treatment Meetings 治療會談當中，專業人士之間的交談(反思) |
| 11. Being Transparent 透明公開 |
| 12. Tolerating Uncertainty 容忍不確定性 |
THE TWELVE KEY ELEMENTS OF FIDELITY TO DIALOGIC PRACTICE
對話式作法之12項真實性要點
1. Two (or More) Therapists
二位以上的治療師
The Open Dialogue approach emphasizes the importance of multiple therapists meeting as a team with the social network. There should be at least two therapists in the meeting. The teamwork is essential to responding effectively to severe, acute crises and chronic psychiatric conditions. One therapist can be interviewing the client(s), while the other takes a listening and reflecting position. Or, it can be the case that both therapists are asking questions and engaging in reflections. The “reflecting process” of Tom Andersen (1991) and the “reflective talk” of Seikkula & Arnkil (2006) are both acceptable formats and will be described in greater detail under Item #10 below. Further, it is important to differentiate Open Dialogue practice from elective, non-crisis-service, outpatient therapy. Over the past decade, Dialogic Practice has been adapted to more ordinary couple and family therapy (Olson, 2012; Seikkula, 2014), in which it is possible to conduct Dialogic Practice as a solo therapist. Of note, we are writing a summary of our experience on how to conduct Dialogic Practice as a solo therapist that we will reference here when completed.
開放式對話強調多位治療師以團隊方式與社群網絡進行會談的重要性，至少需有二位治療師參與會談。團隊合作對於嚴重急性危機及慢性精神症狀方面之有效回應，是不可或缺的一環。一位治療師可負責與當事人進行訪談，另一位治療師則著重傾聽與反思；亦可二位治療師皆加入提問與反思。湯姆．安德森(Tom Andersen)於1991年提出之「反思過程」(reflecting process)，以及亞科．塞科羅(Jaakko Seikkula)、湯姆．艾瑞克．昂吉爾(Tom Erik Arnkil)於2006年發表之「反思對談」(reflective talk)，皆可作為對話模式，第10項要點將再詳述。
尚有一點需注意者為，開放式對話作法為非選擇式、非危機服務、非門診式之療法。近10年來，對話式作法已改良至更貼近伴侶治療與家庭治療之方法 (Olson, 2012; Seikkula, 2014)，單一治療師亦可執行對話式作法。在此一提，文末之結論將述及單一治療師如何執行對話式作法之經驗，以作為此段落之參考。
2. Participation of Family and/or Network Members
家庭成員及/或社群網絡之參與
The engagement with the network begins on the phone with the clinician asking the caller such questions as, for instance: “Who is concerned about the situation or who has been involved?” “Who could be of help and is able to participate in the first meeting?” “Who would be the best person to invite them, you or the treatment team?” These questions both facilitate network participation and help to organize the meeting in a nonhierarchical way, that is, with input from the client(s).
社群網絡之參與，始於臨床人員詢問諮詢者相關問題，例如「何人關心此情況，或與此情況有關」、「何人可提供協助，並能參加初次會談」、「應由何人邀請相關人員最為適當，您、或是治療團隊」。以上問題可促進社群網絡之參與，且因提問內容之資訊由當事人提供，有助於會談不受層級制度的影響。
By valuing the inclusion of the family and other members of the social network from the very beginning, they typically become important partners in the treatment process throughout. At the same time, there is flexibility based on the willingness of the person at the center to have their relatives present. The team can meet separately with different family and network members when conjoint meetings are not possible, as in many instances of violence and abuse.
若一開始即能重視家庭成員及其他社群網絡成員之參與，他們在往後常能成為療程中的重要夥伴。同時，當事人亦可自主決定是否希望相關人員在場，例如暴力與虐待案件中，相關人員無法共同在場，治療團隊便需分別與不同的家庭成員及社群成員舉行會談。
As we will describe below (under Element #6), meetings without family or network members involved can also occur in which the therapist will then ask questions inviting the person to comment on what they think an absent member would say if they were present.
第6項要點亦將述及，家庭成員及社群網絡成員缺席之會談中，治療師亦可鼓勵當事人發表意見，詢問當事人：若缺席者在場時，該人可能訴說何種話語。
3. Use of Open-Ended Questions
使用開放式問題
The actual treatment meeting itself begins with open-ended questions asked by the clinicians. After introductions, an opening thus could be formulated by simply asking, “Who would like to start?” Or, “what would be best way to begin?” Once this kind of collaborative process becomes established and expected, it is naturally carried forward into subsequent meetings as a taken-for-granted element. In the very first appointment, it is important to emphasize the two questions that routinely commence an Open Dialogue meeting and were proposed by Tom Andersen (1991). They are: (1) “what is the history of the idea of coming here today?” And, (2) “how would you like to use this meeting?”
治療會談實務進行，始於臨床人員詢問之開放式問題。簡單介紹後，可使用二則提問作為會談開場：「哪一位有意先開始」或是「會談該怎麼開始比較恰當」。一旦確立此種協作過程，往後之會談將能自然而然採用，作為必備要素。不過在開放式對話的首場會談中，仍需先強調此二則由湯姆．安德森(Tom Andersen)規劃之提問：(1)可否談談今日之所以來此參加會談的來龍去脈；(2)您希望如何運用此番會談。
In this way, there are three subcategories of open-ended questions that we would like to address. First, there is the use of the “two questions” in the very first meeting; second, there is the use of the second of those questions in every meeting, and third, the ongoing practice of open-ended questions throughout the treatment process.
如此一來，我們將面對開放式問題的三種次分類：一、首場會談所使用的「二則提問」；二、往後的會談中，將針對第二則提問「您希望如何運用此番會談」繼續開展；三、療程中持續使用的開放式問題。
A.The History of the Idea to Have the Meeting?
今日之所以來此參加會談的來龍去脈？
“What is the history of the idea of the meeting? This question usually occurs only in the initial meeting and comes at the beginning. But, depending on the nature of the intake, it can also come later in the first meeting. It can be phrased in various ways and is addressed initially to the whole assembly, not just one person. “How did you have the idea to have this meeting?” Alternately, it is possible to start by asking, “Who first thought of having this meeting?” There is also a range of possible follow-up questions meant to engage everyone present: “How did others learn about this idea? What did you think of coming here today? Who agreed the most and least with the idea of contacting the team? What would you like to accomplish?
「可否談談今日之所以來此參加會談的來龍去脈？」此提問通常出現於首場會談的開場白，不過亦可依照實際情形，稍晚再使用於首場會談的對話中。提問有多種形式，一開始是對全體參與者發問，而非針對單一個人，例如「大家是怎麼知道可以來參加會談的」或是「哪一位最先想到要來舉辦會談的呢」。尚有許多後續問題，可使與會者皆融入會談：「其他人怎麼知道這件事的？今日來此會談，您覺得如何？提出要聯絡治療團隊時，哪一位最表同意，又是哪一位最持反對意見？您們希望可以達成什麼事？」
It is important to give everyone a chance to discuss their ideas about the meeting. At the same time, if, at any time, someone does not wish to speak, it is equally important not to force them to do so.
重要的是，會談的各個成員皆需有機會表達意見。同時亦須謹記，若其中有人無意發言，不可迫使其開口說話。
This type of question invites people to speak in a reflective voice. By reflective, we mean asking people to discuss their own purposes, intentions, and aims with regard to the decision of seeking help. Beginning in this way, this first question addresses the immediate context and is neutral toward any definition of a problem or symptom. It encourages people to describe the situation leading up to the meeting and the important people involved. Despite the emphasis on history, the question gives immediate multiple entrees into the present moment.
此類提問可使回答者產生反思，反思意指要求與會者針對其決定尋求幫助之舉，討論他們的目的、意向、以及目標。以反思為前提而開始會談，第一則提問即可立刻切入情境，且對於當事人之難題或症狀，不產生偏頗的指涉。此提問鼓勵與會者敘述會談舉行之前因，以及重要相關人員。雖此提問討論的是來龍去脈，但仍可提供諸多方式引導進入當下的會談。
Andersen (1991) writes, “The idea behind this question is to reach an understanding about how much those who are present are committed to the idea of being present (p. 159).” Often when asked, different participants express different viewpoints on their commitments to being present, which is important to know, especially when the idea of therapy itself may be contested terrain. At other times, this question can locate a potential resource by identifying people not present who could be helpful. This question does not have just one meaning or effect, and sometimes something completely unexpected happens.
安德森寫道：「此提問的用意，是希望在場與會者了解自身對於現前舉行的會談，將能帶來多少貢獻」。問及此，各個與會者通常會針對自身貢獻為何，表達不同觀點，此方面在治療本身具有爭議時，尤顯重要。有時，此提問亦可藉由指明當時未在場但或可帶來幫助之人，協助找出其他可能的資源。此提問不會僅具有單一意義或成效，甚至會出現完全意料以外之成果。
B. How Would You Like To Use this Meeting?
您希望如何運用此番會談
The second question is “How would you like to use this meeting?” The question can be phrased in different ways. As with the earlier question, the second question is addressed to the whole assembly, not to one person. At the same time, it is important to give everyone a chance to respond to this question.
第二則提問為「您希望如何運用此番會談」，此提問亦可使用不同形式的問句，且如同第一則提問之原則，需對全體參與者發問，而非針對單一個人；同時，每個人皆需有機會回應此則提問。
This second question is asked in the first meeting and, with some variation, in all subsequent meetings. Usually this question occurs at the beginning of a meeting. There are instances where it comes later, so the timing depends on the therapist being sensitive to the particular nuances of how a particular meeting is unfolding.
第二則提問將於首次會談中提出，而往後的會談亦可採用不同方式，加入此提問。此提問通常出現於會談之初，有時也可能在會談稍後，提問的時間點，決定於治療師對於會談展開過程的細微差別所抱持之敏銳度。
The rationale behind this question is that in Dialogic Practice, it is the clients rather than the professionals, who principally determine the content of the meeting, That is, we talk about what the clients want to talk about. For this reason, in every meeting, the therapist asks the client how they wish to use the meeting. Over time, with such repetition, the second question may become more implied, rather than directly stated.
之所以採用此提問，基本原因為對話式作法的過程中，會談內容的主要決定權，在於當事人而非專業人士；也就是說，我們討論的是當事人有意討論的話題。因此在每個會談中，治療師皆詢問當事人希望如何運用此番會談。經過多次會談後，此提問因重複提出，其問句方式可能變得較為隱藏本意，而非開門見山道出。
Case Example of the Two Questions: The L. Family
運用二則提問之案例：L家庭
The L. Family consisted of David, age 59, a paralegal, his wife, Tracy, age 56, an occupational therapist, and their son, Jack, age 30, who rarely spoke and lived with his parents. Jack was hospitalized for depression for the first time when he was 16 years old. He has had multiple diagnoses over the years (psychosis NOS, schizoaffective disorder, and schizophrenia) and had been involved with mental health services until several years ago. The first Open Dialogue meeting with this family began with the two therapists and the parents sitting together in a circle, while Jack chose to sit in a chair slightly outside the arrangement, listening, seeming occasionally to be communicating with invisible presences. There were pleasantries exchanged at the beginning and one of the therapists’ then started, signaling the beginning of the therapeutic conversation:
L家庭的成員，包括：大衛，59歲，擔任律師助理；崔西，大衛之妻，56歲，現為職能治療師；傑克，大衛與崔西之子，30歲，沉默寡言，與父母同住。傑克16歲時首次因憂鬱症而住院，其後陸續診斷出未定型精神疾病(psychosis NOS)、情感性精神分裂症(schizoaffective disorder)、以及思覺失調症(schizophrenia)。傑克曾接受心理諮商服務，直到數年前方停止。L家庭的首次開放式對話會談中，二位治療師與父母圍成圓圈而坐，傑克則坐在一張椅子上，位置稍遠離該圓圈，似乎與某種無形的存在溝通交流著。一開始眾人輕鬆寒暄，接著一位治療師開始帶出治療對話：
Therapist 1: “So, here we are. Should we start?”
Therapist 2: “Yes, let’s start.”
