Care and care relationships are located in, shaped by, and shape particular spaces and places. (Milligan & Wiles, 2010, p. 736)

Prelude

Sometimes, one experiences something that fills one with hope. In June 2023, a clinician and a researcher from England, both doing groundbreaking work in the field of mental health, visited the county of Agder, Norway. This visit was a collaboration between the University of Agder, Kristiansand municipality, and Sorlandet hospital (psychiatric services). This resulted in three exciting days that opened new perspectives on how mental health and mental health problems can be understood and how people struggling with mental distress can be helped in their recovery processes.

The visit began with two days with psychologist Lucy Johnstone, who presented the Power Threat Meaning Framework (PTMF). Nearly 600 people, professionals from the municipalities and specialist psychiatric services, as well as peer support workers and members of various user organizations, gathered in Kristiansand. The themes for the first day focused on how psychiatric diagnoses lacked scientific grounding and cannot contribute to understanding the origins of mental health problems, their role in people’s lives, and people’s recovery process. A central idea in the PTMF is that what is traditionally regarded as symptoms of mental illness can actually be considered the person’s responses to difficult experiences (current or past).

The second day, Lucy Johnstone and a group of 30 people explored potential consequences of the PTMF for mental health practices. The central question was as follows: What are the consequences for the person’s understanding of their own life and for professional knowledge and practices if the focus is on difficult events in the person’s life and how they manage these situations when experiencing abuse of power and injustice?

The third day, Jerry Tew (social work professor from the University of Birmingham) presented his research on the social conditions related to recovery from mental health problems. Tew has developed a concept that clearly emphasizes the role of social factors. He considers the person’s access to “recovery capitals” central to understanding what type of help they need.

The five types of capital he identified are personal, relational, identity, social, and economic capital. Tew concluded with a rich exchange about how professionals should meet people struggling with mental health problems in their own social environment, within their social networks, and examine what ways of managing the problems can be developed there.

Another important person that has worked with us over the years—professor and psychologist Jaakko Seikkula, who with colleagues in Finland has developed the work strategy of open dialogue (OD)—was also invited to the event but could not come. In OD, the professionals’ meeting with the person who has problems is moved to their person’s environment (with their own network), and the professionals have no privileged knowledge or expert position.

Our reflection after these three days centered on how knowledge of material conditions facilitating the recovery process—approaches such as OD, PTMF, and recovery capital—can complement each other and gain greater power to help people. This paper follows from these days and the hopeful experience.

Introduction

One of the aims of the deinstitutionalization of psychiatric care in the second half of the twentieth century in high-income countries was to no longer isolate users from their social environment. Instead, psychiatry was to move out into local communities, close to the users’ world, so as to meet them in their respective social contexts. The direction was “from the patient to the person” (Barham, 1992; Barham & Hayward, 1991) and even “from the patient to the citizen” (Rowe, 2015). In this move from seclusion to local communities, the experience, the voice, and agency of the person was made decisive for services and initiatives (Chadwick, 1997; Chamberlin, 1978). More recently Femdal (2018, p. 2) quotes the Norwegian Directorate of Health and Social Affairs on the new services opened in local communities: “Community mental health service is supposed to promote independence, belonging, and strengthen the ability to cope with life.” Furthermore, community mental health services emphasize the person’s relationship to their social context, as well as both the person’s independence and belonging to their environment and the people around them, so that they can contribute to their ability to cope with life’s challenges together with their social network.

This process of deinstitutionalization—affecting both the physical sites of inpatient care and the knowledge, theories, and practices of psychiatry - was in part driven by a criticism of traditional psychiatry that had gained momentum after World War II. Books such as Ronald Laing’s (1961) The Divided Self, Thomas Szasz’s (1961) The Myth of Mental Illness, Michel Foucault’s (1961) History of Madness, Erving Goffman’s (1961) Asylums, and Frantz Fanon’s (1961) The Wretched of the Earth were all published during the first two years of the 1960s. The ideas they carried were slowly put into practice but resulted in a general reduction of inpatient psychiatric care in several high-income countries.

In 1978, for example, the psychiatric hospital in Trieste—where an alternative social approach had been developed—was closed (Aria et al., 2025; Foot, 2014). In several countries, “sectorization” with outpatient clinics developed as the scope of mental hospitals decreased.

