The open dialogue approach, what are we actually doing? A systematic review of adherence

The open dialogue approach is a systemic, therapeutic intervention that aims to support individuals who experience severe and enduring mental health difficulties. Striving to encourage a rehabilitation-oriented approach, open dialogue (OD) has faced several adaptations according to different contexts and countries. This review sought to understand adherence and implementation practices of OD and specifically how they are reported within the OD intervention research literature.

A systematic strategy was used to search five electronic databases (CINAHL, APA PsycInfo, The Cochrane Library, PsycArticles, PubMed) using title/abstract and full text terms. Data were extracted using an extraction template developed for the purpose of this review that incorporated a recently developed OD adherence protocol (Lotmore et al., 2023). A methodological quality appraisal was employed. Narrative synthesis and content analysis were used to analyze the findings.

Of the 1813 studies initially identified from the search string, 28 studies were included based on the inclusion and exclusion criteria. These composed of qualitative (n = 12), quantitative (n = 14), and mixed methods (n = 2) designs. The quality of the methods used in included studies overall was high. A descriptive analysis suggested generally good, though often implicit, adherence to principles of OD (64%). A narrative synthesis revealed five underpinning themes which affected adherence.

Adherence to principles of OD was only of good quality. Assessment and reporting of adherence to OD's principles in research is encouraged to align with rehabilitative practices in mental health services. To support greater adherence to OD, researchers are encouraged to use the OD adherence protocol in reporting their work. (PsycInfo Database Record (c) 2026 APA, all rights reserved).