治療師甲：「好的，那麼我們要開始了嗎？」
治療師乙：「嗯，開始吧。」
The therapists introduced themselves to Jack and asked the parents if they minded being called by their first names. Therapist 1 said, “Jack, do you prefer to stay where you are, listening?” His mother suggested to Jack to join them, but Therapist 1 indicated that he did not mind if Jack stayed where he was, if that is where he felt most comfortable. Therapist 1 then asked the first question:
治療師向傑克自我介紹，並詢問父母是否介意直接以名字稱呼他們。治療師甲說：「傑克，你比較想要待在那裡聽我們講話就好嗎？」他的母親建議傑克加入他們，但治療師甲表示，如果那裡能夠讓傑克感到最為自在，傑克繼續留在原處也無妨。治療師甲接著道出第一則提問：
Therapist 1: So there is a history behind this meeting? Was it the case that you wrote to me? Or, how was this? Someone wrote….
David: I wrote…
Therapist 1: So you wrote to me. Ok.
David: I wrote to both of you (looking at Therapist 2). I got email addresses from your universities. Actually Tracy dictated the first letter. It was a mutual decision.
Tracy: I told him to polish it up…
David: I didn’t expect a direct answer.
Therapist: Yeah. You didn’t expect a direct answer.
治療師甲：能談談這場會談的來龍去脈嗎？是您寫信給我表示想要舉辦會談，還是，其他人寫信的呢...？
大衛：是我寫的…
治療師甲：噢，是您寫給我的。
大衛：我有寫信給你們二位(看著治療師乙)。我從你們的大學網站知道你們的電子信箱。其實，信的內容是崔西念給我聽的，我們二個互相討論決定要參加會談。
崔西：我有跟他說要修飾一下信件內容…
大衛：我沒有想到會收到回信。
治療師：是喔，您沒有想到會收到回信。
The father then described how he had been searching on the web for an alternative to the kind of psychiatric care that his son had dropped out of some years before. There were long descriptions of their negative experiences with professionals. Jack became restless and started to leave the room.
父親開始講述，自從他的兒子在數年前停止精神科照護後，他是如何在網路上搜尋其他的治療方案。父親花了很大篇幅描述與其他專業人士的負面經驗。傑克變得坐立難安，起身準備離開房間。
Therapist 1 (addressing Jack who is standing at the door): When did you hear about coming here for the first time?
治療師甲(對著站在門前的傑克說話)：你是什麼時候第一次知道要來參加會談的呢？
The therapist asked this question several ways, and the parents repeated the question until Jack answered: “Three days ago.”
治療師用了好幾種方式詢問此提問，父母也複述此提問，傑克終於回答：「三天前」。
A few minutes later, the therapist asked the second question:
幾分鐘後，治療師帶入第二則提問：
Therapist 1 (looking at Tracy): How do you think it is best to use this time here now?
Tracy: It is hard for us to know what is the best to do for Jack? That is what we are thinking about mainly now. That is why we think this kind of psych treatment would be better. That it might open him up more to the ……(search for the word.)
Therapist 2: to the community? (A word Tracy had used earlier.)
Tracy. Yes, thank you, the community.
治療師甲(看著崔西)：您覺得我們現在該如何好好利用這次的會談呢？
崔西： 我們實在是不知道該怎麼做才是對傑克最好的，現在我們就是在思考這個問題。所以，我們覺得，這種精神治療方式說不定會比較好，可以讓傑克更能面對……(搜尋用字)
治療師乙：面對群體嗎？(崔西剛才用過這個字)
崔西：沒錯，群體，謝謝你。
These two questions let the therapists know that the parents both were committed to the idea of doing Open Dialogue, rather than in conflict about it, and had a shared motivation to help their son. There was evidence that Jack was not opposed to the idea, since he willingly came with them. These questions created a window on the parents’ joint perception that there was “more to Jack,” whom, as they explained, had been defined as chronic and hopeless by the mental health system. This excerpt also provides an illustration of making contact with each person early in the meeting and allowing each person to have a voice in relation to the theme being discussed, namely, the nature of the meeting.
此二則提問令治療師得知，開放式對話的進行，是經過父母雙方的同意，而非對此意見不合。二人也有共同的動機，也就是希望能幫助兒子。且能明顯看出傑克並不反對參加會談，因為傑克自願與父母一起前來。此二則提問也使父母了解，開放式對話能夠「給傑克更多幫助」，畢竟如同父母所言，傑克在心理健康系統中，以往總是被冠上長期慢性疾患以及無法醫治的診斷結果。此則對話節錄同時也示範了如何在會談之初接觸每位與會者，並使每個人都有機會針對討論主題發聲，這也正是會談的本意。
After beginning with above-mentioned questions, it is important throughout the meeting to have in mind formulating the questions in an open-ended way, so that clients can take the initiative both to speak about what they see as important and in the way that they would like to discuss it. For therapists, this means that they guide the dialogical process by neither determining nor selecting topics, but by their way of responding to clients’ utterances. In the next section, and throughout this document, there will be examples of this kind of open-ended inquiry.
以此二則提問作為會談開端之後，切記必須在會談過程中，以開放的角度，有條理地闡述此二則提問，如此當事人方能主動道出認為重要之處，並以自身慣用的方式進行討論。對於治療師而言，則代表不必由治療師本身來決定或選擇對談主題，而是以回應當事人話語的對談方式，來主導整個對談過程。下個篇幅當中，以及本文各處，皆有此種開放式問題的範例。
4. Responding To Clients' Utterances
回應治療對象的話語
The therapist promotes dialogue by responding to the client’s utterances commonly in three ways that invite a further response. This includes (A) using the client’s own words; (B) engaging in responsive listening; and (C) sustaining attunement to nonverbal utterances, including silences.
治療師可藉由以下三種方式來回應治療對象的話語，以期展開更多回應，提升對話作用：(A)使用治療對象本身的語句；(B)投入回應式的傾聽；(C)維持非口語形式話語之協調，包含對話中的沉默不語。
A. Use of the Client’s Words
使用當事人本身的語句
The clinician actively follows what the client says and integrates the client’s very same words and phrases into their responses. The above example shows how the therapists do this, closely listening to what clients say and repeating the client’s own words in asking questions or making other comments. What the client has previously said is incorporated—with their very same words-- into the therapists’ responses. Here is a brief vignette from the L. family of David, Tracy, and Jack that took place in the initial meeting described above.
臨床人員積極注意當事人所說的話語，並且將當事人使用的語句，一字不漏地放入自己的回應之中。上述案例已顯示治療師仔細傾聽當事人話語，並在回答問題或作出其他評論時，重複使用相同語句，當事人曾說過的話語，完整使用於治療師的回應。以下為上述L家庭在首次會談過程的小插曲：
Case Example of the Use of Clients' Words: The L. Family
使用當事人本身語句之案例：L家庭
David: I didn’t expect a direct answer.
Therapist: Yeah. You didn’t expect a direct answer.
David: I didn’t expect an answer. I knew there was a training program in Open Dialogue. I didn’t think it would be a direct possibility. I thought maybe, you’d say at a future point. I was surprised. It made me think that I was on the right track.
大衛：我沒有想到會收到回信。
治療師：是喔，您沒有想到會收到回信。
大衛：我沒有想到會收到回信。我知道有個開放式對話的訓練課程，但沒有想過真的有機會接觸。我以為，你們可能之後才會安排。我蠻驚訝的，但也讓我覺得我的選擇是對的。
B. Responsive Listening To Make Space for Stories That Are Not Yet Told
投入回應式的傾聽，以引發更多尚未講述的故事
The practice of repeating words leads naturally into “responsive listening,” or listening without a specific agenda. Responsive listening often creates an atmosphere in which the clients’ begin to tell important personal stories that they have not shared--or do not share easily--with others, especially professionals. There is evidence that the therapist’s responses are effective when, for instance, there is change experienced during a meeting in the direction of a calmer atmosphere. The conversation has pauses, silences, and more shared exploration of--reflection about—issues and concerns in a dialogical ebb and flow.
重複語句的作法，將自然而然形成「回應式的傾聽」，或是不存在特定議題的傾聽。回應式的傾聽經常能夠塑造一種氛圍，對象在此氛圍之中，娓娓道出先前未曾與他人分享、或不輕易與他人分享的個人重要故事，尤其是共同談話者為專業人士的情況下。證據顯示，會談當中若感受到氣氛趨向緩和平靜，此時治療師的回應更起成效。對話過程的起伏消長之中，包含了暫停、沉默、以及對於議題與關注層面的深入探討或反思。
In the meeting with the L. family of David, Tracy, and Jack, the therapists listened responsively. They repeated words, or, with small questions, invited alternate and more hopeful perspectives (together with a lot of “Mhms”). In response, the parents expanded on the qualities of their son that gave them hope. They told several pivotal and unexpected stories that the therapists never could have anticipated. For example, his parents described how Jack saved a woman’s life in the residential community he was living in by notifying staff that she was suicidal. This and other affirming stories told during the session characterized Jack as a person capable of acting to help and protect others, rather than only as a person in need of help and protection himself. As these stories were told and heard by the Open Dialogue clinicians, a more positive identity was constituted and new possibilities were reviewed for Jack’s recovery that had not been captured by his diagnoses.
L家庭的會談當中，治療師使用回應式的傾聽，重複當事人的語句，或者利用小問題讓當事人帶出其他更具希望的觀點(也使用許多「嗯哼」)；父母則是詳細描述兒子所具有讓他們感到希望的特質，作為回應。父母說出了好幾個出乎治療師意料之外的重要故事，例如傑克曾通報警方他所住的社區有一位女性企圖自殺，而救了她一命。此則故事和其他在會談中言之鑿鑿的故事，將傑克形容為一位有能力採取行動以幫助與保護他人的人，而非只會單方面索求來自他人的幫助與保護。這些故事打造了傑克的正面特質，而傑克在以往診斷之中遭到忽略的康復機會，亦透過這些故事，使得開放式對話的臨床人員，得以重新審視傑克復原的可能性。
C. Nonverbal Attunement, Including to Silences
維持非口語形式話語之協調，包含對話中的沉默不語
The therapist shows attunement to the client’s analogic (nonverbal) communications. Importantly, this also includes allowing for and tolerating silences in the conversation.
治療師需協助維持類比形式(非口語形式)話語之協調，重要之處也包含了允許並容忍對話中的沉默不語。
It is crucial to pay close attention to what is being communicated through body-based channels as well as words. Here is an example from the above meeting when the therapist returns at a later point in the meeting to address his initial encounter with Jack:
溝通行為中的肢體表達和口語傳達，二者皆須密切注意。以下案例延續上述會談，治療師在會談稍後的某一時間點，提及與傑克的初次見面：
Case Example of Responding to a Body-Based Communication: the L. family:
回應肢體溝通方式之案例：L家庭
Therapist 1 (addressing Jack): When I first met you in the reception, and I proposed to shake hands, you said, “No, I don’t shake hands...” Can you help me a bit more: Why don’t you shake hands?
Jack: I didn’t feel like touching you.
Therapist 1: Oh, you didn’t want to touch.
Jack: No.
治療師甲(對傑克說)：那時第一次會面時，我想和你握手，但你說「不，我不握手...」，不知你是否方便談談為什麼不握手嗎？
傑克：我不想碰到你。
治療師甲：噢，你不想要碰人。
傑克：對。
In the above example, this exchange elicited from Jack a clearly verbalized preference, in contrast to expressing his voice in the meeting principally through physical gestures such as sitting outside the circle or leaving the room when sensitive issues came up. At the same time, while such analogic (nonverbal) behaviors might be viewed as symptoms, they are respected as important communications within the meeting.
上述案例中，意見交流引起傑克以言語明確告知自身偏好，而非僅以肢體動作表達意見，例如坐於圓圈外圍，或是在敏感話題出現時設法離開房間。另外，此種類比形式(非口語形式)話語雖可能被當成症狀，但我們的會談中極為重視此種表達，視為一種重要的溝通作法。
In this way, therapists notice clients’ gestures and movements, their breathing, change in their tone of voice, their vocal pitch, their facial expressions, and the rhythm of their utterances and changes in that rhythm. If a therapist’s question produces a pause in the client’s breathing, this is meaningful. It may be a sign that the question was too difficult or challenging and thus blocking the possibility of new meanings arising.