The global progress of psychiatric deinstitutionalization remains highly fragmented, characterized by both reforms to community-based services, but also persistent structural barriers (Mezzina, 2025). Collectively, these developments underscore that while local successes exist, institutional resistance, service fragmentation, and resource scarcity remain significant impediments to the global implementation of deinstitutionalization (Mezzina, 2025).

From the 1970s onwards, this development has occurred in parallel with the spread of a neoliberal order that affects both the foundation of the welfare state and the cultural understanding of what it means to be human. Wacquant (2010) summarizes this in four points: 1. Economic deregulation that frees market forces from state control (Globalization). 2. The dismantling, privatization, and reshaping of the welfare state, with a focus on making assistance conditional on specific behavioral requirements for the recipients. 3. The emphasis on individual responsibility for one’s own situation in a market where everyone competes with everyone else, and where society bears little responsibility for the well-being of its citizens. 4. A growing legal apparatus that intrudes into various areas to conduct extensive surveillance of those on the fringes of the labor market.

Thus, while deinstitutionalization was viewed as a project of liberation that highlighted civil rights and social inclusion, welfare states have simultaneously come under attack. Deinstitutionalization have been transformed into a cost-cutting project (see Reagan in California, cfr Lovell & Scheper-Hughes, 1986), which marketed individual responsibility for one’s own situation and transformed governance within the health and social sectors according to a corporate model using New Public Management (Karadzhov, 2023; Recovery in the bin, 2026; Tew et al., 2012; Topor et al., 2022).

The process of deinstitutionalization accompanied by a (re)contextualization of the patient, both the view on what the difficulties are and what recovery is about, has led to ongoing tensions within the psy-field (psychology, psychiatry and mental health care). While there have been counter-reactions in terms of new individualization and medicalization, developments of understanding and approaches that are contextual and social in nature have also emerged. This paper presents three of these approaches: Power Threat Meaning Framework (PTMF; Johnstone & Boyle, 2025), Open Dialogue (OD; Pocobello et al., 2023; Seikkula & Arnkil, 2013), and Recovery Capital (RC; Tew, 2013) to start a “trialogue” between them. The idea is that these approaches could supplement each other in developing contextual and social recovery–oriented practices. It should be noted that when selecting Recovery Capital, this does not mean that we relate to the whole manifold of the recovery movement, which on some occasions has been absorbed into mainstream diagnostic rationality and procedures (Karadzhov, 2023; Topor et al., 2022).

We will proceed through three steps: First, we suggest some drivers that counter contextualization; second, we introduce PTMF, RC and OD as contemporary contextual alternatives; and third, we suggest how these approaches can supplement each other and give direction for further developments.

Psychiatric-administrative drivers that keep the patient isolated

Drivers found in the coupling of psychiatry and administration/policy, such as national guidelines mostly based on scheduled methods, support continued individualization and medicalization, which in turn represents an obstacle to further developments of practices along contextual and social lines. During the dehospitalization process, new institutions were created in the form of outpatient clinics, alongside reduced ward-based inpatient care. However, the development was met with some resistance. Smith (2016, p. 7) writes:

The emergence of community mental healthcare meant that psychiatrists were also expected to become more community-minded in a way that relinquished some of their independence and authority, a different sort of balancing act.

Individualization

Individualization continued after deinstitutionalization as the biomedical paradigm was complemented by a psychological/psychotherapeutic one (Madsen, 2014; Topor et al., 2022). Beyond significant differences, the biomedical and the psychotherapeutic paradigm share an approach in which the individual’s problems are treated as if they are located within the person’s body or psyche. The patient can thus continue to be treated isolated from their social context. To this general orientation, new rationalities have been added, mainly in the context of the commodification of the care of people in modern society: Individuals “buy” help formed as products offered to individuals.

The demand for productivity

The demand for productivity has led many organizations to produce a predetermined limited number of sessions with users to meet their budgets. Formalized limits on the number of appointments in advance also provides opportunities to plan patient flow between different organizations.

In practice, deinstitutionalization has often been replaced by a new form of control—not through total institutions, but through national, standardized, short-term interventions to be carried out by the services. An example in the UK is the Improving Access to Psychological Therapies (IAPT) programme. However, outcomes in this programme turn out to be poor (with a 9.2% recovery rate) (Loewenthal, 2017; Scott, 2018; Timimi, 2015).

