Power, position and social relations: Is the espoused absence of hierarchy in Open Dialogue naïve?

Rochelle Einboden*, Lisa Dawson, Andrea McCloughen, Niels Buus

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


Open Dialogue practitioners aim to reduce social hierarchies by not privileging any one voice in social network conversations, and thus creating space for a polyphony of voices. This sits in contrast to the traditional privileging of those voices credited with more knowledge or power because of social position or professional expertise. Using qualitative interviews, the aim of this current study was to explore Open Dialogue practitioners’ descriptions of challenges in implementing Open Dialogue at a women’s health clinic in Australia. Findings revealed how attempts to rhetorically flatten hierarchies among practitioners created challenges and a lack of clarity regarding roles and responsibilities. As the practitioners tried to adjust to new ways of working, they reverted to taking up engrained positions and power aligned with more conventional social and professional roles for leading therapy and decision-making. The findings raise questions about equity-oriented ways of working, such as Open Dialogue, where intentions of creating a flattened hierarchy may allow power structures and their effects to be minimised or ignored, rather than actively acknowledged and addressed. Further research is needed to consider the implications that shifting power relations might have on the roles and responsibilities of practitioners in the move to equity-oriented services.

Original languageEnglish
JournalHealth (United Kingdom)
Number of pages18
Publication statusE-pub ahead of print - 2024


  • equity-oriented health care
  • implementation
  • mental health services
  • Open Dialogue
  • power relations


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