治療師將注意當事人之姿勢、動作、呼吸、語氣改變、聲調、臉部表情、話語節奏及其他改變等。若治療師的提問造成當事人出現屏息的動作，則別有含意，可能代表該提問過於困難或咄咄逼人，反而阻擋了出現新資訊的機會。
Allowing for silences in the therapeutic conversation can be another important form of therapeutic attunement, since silence often offers a creative prelude for untold stories and the emergence of new voices. The allowable period of silence cannot be quantified, but has to be felt from within the shared context. Such indices are essential for the therapists to notice and know how to respond to, with the hope of understanding as much as possible the meaning of what the client utters.
允許治療對談中的沉默片段，亦是維持治療協調的重要形式，其原因在於，沉默的下一階段經常能夠開啟尚未道出的故事，或是帶來新加入對話的與會者。至於受允許的沉默期間，無法量化定之，而需視當時情境而定。
這些基本指標能夠幫助治療師察覺及得知回應方式，以期更為了解當事人所說話語的意義。
5. Emphasizing the Present Moment
強調當前時刻
The clinician emphasizes the present moment of meeting. There are two, interrelated parts to this: (A) responding to the immediate reactions that occur in the conversation; and (B) allowing for the emotions that arise.
臨床人員重視會談中的當前時刻，此原則包含二個互有關聯的部份：(A)回應對談中出現的直接反應；(B)允許情緒湧現。
A. Responding to Immediate Reactions
回應直接反應
This means a preference for responding to the client’s immediate reactions that occur in the here-and-now therapeutic interaction, rather than on their reports on what has happened outside the therapy room. A simple example of this in the meeting described above with Jack and his family is the interchange about shaking hands.
回應對談中出現的直接反應，意指在治療過程時，需能即時回應治療對象當下所出現的直接反應，而非僅參照對象所述有關其在會談室以外發生的情形。上述L家庭案例中，與傑克討論交換關於握手的看法，即為回應直接反應之一例。
B. Allowing Emotions to Arise
允許情緒湧現
A more complex dimension of emphasizing the present moment unfolds if the client becomes emotionally moved while speaking about a sensitive issue. When emotions arise such as sadness, anger, or joy, the task of therapists is to make space for their emotions in a safe way, but not to give an immediate interpretation of such emotional, embodied reactions. Here is an example of the latter:
當事人談及敏感話題而觸發情緒，是強調當前時刻要點當中，較為複雜的面向。當事人若有悲傷、憤怒、喜悅等情緒浮現時，治療師的任務是為他們找到安全的情緒出口，而不應立即詮釋此種外顯的情緒反應。相關案例如下：
The V. Couple: Emphasizing the Present Moment When Emotions Are Present
情緒湧現時強調當前時刻之案例：V夫妻
Margaret was a 25 year -old woman who has been on disability for depression. She and her husband Henry were coming to their second session of couple therapy. The first session had focused on Margaret’s symptom of severe depression. The beginning of the second session seemed rather chaotic and tense. Therapist 1 recalled the way Margaret and Henry, who were about 5 minutes late, entered the building. It seemed that there was some commotion, and Henry had to convince Margaret, who appeared quite upset and agitated, to come into the office. The therapist asked Henry how he was doing. “Quite good,” he answered. The therapist turned to his wife:
瑪格麗特是位25歲女性，長期飽受憂鬱症所苦。她與丈夫亨利此次是第二回前來參加伴侶治療，而第一回治療主要針對的是瑪格麗特的嚴重憂鬱症狀。第二回治療似乎在喧鬧緊張之中開場，治療師甲想起了瑪格麗特與亨利走進大樓的情形，他們遲到5分鐘。當時顯得有些躁亂不安，亨利必須安撫看起來極為不悅且激動的瑪格麗特，讓她願意進入辦公室。治療師向亨利打招呼，亨利回答「我很好」，治療師便轉向瑪格麗特：
T1: “Margaret, what about you?”
M: “Well, I feel differently. I did not want to come here today. I am not usually like this...”
T1: You didn’t want to come here today. For some specific reason or?
M: I think that I have just been working too much, and I am tired.
T1: Mhm.
治療師甲：瑪格麗特，那妳呢？妳好嗎？
瑪格麗特：唉，我不好，我今天不想來這裡，我平常不會這樣的...
治療師甲：妳今天不想來這裡啊？有什麼特別原因嗎，還是？
瑪格麗特：我覺得我一直操勞，現在我累了。
治療師甲：嗯哼。
Margaret’s answer seemed to contain three disconnected statements. The therapist‘s answer--“you didn’t want to come here today?” --was a response to one of Margareta’s utterances and not the other two. It did not comment on her display of emotion, yet addressed the specific concern most active in the present moment, “not wanting to come,” which is an invitation to be in dialogue.
瑪格麗特的回答似乎是三個互不關聯的敘述，而治療師的回答「妳今天不想來這裡啊？」則是回應瑪格麗特其中一個發言，而非回應另二個。對於瑪格麗特的情緒表現，治療師並無給予意見，但仍特別關注當下並作出回應「妳不想來啊」，言下之意其實是想邀請瑪格麗特加入更多對話。
6. Eliciting Multiple Viewpoints: Polyphony
引發多元觀點：複調
Open Dialogue does not strive for a consensus, but for the juxtaposition and creative exchange of multiple viewpoints and voices, even if they are in tension between people or within a person. There are two dimensions to the multiplicity of viewpoints and voices, or polyphony: (A) outer and (B) inner. In outer polyphony, the therapist engages everyone in the conversation, encouraging all voices to be heard and respected, while, integrating incongruent language, and managing a dialogue instead of a monologue. In inner polyphony, the therapist listens for and encourages each person to speak about their own point of view and experiences in complex ways.
開放式對話的目的，並非致力達成共識，而是多元觀點及意見的並行共存與交換，即使與會者之間或個人本身的觀點或意見處於緊繃態勢時，也不例外。觀點及意見的多元性，或稱複調，分別表現於外在與內在二個面向。外在複調當中，治療師讓每位與會者加入對話，鼓勵所有意見皆能表達及受尊重，並整合相歧的語言，維持對話而非獨白的進行。至於內在複調，則是治療師留神傾聽每位與會者，並以各種方式鼓勵所有人道出個人觀點及經驗。
A. Outer Polyphony
外在複調
Everyone should be listened to and given the possibility of speaking, not just the person identified as having problems or symptoms. Experiencing, or “living in,” the polyphony of voices within the meeting, a multiplicity of voices, the clinician should be sensitive to everyone present and hear from everyone about the important themes under discussion. In both the first example of the L. family of David, Tracy, and Jack and the second example of the couple, Margaret and Henry, the therapists made sure that each person was given the chance to speak. With Jack’s family, there was an interweaving of their different voices into a common understanding of their collective isolation, not just focusing on Jack’s predicament. Here is a further example from the therapy of Margaret and Henry.
所有人皆應受到傾聽，且擁有發言機會。對話並非侷限於面臨難題或遭診斷有疾患的單一個人身上。臨床人員在會談當中，體驗(或「實際處於」)意見複調，也就是意見的多元性，應能敏銳感受在場各個與會者，並傾聽各人對於討論的重要主題所持之不同意見。在L家庭及V夫妻的案例中，治療師確認每個與會者皆有機會發言，L家庭更是交織結合不同意見，進而對於他們的集體隔絕情形產生了共同的理解，而非只關注傑克的病情。以下為V夫妻的延伸治療案例：
Case Example of Outer Polyphony: the V. Couple
外在複調之案例：V夫妻
In the second session, Margaret and Henry progressed from a state of turmoil and escalating conflict to the emergence of a more constructive interaction that culminated in their open discussion of their differences. As we described, Margaret began the session in an upset, agitated state. She stated early in the session that her husband was never home. The therapist responded by repeating her word with an edge in his tone of voice and directness that matched her emotional intensity: “What does “never” mean?” After this comment, there was a palpable shift. Instead of continuing to display an escalating sense of misery, Margaret began to speak more respectfully to the therapist, as if she suddenly felt the session might hold the possibility of her being heard. Henry also changed after the therapists’ comment and began to express himself more clearly in an assertive voice that dissented from that of his wife. Prior to this exchange, Henry’s comments were almost incoherent. As the therapist continued to engage with each partner in a responsive way, there emerged a dialogue not only between the therapist and each partner, but also between the couple themselves. They, for the first time, started to speak from distinct “I” positions, addressing their partner as “you.” They were each able to maintain the clarity of their own separate perspectives and listen to and hear the other person’s perspective.
第二回會談中，瑪格麗特與亨利從混亂與衝突攀升的狀態，進展為達成較具建設性的互動，進而能夠開放討論他們之間的差異。如前所述，瑪格麗特一開始是不悅且激動的情緒。她早些曾在會談中描述丈夫不曾回家，治療師便使用符合瑪格麗特情感強度的語氣與直白敘述，重複瑪格麗特的語句，以回應她的話語：「『不曾』是什麼意思呢？」在這句回應之後，情況有了明顯轉變，瑪格麗特不再持續以苦痛折磨自己，而是開始用較為恭敬的態度對治療師說話，彷彿她忽然感到，會談使她擁有受到傾聽的可能性。亨利也在治療師說出該回應之後有所改變，以明確斷定的話語，表達自身意見，有別於妻子瑪格麗特；在此之前，亨利的意見幾乎無連貫性。當治療師繼續以回應的方式參與夫妻二人的對話時，對話不僅僅產生於治療師與夫妻任一人之間，更出現在夫妻彼此之間。他們第一次使用「你/妳」來稱呼伴侶，而不再固守區別意味濃厚的「我」這類第一人稱表達方式。他們二人皆能在保持各自觀點清晰明確的情況下，同時傾聽另一人的觀點。
While not initially agreeing, they, nevertheless, began to negotiate toward eventually forging a new solution to their central conflict. In this way, a small segment of a conversation reconstituted an entire context as a dialogic one that sustained polyphony.
他們開始對於他們的主要衝突進行商討，認為最終應要有新的解決方式，儘管在商討之初並無共識。在此情形下，一小部份對話便重建了整體對話情境，得以維持複調。
Another key dimension of the principle of polyphony is the clinician’s ability to integrate language by other professionals and members of the social network that is jarringly incongruent with the dialogical way of working. The occurrence of such incongruent comments does not occur in every session, but handling such remarks is such an important element of sustaining a polyphonic conversation that we are including it here. Here is an example from a third family, the P. Family.
複調原則的另一重要面向，是臨床人員統整不合對話常理語句的能力，這些語句可能出自其他專業人士及社群網絡成員。雖然並非每場會談皆會出現不合對話常理的語句，但處理此種語句是維持複調對話的一項重要因素，故而在此述之。
Case Example: Integrating Incongruent Remarks: the P. Family
統整不合對話常理言詞之案例：P家庭
The P. Family was seeking help for their 25 year -old son Christopher who had had an acute psychotic episode several years ago while in his last year of college. His parents, John, age 60, and Sheila, age 56, who had been going through a difficult divorce when Christopher had this crisis, had remained embattled and estranged. Sheila was a teacher with a stable job, while John was an unemployed carpenter. During Christopher’s psychosis, his parents had him involuntarily hospitalized at a private university hospital where his treatment was primarily psychopharmacological. He had had trouble holding a job since then and was living at home with his mother, Sheila. Christopher had remained resentful and angry about the hospital commitment and the treatment he received there.