The demand for effectiveness

The demand for effectiveness has been operationalized into the use of “evidence-based interventions.” These are methods and interventions that, following an instrumental logic, are claimed to have demonstrated statistically superior effects and are disseminated in different countries in the form of national guidelines.

As evidence is primarily based on different methods tested in randomized controlled trials, many of these methods have become schedule-bound (Wifstad, 2008). However, many psychosocial interventions are inherently impossible to standardize, as they are based on relational interactions that depend on changing contexts. Thus, they cannot be investigated in randomized controlled trials and have been excluded from the summaries of evidence-based practices (Bergmark et al., 2011).

Evidence-based interventions generally imply that a patient with a particular set of symptoms and a diagnosis is offered a preplanned number of scheduled sessions. The idea is that treatment is best performed at the professional’s workplace, where the risk of unforeseen events is minimized. This also avoids time-consuming travel to users’ different social contexts. This means that practices in mental health services, such as home visits and network meetings, are not prioritized (Mezzina, 2017). When the opportunity to meet the user in their social environment is absent, professionals lose the opportunity to gain knowledge of the context the patient’s “symptoms” are a part of.

The drive toward medicalization

With deinstitutionalization, psychiatric services were able to transfer responsibility for patients’ social lives to other actors (in Denmark, the distinction between “treatment psychiatry” and “social psychiatry;” in Sweden, between “specialized psychiatry” and “social psychiatry;” in Norway, between “psychiatry” and “mental health care” etc.). In Sweden, psychiatric clinics were localized in somatic hospitals. This created better conditions for psychiatry to become a branch of medicine among other branches.

The conservation of the medical-individual approach was also fueled by repeated promises of the development of a diagnostic manual based on biological markers and no longer on normative subjective assessments. However, this promise has not been realized (Kupfer, 2013).

The demand for documentation

The budgets of several mental health organizations are based, to varying degrees, on their output and “quality assurance.” The aim is to enable funders to know whether they have received “the goods they purchased.” The growing demands for documentation are also based on a distrust of professionals and users’ experience-based knowledge by the administration and political leaders (Cottam, 2011, 2018; Svare et al., 2023).

However, documentation requirements take significant time away from clinical practice. Thus, conflicting tendencies arise between, on the one hand, the drive to increase productivity, measured in terms of the number of patients passing through the organization and the number of evidence-based interventions performed, and, on the other hand, the need to implement and develop constantly new documentation systems.

One concept used to describe this development is “paperization,” leading to an increasing proportion of health and social care workers’ time spent on dealing with paper and less on users (Bornemark, 2018). In such a context, the organization of the encounter is rationalized according to the assembly line principle, with users queuing to enter the professional’s room to be dealt with according to the evidence-based care plan. For professionals, this development has resulted in “proletarization,” where their task is reduced to executing interventions determined by others according to a specific template (Standing, 2023).

Taken together, these demands for productivity, effectiveness as operationalized in “evidence-based treatment,” the belief in individualization, medicalization of mental health problems, and documentation have had significant consequences for the encounter between users and professionals. They are all drivers that may make the system and professionals blind to the social context and reality of both the origin of people’s difficulties and the social processes required. They also narrow the space for the voices of those concerned.

Problems also with humanistic alternatives

Alternatives have been introduced by professionals having a more humanistic approach. But also these may suffer from a detachment form the social reality and context of those concerned. Examples are both found in narrative approaches and some recovery-oriented approaches. In some narrative approaches there seem to be an overemphasize on the linguistic part, seeing reality as constructed in language (Bøe, 2021; Bøe et al., 2024), and such approaches often fail to include the social network, and the sociomaterial living conditions.

Also various recovery-oriented and person-centered approaches seem to focus on recovery as a personal and individual process in the hands of the one concerned (Anthony, 1993 Slade et al., 2014), also failing to address and include the social reality in which the persons concerned live their lives (Bøe et al., 2024; Karadzhov, 2023; Topor et al., 2022).

Three contextual and social approaches to recovery

We now return to the three approaches introduced at the start of the paper, setting up a trialogue between them. The trialogue partners are Open Dialogue (Buus et al., 2017; Seikkula & Arnkil, 2006; von Peter et al., 2021), Recovery Capital (Hennessy, 2017; Tew, 2011; Tew et al., 2012; 2013) and the Power Threat Meaning Framework (Boyle & Johnstone, 2020; Johnstone et al., 2018b, Johnstone & Boyle, 2025).

