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

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Health Pub Date : 2024-04-26 DOI:10.1177/13634593241249101
Rochelle Einboden, Lisa Dawson, Andrea McCloughen, Niels Buus
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Abstract

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.

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权力、地位和社会关系:开放对话中没有等级之说是否天真?
开放式对话的实践者旨在通过在社交网络对话中不偏袒任何一种声音来减少社会等级,从而为多种声音创造空间。这与传统的因社会地位或专业知识而赋予那些拥有更多知识或权力的声音以特权的做法形成鲜明对比。通过定性访谈,本研究旨在探讨开放式对话实践者对澳大利亚一家妇女健康诊所在实施开放式对话过程中所面临挑战的描述。研究结果表明,试图在言辞上扁平化从业人员之间的等级制度,是如何造成挑战以及角色和责任不明确的。当从业人员试图适应新的工作方式时,他们又回到了与更传统的社会和专业角色相一致的根深蒂固的位置和权力,以领导治疗和决策。研究结果提出了一些关于以公平为导向的工作方式(如开放式对话)的问题,在这种工作方式中,建立扁平化等级制度的意图可能会使权力结构及其影响被最小化或被忽视,而不是被积极承认和解决。需要开展进一步的研究,以考虑权力关系的转变可能对从业人员在转向以公平为导向的服务过程中的角色和责任产生的影响。
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来源期刊
Health
Health Multiple-
CiteScore
4.90
自引率
0.00%
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0
期刊介绍: Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.
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