P家庭的克里斯多福，25歲，數年前，在大學最後一學年時，經歷了急性精神疾患發作。父親約翰，60歲，母親席拉，56歲，二人在克里斯多福發病後，糾纏於離婚問題，目前態勢依然劍拔弩張，二人關係疏遠，但仍努力為兒子尋求治療。席拉擔任教師，工作穩定，而約翰是個失業的木工。克里斯多福發病期間，父母在他非自願的情況下，讓他到一間私立大學附設醫院住院治療，主要採取精神藥理學的治療方式。此後，克里斯多福工作不穩定，並和母親席拉同住。克里斯多福對於當時接受的醫院照護與治療，至今仍感憤恨不平。
At one network meeting, the family’s longtime primary care physician attended for the first time. He had remained both John’s (the father’s) doctor and his trusted ally, while Sheila and Christopher no longer saw him as their doctor. Sheila, John, and Christopher were all present at this meeting. The doctor said abruptly and immediately at the beginning: “There are three things required in a situation like this: medication, cognitive-behavioral therapy, and family therapy.” Christopher suddenly became flushed, hunching his shoulders and looking distressed. The Open Dialogue clinician knew that this young man had had an extremely negative experience with medication while in the hospital and felt he was doing better without taking them. At the same time, his parents were in tense disagreement about the issue of medication.
在一場社群網絡會談中，P家庭長久以來的家庭醫師初次參與會談，該位醫師仍擔任父親約翰及約翰助手的家庭醫師，不過席拉與克里斯多福已不再將他視為他們的家庭醫師。此次會談中，席拉、約翰、以及克里斯多福皆在場。會談之初，該位醫師不意脫口而出：「這種情況需要三種治療：藥物、認知行為治療、還有家族治療。」克里斯多福忽然面色潮紅，肩膀拱起，看似十分沮喪。開放式對話的臨床人員見此了解，這位年輕人先前在醫院時，對於藥物有著極為負面的經歷，克里斯多福認為不吃藥會對他比較好；同時，克里斯多福的父母也在藥物方面意見相左，莫衷一是。
The clinician responded to the doctor by saying: “Can you tell me a little more about how you reached this conclusion?” The doctor paused and reflected. He then addressed the son, seeming to sense his discomfort: “I am sorry; I think I made a mistake by starting with these three things.” Later in the meeting, the therapist returned to the ideas of an individual cognitive-behavioral therapist and medication and discussed these recommendations with everyone’s participation.
臨床人員回應該醫師：「方便請您多談談如何作出這番結論的嗎？」該醫師停頓一下，陷入沉思，之後他似乎感受到了克里斯多福的不安，對克里斯多福說：「真抱歉，我不該一開始就說這個的。」稍後的會談中，治療師有再提到認知行為治療師以及藥物的話題，每個人皆有一同討論這些提案。
The reason the doctor’s recommendations were incompatible with a dialogical approach is that he began the meeting from a monological position of top-down expertise that generated discomfort, rather than one of collaborative listening that allowed everyone to have a voice.
該醫師的建議之所以不合對話常理，原因為該醫師在會談一開始，即採用由上而下的權威獨白角色，造成氣氛緊張不安；適當作法應是協力進行傾聽，讓每個人皆有發言機會。
B. Engage the Multiple Inner Polyphony, or Voices, of the Client
內在複調(意見多元性)
The therapist listens and engages the multiple views and voices of the client. These may be possibly conflicting viewpoints or voices expressed by the same person. The above example of the primary care physician is actually also an example of accessing an “inner polyphony.” At first, the doctor spoke in his professional role as a knowledgeable expert, in which he inadvertently produced a breach of empathy with Christopher. He then repaired the breach by expressing his sensitivity to Christopher’s discomfort. In this way, the doctor himself spoke in more than one voice: first, as an expert using general knowledge, and second, as an empathetic clinician responding to the present interaction. This kind of movement is key to Dialogic Practice.
治療師傾聽並融入當事人的多元觀點與意見。有時，同一個人所表達的觀點或意見，可能彼此衝突。上述案例之家庭醫師，即是「內在複調」之明顯例證：該醫師起初以專家角色自居，自詡博學多聞，卻無意間糟蹋了對於克里斯多福的同理心；之後因感受到克里斯多福的不安，向其表示歉意，以挽回自身言詞造成的損害。此案例中，醫師說出了一種以上的意見：一個是大談常識的專家，另一個是能夠感同身受的臨床人員，回應當前的互動。內在複調在對話式作法之中，居有重要地位。
While interviewing clients, dialogical therapists ask about absent members. This is another way to evoke the expression of inner polyphony. A usual question is: “If X had been here, what would they have said about the issues discussed?” This is an example of a hypothetical question. The idea of such a question is for the client(s) to imagine a conversation with an important and relevant person in their life who could not be present in the meeting. In this way, the voices of important others becomes part of the outer conversation, and the client’s inner dialogue becomes subject to new examination and reflection. At times, the question itself provokes a spontaneous shift in a dilemma posed by a client in relation to an absent other. A powerful example, which comes from the L. family, occurred not in the first meeting but later on in the treatment process.
對話治療師與當事人進行訪談時，常會問及不在場的人員，這是另一種引起內在複調表達的作法。通常以如此假設語氣詢問：「如果某人在這裡，他對我們討論的議題可能會有什麼看法？」，用意在於使當事人(們)設想與一位當時不在場的重要相關人物對話。在此作法之下，其他重要人物的意見將成為外在談話的一部分，而對象自身的內在對話又可帶來新的檢視與反思。當事人有時給不在場人員設下的兩難情境中，提問本身將同時引發此種情境的轉變。L家庭的案例是個有力證明，不過這次並非發生在初次會談中，而是稍後的治療過程。
Case Example of Engaging Absent Members: the L. Family: Inner Polyphony and Engaging Absent Members as Voices in the Inner Dialogue
導入不在場人員之案例：L家庭－－
內在複調，以及於內在對話中加入不在場人員的意見
This example comes from the L. family described earlier: David, Tracy, and their son, 32-year- old Jack. During the course of treatment, Tracy died suddenly. David was grieving and despondent. At the time of his deepest grief, he once questioned whether Tracy might still be alive, if he had attended more to getting medical care for her, rather than focusing so much on getting this new form of mental health treatment for Jack.
此案例依然為先前提及的L家庭。治療過程中，崔西突然過世，這消息來得猝不及防，令大衛傷心欲絕，消沉喪志。在最為悲痛之時，大衛甚至曾經問過，如果他在這段時間多帶崔西去看醫生，而不是為傑克花費如此多心思在這種新的心理治療方式上，崔西是不是有機會活得久一點。
In a meeting, Therapist 2 asked: “If Tracy were here now, what would she say about the decision to devote your efforts to getting help for Jack?” David thought about it, and said that Tracy was happy that they had spent the last year of her life going to these meetings as a family. She told David that her oncologist had said that it was likely she had actually lived longer to ensure that Jack was in a better place before she left the world. Jack was present when David spoke about Tracy’s perception that Jack had been improving, had a future, and had likely helped to prolong Tracy’s life instead of hastening her death.
在一次會談中，治療師乙問道：「假如崔西現在還在，你覺得她對於你們努力幫助傑克的這個決定，會有什麼看法呢？」大衛思索一番，他說，崔西很高興在人生的最後幾年，一家人能夠共同參加這樣的會談。她曾告訴大衛，她的腫瘤科醫師說，她之所以會多活幾年，或許是因為她希望在離世之前，能夠確定傑克的情況好轉。大衛提到，崔西認為傑克有在持續改善，傑克的未來重燃希望，而且傑克可能幫助了延長她的生命，而非加速她的死亡。當大衛說這些話時，傑克也在場。
7. Creating a Relational Focus in the Dialogue
對話中「關係聚焦」(relational-focus)之運用
While interviewing clients, dialogical therapists are interested in working with the themes and issues within a relational frame. For instance, when a family member is angry and critical toward a professional, it is not framed as manifestation of a “personality disorder,” but as their response to an actual relationship and specific interaction with that professional, thus making their anger one voice within a polyphonic conversation.
對話治療師與當事人進行訪談時，有意採取「關係」的框架，在此框架中討論主題和各種議題。舉例而言，若一位家庭成員對一名專業人士感到憤怒並批評，此並非「人格障礙」的表現，而是一種與該名專業人士的實際關係及特定互動的回應，可看作是複調談話的多元意見中的其中一個憤怒意見。
Relational questions are an offshoot of this relational way of thinking and are asked in order to bring greater clarity to the situation. This can be achieved by, for example, asking questions that address more than one person, define the relationships in the family, and express an interest in the relational context of the problem or symptom. In the meeting with Jack’s family previously discussed, one of the therapists asked Jack’s parents to define what percentage of the time they spent caring for Jack as opposed to focusing on their own relationship and their own lives. This question is relational in the sense that it draws several participants into a discussion in which relationships can become more clearly defined and differentiated, instead of more confused.
關係問句是關係思維模式的一種衍生方式；關係問句的運用，目的是希望更清楚了解情況，例如可向一人以上的當事人提出問題，定義他們在家庭中的關係，並表達自身有意探討當事人之難題或症狀的關係情境。前述L家庭之案例中，一位治療師詢問傑克的父母，他們花費在照顧傑克的時間，以及他們關注自身關係與生活的時間，二者比例如何。此提問可使多名與會者加入討論，並在討論之中，對於彼此關係愈能得到清晰的了解與辨別，而非混淆不明，因此可視為關係問句之一例。
In Open Dialogue, there are many variations of relationally oriented questions that draw on systemic, solution-focused, narrative, and psychodynamic styles of inquiry. For instance, we can ask the kind of so-called “circular” questions that were first invented by the Milan systemic team (Boscolo, Ceechin, Hoffman, & Penn, 1987). Such questions highlight a difference or address relationships in the family. (For a more in-depth discussion of circular questions, please see the Chapter X: Open Dialogue and Family Therapy).
開放式對話中，關係導向問句有許多不同形式，但皆屬於系統性、焦點解決性、敘述性、以及精神動力學方面的問句，例如可使用米蘭系統性家族治療(Milan Systemic Family Therapy)團隊所謂之「循環提問」方法(Boscolo, Ceechin, Hoffman, & Penn, 1987)。此類提問能夠標示出家庭成員中的差異性，或者探討家庭成員關係。(關於循環提問的深入討論，請見第十章：開放式對話與家族治療)。
In Open Dialogue, we do not ask these or any questions as part of a structured interviewing methodology or a preplanned sequence of questions that will lead toward crafting an intervention. Such structured methods tend to constitute monological sequences, rather than dialogically structured interactions. Instead, in Dialogic Practice, questions are put forward as responses that it is hoped, resonate with the unique opportunities within the conversation, thus used in a creative, improvisational, and sparing way to open up new pathways for voice and expression. We have coined the term “relational questioning” to signify this kind of dialogical inquiry.
開放式對話中，此類提問或其他任何提問，皆不應作為組織條理形式的訪談方法、或是預先規劃而成的提問串列，以致於造成刻意干預。使用具有組織條理形式的訪談方法，將可能演變為獨白談話，而喪失了自然成形的對話互動。恰當的對話式作法應為：提問之運用，需作為一種回應，期望能夠捕捉到談話中的獨特細節，與對方產生共鳴；提問應以更具創造力與即興風格的方式，適度運用不浮濫，以此開啟意見與表達的新窗口。我們創造「關係問句」一詞，以明確指出此種對話提問方式。
Case Example of Using a Circular Question: the H. Family.
運用循環問句之案例：H家庭
An example of the use of a circular question comes from a different family consisting of two parents, Mike, a business executive, and Anna, a consultant with two children: 18- year-old Carla, and 16 year-old Joe. Carla was hospitalized after she confided to her brother that a cricket was telling her to jump off the 3rd floor porch outside her bedroom. The psychiatrist at the hospital told the family that their daughter had a chemical imbalance in her brain. She was treated with high levels of medication. The medication eradicated her “psychotic” voice, and Carla has continued to be under the care of an outpatient psychiatrist. The maternal grandfather thought the family should also pursue Open Dialogue therapy.