What these approaches have in common is that they all theoretically situate the person and their problems within a social and material context and, accordingly, argue that practices should be socially and contextually oriented. Material and social aspects are central both for understanding the origin of problems, how persons and their social environment deal with them, and devising a way forward (recovery). This common denominator places the three approaches in a field of research and practice that can be labeled as contextual recovery (Harper & Speed, 2012; Tew et al., 2013; Topor et al., 2022). Together, however, their respective strengths can be combined, and their limitations countered. In the following we will suggest their respective strengths and how can they complement each other.

We refer to the trialogue partners as “approaches.” However, it should be clear that in a sense, they belong to different “levels.” Only OD offers a concrete social practice for help that can be used as a guideline for professionals and organizations. OD also has a 40-year long history of being practiced and evaluated in several countries (Bergström et al., 2022; Buus et al., 2021; Lakeman, 2014; Pocobello et al., 2023; Putman & Martindale, 2021). The other two are more recent and compatible with a range of different kinds of approaches and initiatives—as they emphasize formulating broader frameworks for understanding the background of the challenges persons might face (PTMF) and a somewhat corresponding framework on the specific elements in any successful recovery process and, hence, in interventions (RC) (Topor et al., 2018). It is important to note that PTMF is not directly about clinical interventions, but it is a set of conceptual tools that can be used in different settings, with or without professional support.

We suggest that the way these approaches may enrich each other can be articulated in a processual manner and in accordance with how mental health difficulties may develop and be resolved in a person’s life: First, the PTMF offers a way of understanding the origins of and the meanings of emotional distress. Second, RC offers knowledge about what kind of resources or capital that are at hand and that should be introduced into a person’s life to move ahead in ways that alleviate the distress and cope with everyday life. Third, OD has developed a certain way to do this, a way for professionals to step into people’s lives that bring together the ideas from the PTMF on how threatening events may lead to the crises of those concerned and a way to get (some of) the resources that RC points out into the lives of those in crisis.

Power Threat Meaning Framework

In 2013 a working group with clinicians, users/survivors of psychiatry and researchers started to develop the PTMF. This initiative was based on a statement by The British Psychological Society, Division of Clinical Psychology, and funded by the same organization. They started a critical review of the scientific basis of the diagnostic model in psychiatry, incorporating the results of a wide range of research and clinical experiences (Johnstone & Boyle, 2025) to lay the foundations for an alternative framework for understanding and practice.

The core of the PTMF is that what in a diagnostic model is perceived as symptoms of a pathological state, in the PTMF, it is considered as the person’s responses to deal with various exposures to negative power, both in past and present threats. Threatening events are situations the person has been exposed to and/or is exposed to by external forces, “powers” in social relations, or groups and at a societal level. Such negative operations of power include various kinds of powers ranging from physical and mental abuse, lack of money, poor housing, lack of rights, to ideological power in terms of others holding the power over language and meaning (Johnstone et al., 2018a,).

In the response to these threats, a crucial aspect is the way in which meanings of life situations, including these threats, are constructed. Processes of meaning attribution are central for the person and essential for the professionals when getting to know the difficulties of the person and are a central part of what is conceived in the framework as threat responses. These threat responses may have been both comprehensible and adequate at the time, based on the power relations that existed when they occurred, but may later constitute obstacles for the person to move forward in life. The PTMF point out possible power resources, as derived from relations, social groups, material contexts, economic rights and so on, that can be mobilized for the person concerned.

This alternative to the diagnostic model is also identified as a shift from the question “What is wrong with you?” to “What happened to you?” (Johnstone et al., 2018a). This change of focus promotes the development of an alternative narrative that can make sense of the feelings and experiences the person has been through and the actions they have taken—a story that transforms symptoms into understandable thoughts, feelings, and actions. Further, helping initiatives may include social action to empower the persons concerned, reduce social injustice, and restore social relations (Johnstone et al., 2018a). In the UK the PTMF is often used in combination with trauma-informed perspectives (Nikopaschos et al., 2023; 2025).

