IS DIALOGUE LIFE, LOVE, OR CURE? Uncritical review of Jaakko Seikkula’s new book

Reading the book Why Dialogue Cures? Explaining What Makes Dialogue Unprecedentedly Effective in Difficult Crises (Springer, 2025) was, for me, a deeply satisfying experience. For more than fifteen years I have had the opportunity to meet the author of this book in different contexts. He is one of the most important teachers I have had in my life, and I do not mean only in psychology or family therapy. His ideas, experience, and way of being have inspired much of what I do. For that reason, I will refer to him simply as Jaakko in the following text.

I do not know how satisfying it was for Jaakko to write this book, but I imagine it must have been a very special undertaking. In many ways it reflects a lifetime of practice and research, deeply intertwined in his work. He also shows how his understanding of dialogue developed through engagement with interdisciplinary scholarship and how he and his colleagues have drawn on these ideas in their work with people experiencing the most difficult life crises.

In his two previous books in English, co-authored with Tom Arnkil, readers could follow the origins of their respective approaches: Open Dialogue (Jaakko) and Anticipation Dialogues / Early Dialogues (Tom). This new book reaches further and can inspire dialogical practice in many contexts. Although most examples come from the original Open Dialogue team at Keropudas Hospital or from Jaakko’s own clinical work with couples and families, readers are invited to explore the implications for their own contexts of practice.

Grounding

In 2014, when we as the Narativ group invited Jaakko to Brno for a workshop for the second time, he politely asked whether he could talk about “something else than Open Dialogue.” We took the risk, even though we knew that a workshop about Open Dialogue would have been a safe bet. Many professionals and peer workers were eager to learn about the successful model from Northern Finland that enables people with psychosis to recover with far less medication and hospitalization than in conventional psychiatry.

The workshop, which primarily focused on the embodiment of dialogue, nevertheless attracted enough participants. It also gave us an opportunity to look behind this successful model of care. Jaakko introduced a conception of the human mind rooted both in relational processes and in bodily memory. He also shared plans for the upcoming Relational Mind research project at the University of Jyväskylä, which was just about to begin.

In the present book, written after the completion of the Relational Mind project, these ideas are developed further and some of the most interesting findings are presented.

“The human mind can be seen as a process that takes two forms in human relationships. First, it takes place in the relationship of present interaction. All things experienced take on meaning in the present moment in the presence of these people. Secondly, the human mind is constructed from all the relational experiences in the body’s memory, which are shaped into the voices of life according to the theme of each interaction.”

This is not an entirely new understanding of the human mind, nor a radically new conception of dialogue. Rather, it enriches and interconnects perspectives that often focus either on the individual body or on relational processes alone.

For me, it also resonates with the basic idea of social constructionism: yes, we co-construct the world together. But we must also take into account the tools that enable us to construct—our senses, nervous system, our muscles, inner organs, the whole body. This embodied ground makes dialogue possible and the bodily awareness is therefore an essential condition for every dialogical practitioner.

Open Dialogue itself, as a model of care, is certainly present in this book. Readers will find everything they need to understand the approach, its history, and its practice. Yet the broader conception of the human mind—which includes embodiment, intersubjectivity, rhythmic attunement, and triadic relationships—helps illuminate why the approach has been so successful. From this perspective, the outcomes of Open Dialogue appear less as a miracle and more as a challenge to the dominant individual conception of the human mind in psychiatry and society more broadly.

Emotional sharing in the present moment

“Dialogical practice creates a new image of the human, in which the best care is to accept people’s emotional experiences rather than to eliminate psychological symptoms or change the family.”

A question running between the lines of the book—and suggested by its title—is whether dialogue should be understood primarily as a natural feature of life or as a method that must be deliberately cultivated. The book suggests that both perspectives are necessary.

If dialogue flowed uninterrupted through the stream of life, there would be little need for special interventions by mental health professionals. According to Jaakko, psychological symptoms often appear when there is a dysruption in this flow, when something serious is happening within a family or close network and the people involved “lack the words to express their most important experiences.”

Psychotic crisis is a powerful example of what can happen when the flow of dialogue is interrupted. Symptoms such as hallucinations or paranoia—described here as “an active attempt by the embodied mind to cope with extreme stress”—can seriously disturb relationships and lead to intense emotional drama. In a sense, the nervous system expresses experiences that have not yet been integrated and for which words are not yet available.

From this perspective, psychotic symptoms become an important part of emotional sharing in a moment of crisis. For practitioners, this means not only accepting the experiences of the psychotic person—what he or she sees, hears, or thinks—but also helping the family network engage in a shared effort to understand these emotional processes. By showing genuine curiosity about what people are trying to communicate, we increase the chance that these experiences can eventually be integrated, even when this seems almost impossible at the beginning of the crisis.

A similar perspective can be applied to many other kinds of symptoms. Whether we are dealing with anxiety, depression, compulsions, or self-destructive behavior, the dialogical viewpoint suggests that there is always some experience that has not yet found words. Helping professionals, instead of focusing on suppressing symptoms, can help the network find ways to describe and share these experiences.