運用循環問句之案例，來自另一家庭：父親麥可擔任企業專員，母親安娜則是一名顧問，二人育有二子，分別是18歲的卡拉，以及16歲的喬伊。卡拉曾偷偷告訴弟弟喬伊，有隻蟋蟀叫她從她三樓房間的陽台跳下去，卡拉因此送往住院觀察。醫院的精神科醫師向家人表示，卡拉腦部出現化學物質失調情形，卡拉並接受高劑量藥物治療。藥物抹除了卡拉的「有精神病」的內在聲音，卡拉仍持續於精神科門診部看診。卡拉的外祖父認為，這家人也應嘗試開放式對話療法。
In this example, the therapists were meeting with the family for the second time. The father began by bringing up the idea of a “chemical imbalance” and seemed to be greatly irritated by having to participate in family meetings, especially ones that seemed to be about “process” instead of “concrete steps.” After listening and acknowledging the father’s point of view, the therapist asked the family a difference, or circular, question about agreement versus disagreement, “Who else in the family agrees with Father about the family meetings?” Joe said, “Well, there are other things I could be doing.” Carla answered that she agreed that she had a chemical imbalance and needed the medication, but thought the first family meeting made her “feel less isolated.” The mother answered,
本案例中，治療師與H家庭正進行第二次會談。父親在會談一開始便提出「化學物質失調」，且看似對於參與家庭會談一事感到十分不耐煩，尤因家庭會談似較偏向「過程」而非「實際步驟」。治療師傾聽與接收父親觀點之後，便就同意與不同意方面，對家庭成員提出另一種不同的問句，或是循環問句。治療師問：「家裡還有誰也同意爸爸對於家庭會談的意見呢？」喬伊說：「呃...我覺得我還可以幫上其他忙。」卡拉則回答，她同意自己腦部有化學物質失調情形，也需要藥物治療，但她覺得第一次的家庭會談讓她感到「沒有那麼孤立無援」。母親也回答了：
“I disagree with Mike. I think that when I think about all four of us together, I can understand why Carla hears voices. I think her voices are a product of all of us together … I can’t really explain it, but I think we need to meet as a family and discuss whatever issues come up. There are a lot of things that we do not talk about, that we should talk about, not only to help Carla, but all of us. Yes, that is what I really think.”
「我不同意麥可的意見。我覺得，當我想到我們四個在一起的時候，我就能理解為什麼卡拉會聽到有人在說話，我認為她聽到的聲音，是因為我們四個在一起而造成的...我也不太會解釋，但我覺得，我們要以一家人的形式來進行會談，討論任何議題。有很多事我們還沒談到，這不僅是為了幫助卡拉，也是幫助我們全部的人。嗯，這就是我心裡面真正的想法。」
Carla, who was sitting next to her mother, took her hand, linked her fingers inside her mothers,’ and exchanged a smile. In this way, the question about the meeting itself allowed the mother’s voice to be heard in a family where the father’s perspective, aligned with the dominant psychiatric discourse, had become too important. The relationship between the parents became more clearly defined when the conflict between them became openly stated. In part because of this conversation, a treatment team was formed in which a new psychiatrist regularly joined the family meetings together with the Open Dialogue therapists. The family made good progress with this arrangement, especially Carla, who began to recover. She returned to school and began tapering off her regimen of psychotropic medications. After approximately 18 months of meetings in this configuration, Carla’s parents asked to do couple therapy instead. Carla continued seeing an individual therapist, while moving forward with her own life, having her first boyfriend and returning to school.
坐在母親身旁的卡拉，此時握住母親的手，與母親十指交扣，彼此微笑相對。在此情形之下，此番有關會談本身的問句，使得母親的意見有了發聲管道；而父親訴諸精神病學論述的觀點，以往總是主導家人意見，在此顯得過於沉重。父母親之間的衝突公開討論之後，二人的關係更能明確定義。且部份由於此次談話的因素，一群治療團隊自此成立，其中有一名新的精神科醫師，經常與開放式對話的治療師共同參與會談。H家庭在如此安排之下，進展良好，尤其卡拉已開始復原。卡拉返回學校，逐漸減少服用治療精神異常的藥物。此種會談進行約18個月後，卡拉的父母親轉而要求進行伴侶治療。卡拉則是持續與一名個別治療師進行會談，生活一如往常進行，交了第一個男朋友，並且重返校園。
8. Responding to Problem Discourse or Behavior as Meaningful
對於論述或行為的回應，注重意義
There is an emphasis in Dialogic Practice on “normalizing discourse” in contrast to speaking about issues as pathological, which often is where things start. The therapist listens for the meaningful and “logical” aspects of each person’s response. What this means in practice is that the therapist strives to comment and respond to what was said in a way that sees symptoms or problem behavior as making sense, or “natural” responses to a difficult situation. This shift to normalizing discourse affirms people by emphasizing how problem behavior is meaningful within a particular context, rather than how it is “wrong” or “crazy.” Normalizing talk has an affinity with the Milan systemic therapy technique of “positive or logical connotation,” although the latter technique is given as an intervention in the form of an explanation to the family. “Normalizing talk” is a much more subtle process of understanding and responding woven into the conversational back-and-forth exchange. It also can occur by means of locating unique outcomes, or exceptions, in “problem-saturated stories” (Olson, 2006; White, 2007). (Please also see Chapter X that compares Open Dialogue and family therapy and further describes the differences between normalizing talk and family therapy interventions such as “reframing” and “positive or logical connotation.”).
一般情況常以病理觀點作為議題討論開端，但對話式作法著重於「論述正常化」(normalizing discourse)。治療師傾聽各人回應之中，有意義以及「符合邏輯」的層面，也就是在實務作法上，治療師致力將症狀或問題行為，視為用來對付難題的有意義或「自然」反應，以此方式來評論或回應當事人所說話語。論述正常化之作法，強調問題行為在特殊情境中的意義性，而非批判其「錯誤」或「瘋狂」，藉此給予認同。論述正常化與米蘭系統性家族治療之「正面或邏輯性內涵」方式，二者有密切關聯，不過後者是作為對於家庭成員提供解釋的干預形式，至於「論述正常化」則是更為細膩的理解與回應過程，巧妙安排於對話交流之中，亦可透過「充滿問題的故事」(problem-saturated stories)方式，安插獨特的結局或例外情形，以實現論述正常化(Olson, 2006; White, 2007)。(亦請參見第十章，將開放式對話與家族治療二者進行比較，並深入敘述論述正常化與家族治療干預形式如「重組」、「正面或邏輯性內涵」等之差異)
For instance, in the earlier excerpts of the L. family and the V. couple, a normalized discourse replaced a pathological one in the collaborative emergence of meaning. The very first session described above allowed a discourse to evolve that embedded the experience of Jack and his family in a history of isolation and estrangement from their families of origin, a normalized context in which their experience became more understandable. Similarly, in the session with Margaret and Henry, Margaret’s symptoms became connected through the discourse to the normalized context of a young couple being “between two families,” with a particular focus on the loyalty bind of the husband in relation to his mother.
舉例而言，前述L家庭與V夫妻之會談節錄中，便使用正常化論述取代病理學論述，共同發掘意義的存在。本文所舉之第一個案例中，正常化論述方式得以呈現傑克及其家人受到原生家庭隔絕與疏遠的往事，處於此般正常化的情境之下，也更能夠理解他們的經歷。同樣地，在與瑪格麗特及亨利的會談中，透過正常化論述，將瑪格麗特的症狀連結至一對年輕夫妻「介於二個家族之間」的情境，並特別關注亨利與亨利母親的親情束縛。
9. Emphasizing the Clients’ Own Words and Stories - Not Symptoms
強調當事人的話語及故事，而非症狀
Dialogic Practice invites the telling of what has happened in a person’s life, their experiences, thoughts, and feelings, instead of reporting on symptoms. Telling stories may happen easily or may require a more deliberate search for language. Openings in the form of one word or sub-sentences may be key words with highly relevant associations to the problem situation. The therapist zeroes in on these words that can give access to a narrative of a person’s suffering. This is part of a larger process of evolving a common language, and larger story.
對話式作法不報告當事人症狀，而是鼓勵當事人訴說生命中所發生的事情、經驗、思想、以及感受。故事可能容易敘述，也可能需要精準搜尋用詞。以單一字詞或是子句作為開端時，該字詞或子句或許即為與問題情況具有高度關聯的關鍵詞。此類詞句往往能夠通往當事人的痛苦回憶，因此治療師將特別注意，這也是開展共通語言以及進入層面更廣大的故事時，所需歷經的龐大過程之一部份。
In this way, severe symptoms may be understood as embodying inexpressible or unspeakable dilemmas. They are often rooted in terrible, often traumatic, experiences that resist ordinary language and the ordinary capacity to express experience in narrative terms. For instance, hallucinations may be signs of such otherwise inexpressible experiences. The person who exhibits the most severe symptoms may also have the least access to language. More time may be devoted to exchanges with the most acutely symptomatic person whose voice may be the most incoherent, and thus, the weakest. Further, in meetings that take place during crises, the most difficult, and consequently the most important, issues are often indicated by a single, key word a person says, rather than expressed as a full story. This type of one-word utterance that may sound strange, may be repeated and turned over, slightly altered by the therapist until a more mutual wording evolves. The aim is to arrive at shared understandings that give voice to the person’s experience, making it more understandable and thus, fostering new possibilities for everyone. This often means focusing on the small details of the person’s description of what happened, or what actually happens in the room while the person is telling their story.
在此原則之下，當事人的嚴重症狀，或許可理解為對於無法形容或言說之兩難困境的一種呈現方式，此種兩難困境往往根源於令人感到恐怖的經驗，且常為創傷回憶，因此當事人抗拒以一般的語言或敘述性形容方式來表達。例如，幻覺可視為一種徵兆，顯現出無法形容的經驗。症狀最為嚴重的當事人，可能也最無法運用語言，意見雜亂無章，論點不足，因此需花費更多心思與此種當事人溝通往來。此外，在危機之間舉辦的會談，常可透過當事人所說出的單一關鍵詞語，探知最困難且亦為最重點的問題所在，而非透過長篇大論方能描述。此類單一詞語之敘述方式，聽似怪異，當事人可能一再重複拋出話語，治療師也會在對話中將此種話語作出些許轉換，直到最終出現一個共通的措辭。此種作法透過針對當事人的經驗提供意見，使其更易理解，並對於每個人皆產生新的可能性，期能達成共同理解之目標。這也通常意味著，必須注意當事人描述之中的微小細節，無論是描述已發生的事件，或是描述自身講述故事時所處之會談現場情形。
Case Example of Emphasizing Stories, not Symptoms; the P. Family
強調故事而非症狀之案例：P家庭
This example comes from the work with 25-year-old Christopher. We described this treatment earlier in relation to the network meeting with the family doctor. Christopher had suffered an ongoing crisis for three years. The therapists were meeting with his parents, John and Sheila, who were divorced, and Christopher, who had a psychotic episode in college from which he had not fully recovered. He had had trouble functioning since that time and had been living with his mother. Therapist 1 was joining this therapy as a consultant.
此案例為前述25歲的克里斯多福，與家庭醫師一同進行社群網絡會談。克里斯多福大學時期開始出現急性精神疾患發作，至今仍未完全復原，生活無法自理，與母親同住。克里斯多福受到此一持續的危機所苦，已有三年之久。治療師與克里斯多福的父母(已離異)及克里斯多福進行會談，而治療師甲以諮商人員的身份加入。
Therapist 1: So…. Where should we start? (Looking toward Christopher) I understand that this is not your first meeting, but perhaps you can say something for us. How do you understand what this is all about?
Christopher: Sure. Well, for about five years, five years ago, I have felt sort of muddled in my head, um, just had thought that it was depression, um but, sort of um, had trouble focusing, after I came back from a semester abroad in (a foreign country), I was doing fine for my whole life, you know, before that, um, then I went to my junior year abroad, fall semester junior year, fall semester, of college, I am twenty-five, yeah, and I was in college for four years, um, after I came back I started having trouble, some depression, just trouble focusing in class, and just was unhappy generally, with my mental state, um, a lot of thoughts going around, the best way I describe it was like, fuzzy, fuzzy thinking, so um, like, um, that has been going on for the past five years, so um, yeah um…
Therapist 1: – You said that you were “unhappy”?