Recovery Capital

The work of mapping the user’s RC emerged in substance abuse services (Cloud & Granfield, 2008) and was introduced to the psychiatric field in the 2010s in connection with a critical review of the lack of a social perspective in recovery-oriented practice and research (Best & Hennessy, 2025; Tew et al., 2012; 2013). RC broadly refers to the total internal and external resources persons draw upon to initiate and maintain long-term recovery—not just from substance misuse but also from mental health challenges. Cloud and Granfield (2008) conceptualized RC as the “breadth and depth” of such resources, including personal strengths, social networks, financial stability, cultural belonging, and community support. Tew (2013) expanded the notion into the mental health field, arguing that sustainable recovery depends not primarily on clinical interventions but on empowering persons through personal agency and socially inclusive environments. He emphasized that recovery involves more than symptom relief; it requires rebuilding a meaningful life in the context of supportive relationships, community inclusion, and social justice.

Recovery Capital, specifically, offers a broad view on the resources that seem crucial in recovering from mental health difficulties which are interpersonal and social in nature. Tew (2013) proposed a fivefold typology of RC: personal (resilience, coping strategies), relationship (supportive and trusting relationships), identity (a valued and coherent sense of self), social (community connections), and economic capital (access to housing, employment, and material resources). Rather than focusing on individual deficits, this model highlights the resources needed to foster recovery as a socially situated process. Tew also emphasized the importance of addressing negative RC—such as discrimination, poverty, or exclusion—which can erode a person’s possibilities to fulfill a recovery journey. This strengths-based approach reframes recovery as not merely personal rehabilitation but as structural enablement through inclusive policies, relational practices, and community transformation.

Service users and practitioners, as well as relatives and other stakeholders, are often parts of the individualistic ideology and, therefore, lack interest in/knowledge about the sociomaterial context that determines the possibilities for helping situations to emerge and develop. RC helps both professionals and service users to structure their perceptions of the person’s actual needs to start and go on their recovery journey.

RC broadens the view from a focus solely on the isolated individual with some form of internal deficiency to a contextual focus. It also shifts the focus from the person’s own understanding of their situation to the context that forms the basis of that understanding. RC thinking forces both the user and the professional to look beyond the person’s own outlook on the situation and be aware of the presence or absence of material, social, and personal resources. It also helps them to develop and seek interventions and support outside the traditional medical framework.

Open Dialogue

OD has developed from the experience of Western Lapland in the early 1980s. There, a group of clinical staff began to work purposefully to reduce the number of admissions to mental hospitals (Borchers et al., 2014; Seikkula et al., 2006). They developed a network-oriented, dialogue-based approach in which persons from the social network are invited from the very onset. This social network could be persons from familial relationships, neighbors, colleagues, persons from services, and so on. They preferably went to the home of the person in crisis, where social network meetings were held (Borchers et al., 2014).

These network meetings were not a method, among many, chosen based on professional premapping or diagnostization but the starting point for all interventions (Seikkula & Arnkil, 2013). These first network meetings were at the core of the help in the sense that in OD mobilizing resources and giving those present a voice is crucial for the processes for change aimed at. OD implies that the professionals have no given answer to the crisis and the difficult experiences articulated in the meeting. The main role of the professional is to facilitate a dialogue that may be helpful at many levels—ranging from ethical aspects as the feeling of being heard and recognized in the meeting, via hermeneutic aspects of understanding the situation in new ways, to actions taken that affect the person’s everyday life and arrangements (Bøe et al., 2015).

In OD, the professional moves into the user’s social world, both literally when meeting people their homes or other important places in their lives (school, workplace) and in the sense that the dialogue invites those present to find their own words to describe the difficult situation they are in and together search for ways to move forward. The recovery capital available among the participants in the dialogue can be updated and used in the immediate situation and in possible actions after the meeting.

How PTMF, RC and OD can supplement each other – a trialogue

We are now at step 3 in our investigation. In this section, we suggest how these three approaches can supplement each other. It should be noted that the authors of the PTMF documents point to a range of practices in the mental health field they consider to be compatible with the framework. OD is one of them, presented as one of the ten examples of good practices (Johnstone et al., 2018a). We have illustrated this in the following table, and then we will discuss the topics further (Table 1).

In the following, we present the “specialities” of each approach and what they can offer the other approaches. We also indicate what the others can offer back.