At a conference in Sarajevo in 2025, where Jaakko presented his book, one participant raised a question about the word “cure” in the title. Is it not too much to call something as ordinary as dialogue a cure? Or, from another perspective, does calling dialogue a cure reduce it to the level of a pill?

Yet we have many similar examples. In the Czech Republic, in the town of Jeseník—where Open Dialogue has also been successfully applied—there is a famous spa that uses water as its primary healing agent. When its founder, Vincenz Priessnitz, established the institute, it seemed miraculous: water was used to treat conditions for which there had previously been no cure.

Yes, ordinary things such as water, breathing, or movement can have healing power.And so can dialogue.

The skill of dialogical practitioners lies in facilitating the processes that allow transformative experiences to emerge. We do not introduce special techniques designed to enhance dialogue. Instead, we try to remove the obstacles that stand in its way. By listening carefully and slowing down the process, we allow the most healing moments to appear.

The autonomic nervous system in the dialogical flow

Jaakko emphasizes that emotional sharing takes place primarily without words. When we begin to use words, we are already interpreting emotional experiences unfolding between our bodies. Indeed, this process of interpretation is crucial. It is one of the aims of psychotherapeutic meetings: to name experiences and find words for what previously was wordless. But before doing so, it is important to create space for noticing the experience itself, which can be understood as a dialogue between our autonomic nervous systems.

“It is through the autonomic nervous system that we are most directly connected to the reality around us.”

Jaakko emphasizes that our bodily systems—especially the autonomic nervous system—are in continuous interaction during every encounter, often without our awareness. This was one of the key questions explored in the Relational Mind project at the University of Jyväskylä: how the nervous systems of people participating in a therapy meeting influence one another and whether they tend to synchronize.

The project offered many implications for psychotherapy, several of which Jaakko summarizes in the book.

• For example, when our bodies become tense, it may be the right moment to create space for people to speak about their experience. Through the process of talking about what is happening, the tension can begin to ease.

• Similarly, when therapists talk to each other in a reflective conversation, clients often move into a state of increased sympathetic arousal. While a certain level of activation can sharpen focus and attention, when arousal becomes too high clients may move outside the “window of tolerance,” to use Daniel Siegel’s well-known term. The art of reflecting therefore involves being respectful, appreciative, brief, and allowing clients enough space to verbalize their emotions after the reflections.

• Another practical guideline may be to use a soft prosody of speech that can be more easily received by other bodies, helping them calm down and share more.

  
  

I remember one consultation where Jaakko worked with a mother and son together with a co-therapist trained in another therapeutic approach. Interestingly, she commented on emotions much more than Jaakko did. Yet at the end of the meeting the mother said that the difference was that with Jaakko, even if he didn't talk so much about the emotions, she could feel he was truly present with her. This quality of presence within the process of emotional sharing is perhaps what makes dialogical practice so distinctive.

“For a therapeutic conversation, this means that it is important first to give space to the emerging emotional experience—to be present with the emotional state—and only after the arousal begins to discuss meanings, explanations, and interpretations.”

Increased reflexivity

One of Jaakko’s major influences was professor Tom Andersen, best known for introducing reflecting teams in family therapy practice. In my experience, reflecting teams can differ from what happens in Open Dialogue network meetings.

In Jaakko’s approach, reflections are often used directly in the present moment—to help participants slow down and notice something important about themselves or their relationships. This differs from some versions of reflecting teams where reflections occur only once in a session and may revisit topics already discussed.

From my perspective, both forms of reflection can be valuable. Brief reflections that immediately bring back a person’s own words allow them to look at their experience from a slightly different angle in the present moment. At the same time, connecting different parts of a conversation can reveal new patterns, similarities, and differences.

Perhaps Jaakko’s writing encourages us not to hesitate too long before offering reflections so that we can widen the moment where something important is happening. Responding in the present moment is, after all, the essence of dialogue.

“What is the response? The response is not so much a piece of information or an explanation of a problem, but rather a sensation of the moment.”

Dialogue as cure?

Perhaps this also points to an answer to the central question of the book: why is dialogical practice so helpful?

At its best, dialogical practice crystallizes something very simple yet profound: an act of love. The unconditional respect for another human being, especially for one who is suffering. Such respect creates the possibility of a genuine encounter.

This places a demanding expectation on us as professionals. We cannot rely primarily on a toolbox of techniques prepared in advance. Instead, we remain attuned to the polyphony unfolding in the present moment.

In dialogue, we are first and foremost human beings. Paradoxically, this humanism is the place where the deepest form of professionalism begins. The competence of the dialogical practitioner lies not so much in applying techniques as in cultivating the ability to stay present, responsive, and open to the other.

In this sense, dialogue may indeed become a cure—but not in the sense of a medical intervention. Rather, it is a cure that grows out of human encounter itself. And the task of dialogical practitioners is simply to help create the conditions in which such encounters can happen.