Christopher: Yes, unhappy….
治療師甲：那...我們從哪裡開始好呢？(看向克里斯多福)我知道這不是你第一次參加會談，不過我想你還是可以說些什麼給我們知道。你對於目前的情形是怎麼看的呢？
克里斯多福：好的，那麼，大概五年、五年前，我覺得腦子一片混亂，嗯，就是覺得我有憂鬱症，嗯，但是，有一點，嗯，注意力很難集中，我在國外那一學期回來之後開始的。在那之前，你知道的，我過得很好，嗯，然後我大三出國，大三秋季班，秋季班，大學的，我25歲，對，我讀大學四年，嗯，我回國後開始不太對勁，像有憂鬱症，上課很難專心，總之就是不開心，心裡面，嗯，一大堆想法在跑，最好的形容方式，就像是混沌，思考混沌，所以，嗯，像是，嗯，過去五年的一切，所以，嗯，對，嗯...
治療師甲：－－你剛才說，你「不開心」是嗎？
克里斯多福：對啊，不開心...
The therapist asked each of the parents how they understood the situation. They each had different perspectives. (This is also an example of outer polyphony.) Mother described how she lived with Christopher and observed his “fear” of life. Her understanding was that the “code of silence” in their family when Christopher was growing up had caused the current situation. By “code of silence,” she meant that the problems in the family were rarely openly discussed. Father disagreed and said instead that the problems Christopher had stemmed from his childhood difficulties, including a longstanding problem with not being able to interpret “social communication.” Christopher challenged his father’s point of view. The therapist then returned to Christopher and asked him to say more about how he understood his own situation. Christopher answered, “heartbrokenness.” “Heartbrokenness” was Christopher’s word. The therapist repeated the word. The therapist’s response invited Christopher to tell the story of having fallen in love with a girl while on a semester abroad and having had to leave her to return to the US. He thought this experience was the basis of everything else that had happened so that he had become, to use his mother’s word, “paralyzed” in life. The separate voices and viewpoints of each of the family participants remained polyphonically distinct in the discussion, nor was there one perspective that the therapists explicitly privileged over another. That said, the therapists nevertheless spent a great deal of the session helping Christopher to expand the story of his “heartbrokenness.”
治療師詢問父親與母親對於此種情況的理解與認知，二人看法不一(此亦可作為外部複調之案例)。母親描述著她如何在與克里斯多福的共處當中，察覺到克里斯多福生活中的「恐懼」；母親的理解是，克里斯多福的成長階段，家庭瀰漫著「沉默守則」的氛圍，也就是罕於公開討論家庭問題，而造成克里斯多福有如此境況。父親對此不以為然，他說，克里斯多福的問題源自於童年時期的障礙，包括克里斯多福長久以來無法理解「社交溝通」的一個問題。克里斯多福則是不認同父親觀點。治療師回到與克里斯多福的談話，請他多談談對於自身情形的理解。克里斯多福用了「痛心」(heartbrokenness)這個字來回答。治療師重複這個字，接著請克里斯多福講述故事大學出國那一學期的愛情故事，那時克里斯多福與一名女生談戀愛，但回美國時不得不與她分手。克里斯多福認為，這場經驗是造成他人生「全面停擺」(用母親的話來說)的根本原因。討論之中，家庭成員各別的意見與觀點，維持多重複調，治療師之間亦無互相提出可凌駕另一人的觀點，這代表著治療師主要利用會談過程，幫助克里斯多福展開他的「痛心」故事。
10. Conversation Among Professionals in the Treatment Meeting: The reflecting process, making treatment decisions, and asking for feedback
治療會談當中，專業人士之間的交談：反思的過程，作出治療決策，以及詢問回饋意見
In every meeting, the professionals’ conversation with each other should be emphasized.
When doing so, they are advised to look at and talk to each other and not at the family or any other participant.
每場會談中，必須重視專業人士之間的交談；而專業人士們注視及交談的對象，建議應為其他專業人士，而非家庭成員或其他與會者。
There are three parts to having a conversation in front of the family. The first two are interchangeable; but the third one always comes after the professionals’ dialogue. First, there is the reflecting process, in which the therapists engage in reflections that center upon their own ideas/images/associations, with the client and family present. Second, the therapists converse with the other professionals during the meeting on planning the treatment, analyzing the problem, and openly discussing the recommendations for medication and hospitalization. And, third, the family comments on the professionals’ talk. That is, after the reflections, one of the therapists invites the family and other network members for their responses to what they heard.
專業人士在家庭成員面前的交談，分為三個階段，前二階段可互相調換順序，但第三階段一向出現在專業人士對話結束之後。第一階段是反思的過程，治療師在反思過程當中，集中精神在治療師本身對於當事人及在場家庭成員的想法／形象／聯想。第二階段中，治療師在會談期間與其他專業人士交談時，一併規劃治療方式、分析問題，並且公開討論用藥及住院方面的建議。第三階段則是家庭成員對於專業人士談話的評論，也就是治療師在反思之後，其中一名治療師邀請家庭成員及其他網絡成員，針對所聽見的談話內容，請他們給予回饋意見。
A. & B. Reflections as Ideas/Images/Associations and Planning
想法／形象／聯想之反思，以及決策規劃
“Reflecting talks” among professionals in a treatment meeting and in front of the family was pioneered by Tom Andersen in (1991). Another version is the “reflective talk” of Seikkula & Arnkil (2006). Both types of reflections are acceptable formats in Dialogic Practice during team meetings. The reflecting process (or talk) occurs among the professionals in the presence of the family. Andersen originally proposed well-defined alterations of talking and listening in the therapeutic conversation with a “reflecting team” (usually 3 professionals) sitting separately, though in the same room as the family, or behind a one-way screen. Making this process more interspersed and spontaneous, Tom Andersen and the Finnish team eventually started to apply the idea of the reflecting process in a less structured way as part of the ongoing flow of the meeting.
早在1991年，湯姆．安德森(Tom Andersen)已率先提出治療會談中，專業人士之間在家庭成員面前的「反思對談」，另一版本則為塞科羅(Seikkula)及昂吉爾(Arnkil)於2006年所發表，二者皆可用於團體會談之對話式作法的對話模式。專業人士之間的反思過程(或對談)，於家庭成員面前進行。安德森一開始在治療對話中的對談及傾聽過程上，作了精心變改，其中的「反思團隊」(常為3名專業人士)坐在房間一頭，家庭成員則位於房間另一頭、或是坐在一面單向透視屏風之後。安德森及芬蘭團隊為了讓過程顯得更為隨性自然，最終採用了反思的過程，此種反思過程並未事先規劃，而是會談流程本身持續進行的一部分。
As indicated, the talk among the professionals ranges from reflecting upon the ideas, images, feelings, and associations that have arisen in their own minds and hearts while listening to planning the treatment. The purpose is to create a place in the meeting where the therapists can listen to themselves and thus have access to their own inner dialogues. It also allows the clients’ to listen without being under pressure to respond to what the professionals are saying.
如同先前所述，專業人士在規劃治療決策時，彼此之間的對談包含了內心浮現的想法、形象、感受、以及聯想，目的是希望在會談當中創造一個空間，治療師可在其中傾聽自身聲音，通往內在對話。此過程也使當事人能夠在無壓力的情況下，聆聽專業人士對談，並給予回應。
Following Tom Andersen (1991), the helpers use ordinary language, not jargon, and should be speculative based on the themes introduced by the family. This is called “speaking as a listener rather than as an author” (Lyotard, cited in Seikkula and Olson, 2003).
遵循湯姆．安德森的建議，專業人士將使用一般交談會出現的語言，而非賣弄專業術語，且對於家庭成員帶出的主題，需保持思索臆測，此過程稱之為「以傾聽者的身份發言，而非以作者的身份大放厥詞」(Lyotard, cited in Seikkula and Olson, 2003)。
Case Example of Reflecting Conversation Among Professionals: the L. Family
專業人士之間反思對談之案例：L家庭
Returning once again to the first meeting with the L. family of David, Tracy, and Jack described at the beginning, the professionals had a conversation in front of the family, in which they first engaged in reflections and then discussed issues related to treatment. Therapist 1 started the dialogue by asking the family, “Do you mind if I have a word with my colleague?” The parents said they did not mind. Therapist 2 began by reflecting on what she heard and all the positive things the parents had said about Jack and using their actual words: “sensitive,” “loving,” “bright,” “protective,” and so forth. She also repeated fragments of the positive stories. Therapist 1 went on to say that he liked how Jack had participated in the meeting, staying a bit on the outside and listening. Therapist 1 went on to address the issues of treatment and observed that the parents seemed “mixed” in terms of whether to try to find a residential program for Jack or do Open Dialogue. This statement led to a longer conversation between the therapists that straddled further reflection on the relationships among the family members and practical decisions. Jack and his parents decided they all would like to meet again with these therapists.
回到本文最初之L家庭，成員有大衛、崔西、與傑克。專業人士在家庭成員面前進行的一場對話中，起初自我反思，接著討論治療相關議題。治療師甲詢問家庭成員「您們介意我和同事說幾句話嗎」，以此作為對話開端。父母親表示不介意。治療師乙開始提出反思，內容為所聽得之訊息，以及父母訴說有關傑克之所有正面事項，並採用父母實際的用語如「敏感」、「有愛心」、「開朗」、「樂於保護他人」等。治療師乙也重複道出正面故事的片段。治療師甲繼續說著，他喜歡傑克參與會談的方式，也就是傑克坐在偏外側的地方傾聽。治療師甲進一步談論治療相關議題，並注意到父母似乎對於應為傑克尋求居留治療服務，或是開放式對話治療，感到茫然困惑。此般發言拉長了治療師之間的對談，反思內容並延伸至家庭成員間的關係，以及實際的決策。傑克與父母的決定是，他們都希望還能再與這些治療師進行會談。
C. The Family Comments on the Reflections
家庭成員對於反思的回饋意見
After the therapists give their reflections, the family should have a place to say what they think about their discussion. Asking the family to comment on the professionals’ talk gives them a voice in their own future. So Therapist 2 asked the L. family: “I am wondering if you have any thoughts about our comments? What struck you? What did you agree with? Is there anything you disagreed with? Tracy responded by saying: “I think you hit the nail on head. Him (Jack), looking after us. I didn’t realize we felt so positively about Jack. (Jack laughs). But, we do.” Jack and Tracy both exchanged glances and laughed. David responded to the word “mixed” used previously byTherapist 1, and discussed the various practical options with the therapists.
治療師提出反思後，家庭成員應有機會說出他們對於治療師討論內容的意見。邀請家庭成員對於專業人士對談提出回饋意見，可讓家庭成員得以評論自身未來走向。因此，治療師乙詢問L家庭：「我想了解你們對於我們的意見是否有任何想法？你們在哪方面感到驚訝？你們在哪方面深表同意？是否有不同意之處？」
崔西回答：「我覺得你們真是一針見血。他(傑克)，照顧著我們。我們從來就不知道自己對於傑克的看法是這麼正面積極。(傑克笑了)。但是，我們真的就是如此。」傑克和崔西眼神交流，會心一笑。大衛回應了治療師甲所使用的「茫然困惑」這個字，與治療師討論各種實務治療選項。
11. Being Transparent
透明公開
All treatment talk is shared with all participants. Everyone in the network meeting is equally privy to all discussions and information shared. This means that all discussion of hospitalization, medication, and treatment alternatives occurs with everyone present. Often transparency occurs as a feature of the reflections. As seen above in the session with the L. family, the treatment decisions were initially addressed as part of the dialogue between the therapists. For instance, as already indicated, the therapist reflected on what he saw as various options in planning the treatment, making his ideas open for discussion, rather than giving an expert recommendation.