PTMF – a sociomaterial view based on evidence

The specialities of PTMF

Based on review of extensive research (Johnstone et al., 2018b), the PTMF offers a rationale that recognize the person as an agent—even with regard to the thoughts, feelings, and actions that, from a diagnostic model, are considered symptoms. The PTMF introduces a shift of focus related to mental health from the individual’s interior (biological and psychological) to the lived life in sociomaterial contexts.

The PTMF aims at making the distress and problems understandable and appropriate, given the context. This is achieved when professionals together with the person in question forms a narrative. A suggested series of questions may guide this narrative formulation (Johnstone et al., 2018a, p. 10): 1. What has happened to you? (How has power operated in your life?), 2. How did it affect you? (What kind of threats does this pose?), 3. What meaning did you make of it? (What is the meaning of these situations and experiences to you?), 4. What did you have to do to survive? (What kinds of threat responses are you using?), 5. What are your strengths? (What access to power resources do you have?), and to integrate all the above, 6. What is your overall story? Through these questions, what from a pathological perspective are viewed as symptoms are understood as threat responses.

Power is a key aspect in the PTMF, and the presence of power is addressed in various contexts/levels, ranging from close relations to groups and society. Such powers also include the exertion of ideological power in which the language and knowledge of the persons concerned is ignored or devaluated, or they are denied access to information. This may offer OD and RC a view that enforces how aspects of power can be addressed. The PTMF not only gives attention to past threatening events but also encourages an exploration of how power operates in the person’s current situation. This aligns with OD.

What the PTMF can offer OD and RC

In OD, there is a norm that professionals should not introduce anything to the conversation that the participants themselves have not addressed. This may result in potentially important issues not being thematised. The PTMF may offer suggestions for various aspects that may be relevant both for reflecting on possible adverse experiences and possible recourses that may by mobilized. The PTMF may also expand on how relational/dialogical circumstances (including power) become relevant in close relations, but also at a societal level as PTMF address general social narratives or patterns (e.g. about what a life in poverty means). PTMF offers some important critical analysis of the power imbalances, including those in relationships between those in need of help and the professionals and their institutions.

This framework may supplement RC by suggesting the construction of a supporting narrative of the origins of the person’s situation and problems.

In the original versions of OD, the team’s primary task is related only to the meeting and normally does not include following up the user through sociomaterial actions (economy, school, work, housing, etc.). In this sense, the PTMF may potentially supplement OD by including sociomaterial initiatives from professionals in the everyday lives of the user and their family.

What OD and RC can offer back to PTMF

OD, with its focus on how to facilitate dialogue and polyphony in the actual meeting, can mobilize persons, resources, and new perspectives by just opening up for dialogue on the terms of those present. The social network can contribute with material, relational, and emotional capital to the identified patient. This can include support in everyday life, work, participation in pleasurable social activities, a renewed sense of community, and more.

OD recommend meeting the family in their own home, as the place where the problems are discussed might be of crucial importance. The PTMF does not seem to pay attention to the place where the professional meets the person. However, the answers to PTMF’s basic questions for the formulation of a person’s narrative might be different, depending on if they are developed on the professional’s or the person’s home ground. Places are often connected to which people can participate in the encounter, influencing the elaboration of the narrative. Finally, the place also influences the time available for the participants. OD stresses the possibility of both a long time for each encounter and repeated time, as the encounters can be arranged frequently if needed.

RC—the personal, social, and community resources that persons can draw on to support recovery—offers a valuable lens for operationalizing the PTMF in practice. While the PTMF shifts the focus from “What’s wrong with you?” to “What has happened to you?” (Johnstone & Boyle, 2025), Tew’s (2013) framework adds depth by highlighting the structural and relational capacities that enable people to move beyond distress and marginalization. RC recognizes that healing and resilience are not merely internal but deeply embedded in access to meaningful relationships, inclusive communities, and socioeconomic resources. This aligns with the PTMF’s emphasis on the role of power in shaping psychological distress and the importance of restoring power through connection, justice, and meaning-making (Johnstone et al., 2018a). By mobilizing RC, practitioners can support people not only in understanding their experiences through a PTMF lens but also in building the relational and material powers that sustain recovery and agency (Tew, 2011, 2013).

RC – identifying crucial resources

The specialities of RC

RC includes aspects of life that are at risk of being overlooked in the person’s (and also their network’s) frame of mind. RC also has the potential to add more perspectives—personal, social, relational, and material—when exploring how recovery-supporting initiatives can be formed. Moreover, RC may help to spot both available resources and what resources are lacking in a person’s life, including considerations of whether they can be remedied or not.

What RC may offer the PTMF and OD

RC can be considered an instrument to widen the person’s perceptions of their living conditions by pointing out different forms of capital and resources lacking in the actual situation. RC helps in the search for resources that can be brought to their disposal. OD gives attention (only) to what those concerned, the user and their network, brings forth. RC may enrich the helping effort by suggesting resources that are vital to create conditions for a better life. RC may supplement the PTMF by directing attention to a specific range of power resources, which can be used both to explore power resources present in a person’s life and which may be lacking.

What OD and the PTMF may offer back to RC

OD may supplement RC, as RC does not explicitly address the importance of the context in which the review of resources/capital is conducted and thus risks being limited by the user’s narrative of their situation and missing the hidden resources of the social network. The context created by OD might function as a forum for awareness and discussions about RC.

The PTMF is another component to insert the presence/absence of different forms of capital in the person’s narrative construction. Thinking in terms of capitals could be the basis to develop a counterpower against the initial oppressive power’s threats the PMTF addresses, not only in the form of a narrative but also in gathering concrete resources together with new allies and acting in real life. Ideological power does not seem to be explicitly addressed in RC, and it is something the PTMF can potentially offer. For example, people can be encouraged not just to secure more material resources etc but to consider dropping their imposed diagnostic identities, on the basis of new knowledge about alternatives.

OD can supplement RC because the mapping of a person’s capitals can easily be transformed into filling out a fixed questionnaire imposed by various authorities. Through OD, the person’s network is included in the construction of a common available capital and the formulation of possible additions to this capital.

Through dialogical practices that promote shared understanding and mutual respect, OD facilitates the restoration of agency, identity, and belonging—key dimensions of personal and social RC (Borchers et al., 2014; Tew, 2011). The PTMF also complements RC by the way it frames psychological distress as a response to power imbalances and threats (Johnstone & Boyle, 2025; Read & Harper, 2022). By creating space for alternative narratives and redistributing power within therapeutic encounters, OD supports the core aims of both RC and the PTMF, enabling more socially just, empowering, and contextually grounded responses to distress.

OD – help from within the social reality of those concerned

The specialities of OD

In OD, the professionals leave their home ground and move to the user’s world and there meet them with their social network in a meeting where nothing is given from the start and no decisions are made without the participation of the user and those invited. This has significant consequences for the stories, understandings, and interventions that can emerge.

Access to time plays an important role here—as professionals in OD put their time at disposal in a more flexible way, both the time of each meeting and how the meeting can be repeated at short intervals if necessary. Also, the ambition is that meetings can be arranged as frequent as those concerned wants to. When meeting in people’s homes, the place provides space for various social interactions, emotions, and stories, as it is not associated with a clinical/therapeutic setting and rationality.

What OD can offer the PTMF and RC

The PTMF and RC do not directly address the situation and context in which the encounter between a professional helper and the person concerned (and persons from social network) occurs and how this dialogue can be facilitated in the best possible way. A key aspect of OD is recognizing the potential in how the dialogue of the meeting directly affects those present. OD has a strong focus on bodily aspects, more precisely how the space for responsiveness and aliveness of those present can have healing effects. These aspects are not explicitly addressed in the PTMF and RC. In OD, resources may also be mobilized there and then in the network meeting as the voices and initiatives of everyone present is asked for. These mobilized resources and the persons willing to act for the better of those affected by the difficult situation continue their work after the meeting.

In the OD approach, because important persons in the social network are present, operates directly in the social reality of those concerned (Brottveit, 2013). The relations, solutions, and new arrangements in everyday life can be altered in the meeting. This is a change or rearrangement that directly affects the person’s situation and daily life. When, for example, a person from the school they attend, the workplace, or welfare services is present, decisions and agreements can be made in the meetings. Also, relations can be restored, and dialogues can emerge between those present from the social network right there in the meetings. This also means that OD expands the scope of action and opens up for unexpected solutions.