所有的治療交談應與每位與會者共同分享，網絡會談的每名成員皆應同等了解所有的討論內容及資訊。此原則代表了關於住院、用藥、治療替代方案的所有討論，需要在每個人都在場的情況下進行。反思過程常有透明公開之特點，例如上述L家庭的會談中，起初由治療師內部對話討論治療決策，接著治療師反思他所認為的各種治療規劃選項，將自身想法開誠布公討論，而非以專家之姿下達建議。
Case Example of Transparency: the L. Family
透明公開之案例：L家庭
Therapist 1: “I had a kind of feeling that the parents [David and Tracy] are very mixed in their position about what to do…mixed in the new ideas of coming here and possibly having dialogical meetings and so on. At the same time, it is all a bit uncertain. How much is this decision for the parents, how much is it a decision for Jack himself to make, and how much is this question for the therapists or other professionals to decide? So there seem to be big issues at the same time that perhaps create a bit of confusion...
This comment, which also illustrates the last element of tolerating uncertainty, evoked a response from the father that led to a clarifying discussion with the parents about their position, which they defined as “not mixed.” Rather, both the parents and Jack elected the option of having dialogical meetings and then explore the other alternatives down the road.
治療師甲：我覺得爸爸媽媽(大衛與崔西)很不清楚他們對於該做些什麼的定位...不清楚要來到這裡、而且可能會進行對話式會談的這種新想法之類的。同時也有很多不確定，像是爸爸媽媽的決策份量、傑克自己的決策份量，還有治療師或其他專業人士的決策份量，要怎麼決定呢？所以可能還會有更大的議題在後面，或許會有點亂...
這段評論也呈現出最後一個原則「容忍不確定性」，父親對此評論作出回應，並引發與父母二人的定位澄清討論，父母認為他們的定位「不會茫然困惑」。父母和傑克都選擇進行對話式會談，也探討未來的其他替代方案。
At the close of first and often subsequent meetings, dialogical therapists engage the participants in planning the structure of the next meeting. There will usually be such open-ended questions such as: Would you like to meet again? Do you have an idea when? Do you know who might come next time? If the family seems hesitant, the therapists might ask, “Would you prefer to think it over and call us? Of course, if the membership and frequency of the meetings has become established, these questions may be unnecessary.
第一場會談及後續會談之結束時，對話治療師將和與會者一同計畫安排下一場會談，且經常使用開放式問句，例如：還想再會面嗎？大概想要什麼時候再碰面嗎？你知道下次可能有誰會來嗎？若家庭成員似乎猶豫不決，治療師可詢問「還是你要不要回去想想看，再打電話給我們呢」當然，若是會談的成員及次數皆固定，可不必使用這些問句。
12. Tolerating Uncertainty
容忍不確定性
Tolerating uncertainty is one of the seven basic principles of Open Dialogue and one of the key elements of Dialogic Practice. Tolerating uncertainty is at the heart of dialogue. It is thus a specific element and an element that defines the other elements.
容忍不確定性是開放性對話的7項基本原則之一，以及對話式作法的12項要素之一，這是對話的核心所在；因此，容忍不確定性是一個特定的對話要點，並且由此要點再定義出其他對話要點。
In Open Dialogue, there is the fundamental orientation of creating an organic understanding of the crisis with everyone’s input (polyphony). This stance is based on the assumption, as well as our experience, that every crisis has unique features. Hasty decisions and rapid conclusions about the nature of the crisis, diagnosis, medication, and the organization of the therapy are avoided. Further, we do not give ready-made solutions such as specific, preplanned therapeutic interventions to the family or the single person in crisis.
開放式對話的主要導向，是透過每個人輸入的訊息(複調)，建構出對於危機的基本理解。此種立場所根據的假設為每個危機皆有不同特點，而我們實際的危機經驗也是如此。因此對於危機本質、診斷、用藥、治療架構等，必須避免急於作出決策或快速下定論。此外，針對處於危機狀態的家庭成員或是單一個人，我們不會給予現成的解決方案，例如已規劃而成的特定治療干預。
The primary idea that professionals should keep in mind in crises is to behave in a way that increases safety among the family and the rest of the social network. Among the specific practices associated with this, it is important to make contact with each person early in the meeting and thus, acknowledge and legitimize their participation. Such acknowledgment reduces anxiety and increases connection and thus, a sense of safety. The availability of the immediate meetings with the team and the frequency of meeting in a crisis also helps the network tolerate the uncertainty of the crisis as the ensemble works toward their own shared understanding of what is frightening and distressing people. Such shared understanding can launch new forms of agency.
關於危機中的處理方式，專業人士首先必須增加家庭成員及其他社群網絡成員之間的安全感，這是專業人士應謹記之主要原則。與此有關之特殊作法中，重點在於專業人士在會談初期便需接觸各個與會者，如此可認同並接受他們的參與。此種認同將減輕焦慮，增進連結，並因此促進安全感。若能在危機中立即並頻繁與治療團隊進行會談，令網絡成員能夠共同理解造成驚嚇及憂慮的原因，亦有助網絡成員容忍危機的不確定性。此種共同的理解，可產生新的自主形式。
In the same spirit, the starting point of a dialogical meeting is that the perspective of every participant is important and accepted without conditions. This means that the therapists refrain from conveying any notion that our clients should think or feel other than they do. Nor do we suggest that we know better than the speakers themselves what they mean by their utterances. This therapeutic position forms a basic shift for many professionals, because we are so accustomed to thinking that we should interpret the problem and come up with an intervention that counteracts the symptoms by inducing change in the person or the family.
相同道理可知，對話式會談的起點，是需重視每位與會者的觀點，並且一視同仁，無條件接受。若治療師表達出當事人應該使用有別於往常的方式思考或感受，此作法實不可取。而以往我們十分慣於認為，需對難題進行詮釋分析，再透過激起當事人或其家庭的改變，以作出可對抗症狀的干預行為；但在對話式會談中，我們不可單純藉由說話者的話語，便自認為比說話者本身更了解他們。
Case Example of Tolerating Uncertainty
容忍不確定性之案例
Helen, a 46 year- old woman, and her husband, Ben, began meeting with an Open Dialogue team at their home during an acute crisis in which Helen was experiencing her second psychotic episode. The team included a psychiatrist, a nurse, and a therapist. In one of the meetings, Helen said:
海倫是位46歲的女性，在海倫第二次急性精神疾患發作後，她和丈夫班恩開始與開放式對話治療團隊在家裡進行會談。治療團隊成員包括一位精神科醫師、一名護理人員、以及一位治療師。海倫在其中一場會談提到：
”This has been very different compared to my first psychosis a year ago. Then we – my family – met with a doctor whose main interest was interviewing my family members about how crazy I was. As if I was not there. Now it’s completely different. I am here and respected. I especially like it when the doctor speaks with my husband and I realize how much my husband respects me.”
「這跟我一年前第一次精神病發作的時候，真的很不一樣。那時候，我們，也就是我們家，有和一位醫生會面，但那位醫生最主要的興趣就是訪問我的家人關於我的瘋狂程度，好像忽視我的存在，把我當成空氣。現在完全不一樣了，我也在場，備受尊重，而且我特別喜歡醫生和我先生說話，讓我了解到我先生是多麼重視我。」
She had been hospitalized in a traditional psychiatric unit a year earlier. They had had a family meeting at this hospital, but apparently the main purpose of the meeting was to find the right diagnosis. The doctor’s questions were geared toward gathering diagnostic information, rather than listening to her and making a connection. This experience had been unsettling for the patient (“as if I not were there”). She articulated the difference between what had happened before and the experience of Open Dialogue. The prior psychiatric interview a year ago left her feeling without power to define her own life and make her own treatment decisions. The more recent dialogical meetings with the team allowed her voice to be heard and for her to feel accepted.
海倫曾在一家精神病院住院，一年多前才出院。他們曾在醫院進行家庭會談，但顯然地，會談的主要目的是想對症下藥。醫生的提問，導向至蒐集診斷資訊，而非傾聽海倫並與她產生連結，這番經驗使得當事人感到心神不安(「好像忽視我的存在」)。海倫說出先前經驗與開放式對話二者的差異之處，一年前的第一次精神科訪談，讓她覺得無力確定生活，無法作出自身的治療決策。近來海倫與治療團隊的對話式會談，使得她的聲音有了被傾聽的機會，並且感到被接受認同。
On the other hand, the psychiatrist on the team who was new to this way of working said that, at times, he was very uncertain about what-- if anything-- was happening during this process. In this instance, it was the professional for whom the uncertainty was most intense, because the treatment process no longer proceeded according to concrete, planned steps that are prescribed and controlled mainly by the expert.
另一方面，治療團隊中的精神科醫師是首次認識此種開放式對話作法，他說，有時候仍很不明白治療過程中發生了什麼事，或是到底有無發生任何事。這也顯示出專業人士的不確定感最為強烈，因為治療過程再也不是遵循著主要由專業人士所規劃掌控的既定步驟。
If change does occur in the process of Open Dialogue, this may be attributed to the process of engaging everyone’s point of view within the meeting. It is therapists’ responsibility to conduct the meeting in a way that creates a space where it is safe for everyone to express themselves, in the ways we have outlined above. Finally, the therapists do not simply facilitate polyphony and erase their own voices. They also express their perspectives, but in the form of reflections that they exchange in the presence of the family. Their ideas thus are “overheard” and can be commented upon—and critiqued-- by the network, rather than being “truths” directly imposed in a top-down fashion.
若是開放式對話的過程中確實出現改變，或許可歸功於會談當中確實有採納每位與會者的觀點。治療師的責任是在會談中開創安全的空間，每個人皆能在此空間裡表達自我，如同前述方式。最後要注意的是，治療師並非單純運用複調，卻抹煞治療師本身的意見；治療師仍會表達觀點，不過是以反思的形式，在家庭成員面前交換意見。因此，治療師不再由上而下強制灌輸「真理」，而是網絡成員能夠「竊聽」治療師的想法，並且表達評論或批判。
All in all, in a fruitful dialogue, clinicians participate in a human way with feeling and compassion and fulfill their professional roles’ with an element of personal warmth. This promotes a therapeutic connection and avoids being too distant or giving clients the sense that they are being scrutinized or objectified.
一場成效斐然的對話，從各方面觀之，臨床人員是以人本的形式參與其中，充滿感受及憐憫之情，並散發個人溫暖，實現專業人士角色。此種作法可促進治療上的連結，避免過於疏遠，且不至於令當事人感到遭受檢視或被物化看待。
CONDUCTING THE TREATMENT MEETING: THE CONTEXT OF OPEN DIALOGUE & DIALOGICAL PRACTICE
進行治療會談：開放式對話與對話式作法的情境
In Open Dialogue, the treatment meeting is the context for Dialogic Practice. A treatment meeting should occur as an immediate response within 24-hours of the initial contact from someone seeking help with a crisis. In advance of any decisions about hospitalization or therapy, this meeting brings together the person in acute distress with all other important persons, including other professionals, family members, and anyone else closely involved. It is the responsibility of the professional who took the initial call to organize the meeting, with input from the client(s).
開放式對話中，治療會談為對話式作法的情境。當事人或相關人員初次聯繫治療單位以尋求危機協助後，治療單位必須在24小時內快速回應，舉行治療會談。決定住院或採用其他療法之前，治療會談可集中急性憂鬱之當事人及其他重要相關人員，包括專業人士、家庭成員、以及關係密切者。專業人士一旦接獲初次聯繫，得知當事人的消息資訊，便需負責安排會談。
The meeting occurs in an open forum with all participants sitting in a circle. The team members who have initiated the meeting have the responsibility for fostering the dialogue. The team may decide in advance who will conduct the interview and what role the rest of the team will have. Usually if the team is experienced, they start with no prior plan regarding who initiates the questions. All team members can participate in interviewing. The initial, “two questions” referred to earlier invite the network to talk about the issues that are most pressing for them at the present time. The team does not plan the themes of the meeting in advance. From the very beginning the therapists listen carefully and elicit all voices, words, and stories in the manner we have sketched in this document. If the person at the center of concern does not want to participate in the meeting or suddenly runs out of the meeting room, a discussion takes place with the family members about whether or not to continue the meeting. If the family wants to continue, one of the clinicians informs the person that they can return if they want to.