“Mobilizing resources and effecting change in OD is not dependent on first making a narrative for understanding (and then act according to that new narrative). In our reading of PTMF we see an important and recurring attention to narratives. PTMF, through for example the key questions (see above), offers a framework that may be of help to understanding both the power one have been exposed to, the emotional stress and the threat responses in new ways, through the formulation of new narratives. However, such an attention to narratives is not the primary focus in OD, which emphasize the direct change of relations and space for vitality together with others in dialogue and their social network also outside the meeting. This should work well together with other aspects of the PTMF, that are not so focused on narratives.

In fact, Harper (2022), coauthor of the PTMF, points out that the narrative perspective in PTMF must not become too dominant in its use. He specifically cautions against the assumption that everyone must experience life narratively to have a well-lived life (p. 71). Furthermore, Read and Harper (2022) show how PTMF points to the social realities and real adversities (social, economic, and material) as the cause of the distress and difficulties that people develop. This clarifies that the intention of the PTMF is not to create narratives understood as linguistic constructions detached from reality, but rather to maintain an awareness of real conditions of power inequality that are stressful and threatening (Harper, 2022; Pilgrim, 2022).

What the PTMF and RC can offer back to OD

However, OD may not have the structure for identifying the various forms of capital present or lacking among the participants, and outside them, and thus go beyond the participants’ own lifeworlds and their cultural limitations. Both RC and the PTMF may be of help here, with the sociomaterial understanding of both how the difficulties have emerged and how recovery can be achieved.

It may follow from PTMF and RC that the norm in OD to follow the words and voices of those present in the network meeting, and not introduce issues from outside the context, is problematic. The PTMF imply that new perspectives and in particular questions of power should be addressed (by the professionals, by peers, by texts or other sources). In line with PTMF the literature on OD suggests that e.g. psychosis can be viewed as a response to adversities, stress, violation (exposition to negative power) (Seikkula, 2019). However, what OD infer from this is that those concerned should be given the opportunity to find their own words for difficult experiences, in and through the dialogue offered, and that it is important that professionals refrain from giving certain interpretations or certain theories about the nature of their problems. Importantly, OD perhaps has its quality in how a space is created where the person concerned can be brought into dialogues and relations with other persons important in their lives and in this way bring about change. This change is of another order than new understandings. It “works” through offering a space for new expressivity and vitality (Bøe et al., 2015). Both in PTMF and OD, as we see it, it’s the change in relations, dialogues, social reality that matters, not the new understanding or theory about the difficulties. Change doesn’t have to go via new understanding.

A continued dialogue between OD, RC and PTMF, including experiences in practice, related to these questions could show possible new steps to be taken. A possibility to be explored could be to introduce ideas from the PTMF into the dialogue via the reflection sequence between the professionals that are part of the network meeting in OD.

Conclusion: a kind of trialogue practice

This paper was inspired by our hope and enthusiasm after some days in Kristiansand, Norway, with Lucy Johnstone presenting PTMF, Jerry Tew presenting RC, and Jaakko Seikkula, although absent but supposed to present OD. We suggest that these three approaches are examples of promising social approaches to mental health difficulties. The idea pursued in this paper is that bringing these three approaches into dialogue might give something more than each approach can offer on its own. The way they enrich each other can be articulated in a kind of processual manner and in accordance with how mental health difficulties may develop in the person’s life: The PTMF address how the difficulties origins in relational, social, and societal power imbalances and in epistemic injustices. RC address the resources needed for change, and OD offers a way of “putting this into life” with those concerned.

Further steps could be to develop practices that combine these approaches in mental health services. OD could be a practice that incorporates the knowledge and insights from both RC and the PTMF, and such practice development should be accompanied by research and evaluations. However, our point is not that these three approaches are the only socially oriented approaches. Various practices are invited to contribute to practices that take into account social contexts, the question of power and resources, and the profound dialogical way of collaborating with those concerned.

Each approach we have mentioned in this article can be seen as a way to fulfill some of the expectations and hopes behind the deinstitutionalization process of psychiatry’s practices and knowledges, involving both professionals and persons with mental health problems and their network. Combined, they could gain a greater power and constitute the basis for both improved practices and to influence the future of the psy-field.

Acknowledgment

We want to thank Pär Engholm for most valuable feedback on an early draft of the paper