會談在開放空間進行，所有與會者圍成圓圈而坐。開啟此場會談的治療團隊成員，亦負責促進對話進行，治療團隊成員可事先決定由何人進行訪談，以及其他成員的角色。一般情況下，經驗豐富的治療團隊，無須事先規劃何人開始提問。所有的治療團隊成員皆可參與訪談。本文稍早述及的二則提問，可在會談之初，邀請網絡成員談論他們當前最感迫切的問題所在。團隊成員不事先規劃會談主題。治療師在一開始便需仔細傾聽並引發各種意見、字句、故事，相關方式已列於本文。若是最需受到關切者無意參與會談，或突然離開會談室，治療團隊則與家庭成員討論是否應繼續進行會談。若家庭成員希望繼續進行，臨床治療人員則告知該位當事人，待其有意重啟會談時，治療團隊及其他成員可再重返會談現場。
Everyone present has the right to comment whenever they want to. It is advisable that everyone respect and address the ongoing topic of the dialogue, unless clearly proposing an alternate. For the professionals, this means they can respond either by inquiring further about the theme under discussion, or engaging in reflecting dialogue with one another, in which they strive to be open and forthcoming. Therapists speak to –and look at--each other, use ordinary, nonpathologizing language, avoid criticizing family members, and engage in a dialogical exchange with one another. In every meeting, there should be at least some time for the professionals’ reflections with each other, because this format is central to generating bothnew words for the crisis and an open and shared process that encourages a sense of trust and safety. It is also essential that the network members have an opportunity to comment on what the professionals have said.
每位在場人員有權隨時發表意見。適當作法是，各人皆需重視及針對現前的對話主題，除非話題明確轉移；對於專業人士而言，此作法代表他們可視情況採用不同回應方式，例如針對討論中的主題提出深入詢問，或是專業人士之間彼此進行反思對話，而反思對話必須力求公開及傳遞訊息。治療師對每位在場人員說話，注意眼神接觸，使用一般日常話語，不套入病理學論述，避免批評家庭成員，並與各人皆有對話交流。每場會談中，至少需保留一小段時間作為專業人士之間的反思，因為反思是一種重要的形式，可產生描述危機的新字句，創造公開共享的流程，激發信任感及安全感。另一重點則是網絡成員需有機會可評論專業人士的話語。
Any decisions about medication and hospitalization are made with everyone’s input.
作出有關用藥及住院的決定之前，必須先廣納每個人的意見看法。
Discussion of issues related to medication and hospitalization usually occur after family members have had a chance to express their most compelling concerns. After the important issues for the meeting have been addressed, one of the team members usually makes the suggestion that the meeting be adjourned. It is important, however, to close the meeting by referring to the client's own words and by asking, for instance: “I wonder if we could take steps to close the meeting. Before doing so, however, is there anything else we should discuss?” By so doing, the clients have control over the decision to end the session. At the end of the meeting, it is helpful to summarize briefly the themes of the meeting, especially whether or not decisions have been made, and if so, what they were. It is also important to work out the structure of the next meeting if the details are unclear, such as discussing who will attend and when it should take place. The length of meetings can vary, but ninety minutes is usually enough.
對於用藥及住院議題的討論，經常出現於家庭成員表達其強烈關切之後。既已提出會談最重要的議題，一名治療團隊成員常會建議會談可中止；然而必須謹記，應使用當事人自身說出的話語以結束會談，並先行詢問，例如：「我在想是不是該結束這場會談了，不過在這之前，我們還有要討論什麼嗎？」如此一來，當事人可自行決定究竟是否應結束會談。會談之終，如能簡單總結會談主題，尤其總結是否已作出任何結論(如有結論，又為何種結論)，將可帶來幫助。若是下次會談的細節尚未明確，亦不可忽視其安排規劃，例如討論下次會談的參加人員及時間。會談時間長度並無一定標準，但通常90分鐘已足夠。
SUMMARY
結論
Open Dialogue is both a community-based treatment system and a form of therapeutic conversation that occurs within that system, specifically within the treatment meeting. These two layers of Open Dialogue are guided by the seven principles, of which “dialogue (polyphony)” and “tolerance of uncertainty” are the two fundamental coordinates of therapeutic conversation, or Dialogic Practice. Dialogic Practice in Open Dialogue is the same for both acute crises and more longstanding repetitive, so-called “chronic” situations.
開放式對話是以社群為基礎的治療系統，並且在此系統內所呈現之治療對話形式，尤其透過治療會談呈現。開放式對話的此二種層面，由7項原則導引，而其中對於治療對話(或稱對話式作法)最為重要之2項原則，分別為「對話(或複調)」以及「容忍不確定性」。急性與慢性精神危機之處理，皆可使用開放式對話中的對話式作法。
This document has focused on defining Dialogic Practice by identifying and describing twelve, key elements. In the treatment meeting, the principal aim is for the therapists to foster a dialogue in which everyone’s voice is heard and respected. The starting point is the language the family uses to describe their situation. The stance of the therapist is different from that of traditional psychotherapy, in which the therapist makes the interventions and does not disclose personal issues. While many family therapy schools concentrate on specific forms of interviewing, the dialogical therapist focuses more on listening and responding to what has touched them.
本文藉由認識與敘述對話式作法之12項要點，以辨明對話式作法之要義。治療會談中，治療師之主要目標為促進對話，令每個人的意見皆能受到傾聽及重視，並以家庭成員描述情況的字句，作為對話起點。以往在精神治療法之中，治療師進行干預，不揭露個人話題；但對話式作法的治療師，所扮演之角色有別以往。許多家庭治療學院仍注重訪談的特殊方式，但對話治療師更為強調傾聽，以及回應對話中令其感興趣之處。
It is in these moments of “aliveness” in Open Dialogue when a speaker or listener has been touched by something new in the exchange that holds the possibility for transformation. In the prior discussion, we have given examples of these “Striking Moments” (see also, Shotter & Katz, 2007) For example, when Christopher used the word “heartbrokenness,” both he and the therapists were visibly moved. Further inquiry yielded a profound shift of perspective afforded by telling a story of what happened to him that placed his experience in a context. There can be sudden revelations and positive movements toward self-healing and wholeness associated with this process that can be profoundly connecting and astonishing. This transformative possibility seems to rely on a therapeutic stance of remaining present and engaged, attuned to ones’ own inner dialogue and sensitive to the outer, shared dialogue, responding utterance by utterance as an exchange unfolds. For this reason, professionals hold their knowledge and expertise lightly as part of their repertory of responsiveness. This “Striking Moments” approach is contrasted by Roger Lowe (2005) to a “Structured Methods” approach, which refers to those stepwise and unidirectional sequences guided by external theories and hypotheses.
開放式對話正是有此種「活性」，亦即說者或聽者在對話交流中受到某種新觀點打動，而創造出改變的可能性。先前的討論篇幅中，已有數個案例出現此種「靈光乍現」(可另參考Shotter & Katz, 2007)。例如克里斯多福說出「痛心」一字之時，克里斯多福與治療師皆明顯有所感觸，進一步詢問之下，克里斯多福道出了造成他如此現況的過往經歷，帶來深入的觀點轉變。而真相突然披露，並激發出趨於自我療癒及完整性的正向力量時，可能與此種為彼此帶來連結的驚人過程有關。轉化的可能性，似乎端看治療立場是否維持在場與投入，與某人的內在對話一致，並對於外在共同對話具有敏銳度，以對方字句作為回應字句，表示展開交流。基於此原因，專業人士可將自身知識及專業，使用於回應時的詞庫。羅傑．羅伍將此種「靈光乍現」與「條理分明」作為對比(2005)，「條理分明」意指由外部理論及假說所指引的單向逐步順序。
The Dialogic Practice of Open Dialogue emphasizes “being with” rather than “doing to.” There is an open-ended inquiry that emphasizes the present moment. Clients’ words and stories are felt to be precious and are carefully attended along with their silences and the whole gamut of gestures, emotions and body-based utterances. The therapists’ respond to the clients’ expressions by repeating words and listening carefully and try to understand without imposing their own overlay of jargon, interpretation, and hasty conclusions. If someone is difficult to understand, there is an ongoing search for words to give more lucid expression to what they might be trying to say. There is the assumption that the situation is meaningful and that everyone is struggling to make sense of it. New, jointly produced possibilities emerge as new words and stories enter the common discourse. The meeting creates a context for change by generating exchange among the multiple voices all of which are valued and important. Common language and understandings can help undo the tangle of the confusion and ambiguity and produce a greater sense of orientation and agency.
開放式對話中的對話式作法，強調的重點為「陪伴對方」而非「給對方下指導棋」。使用開放式問句，著重當前時刻，當事人的字句與故事皆視如珍寶，善加吸收，允許沉默片段，並注意對方各種姿勢、情緒、及肢體語言。治療師仔細傾聽當事人話語，回應時重複其字句，並且在屏除治療師賣弄個人專業術語、作出詮釋、急於下定論等前提之下，嘗試理解當事人。若當事人不易理解，治療師可持續尋找字句，以明確表達出對方欲吐露之言語。假想情況為，情況富有意義，且每個人皆努力想了解情況。新的字句與故事進入共同論述之後，便能出現共同創造的新機會。治療會談打造各種意見的交流空間，所有意見皆受重視並具有價值，以此方式造就出改變的情境。共同的語言，共同的理解，將能幫助破除混沌狀態，產生更高的方向感與自主感。
A REQUEST FOR FEEDBACK FROM YOU THE READER
歡迎讀者提供寶貴意見
Of note, in order to continue to clarify, refine, and update the 12 key elements of fidelity to Dialogic Practice discussed in this document, we encourage readers to provide feedback on whether this text captures your experience of doing Open Dialogue and Dialogic Practice, helps in reflecting on your work, is useful in training and supervision, and assists in doing research. We see this text as a living document. Future studies of the reliability and validity of the “The Key Elements of Dialogic Practice in Open Dialogue: Fidelity Criteria” are needed and forthcoming. Please email us and share your comments at: Dialogic.Practice@umassmed.edu.
Thanks – Mary, Jaakko, and Doug September 2, 2014
本文討論對話式作法中的12項真實性準則，為了持續對其闡明、修飾、更新，我們十分歡迎讀者提供寶貴意見，無論是本文記錄您的開放式對話及對話式作法的自身經驗、協助反思您的個人作品、用於訓練及監督、以及成為研究上的輔助資料，皆誠摯邀請您給予回饋。我們將此份文件視為動態文件，需要持續進行對於本文可靠性及有效性之後續研究。請將您的寶貴意見寄至以下電子信箱：Dialogic.Practice@umassmed.edu
誠摯感謝
瑪莉／亞科／道格 敬上
2014年9月2日
ACKNOWLEDGMENTS
致謝
We would like to express our gratitude to the families from whom we have learned so much. We thank them for their permission to describe examples from our work together. We have altered theses examples to protect confidentiality and remove any identifying information. We also want to thank our colleagues for their invaluable feedback: Jukka Aaltonen, Volkmar Aderhold, Magnus Hald, Lynn Hoffman, Peter Rober, Markku Sutela, and the UMass Medical School research group, including Daniel Breuslin, Nancy Bryatt, Robert Clyman, Jon Delman, Daniel Fisher, Christopher Gordon, Stephanie Rodrigues, and Makenzie Tonelli.
在此向參與本文開放式對話治療的各個家庭，表達無限感謝，我們真正獲益良多。感謝各個家庭允許我們採用其經驗作為案例，我們對於細節進行變改，以保護當事人隱私，並移除可供辨識的資訊。此外，我們也要感謝同事們的無私奉獻：Jukka Aaltonen、Volkmar Aderhold、Magnus Hald、Lynn Hoffman、Peter Rober、Markku Sutela，以及麻大醫學院研究團隊成員Daniel Breuslin、Nancy Bryatt、Robert Clyman、Jon Delman、Daniel Fisher、Christopher Gordon、Stephanie Rodrigues、與Makenzie Tonelli
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