The difference that makes the difference: a conceptual analysis of the open dialogue approach

In this paper we focus on the Open Dialogue (OD) approach to acute psychosis with the aim of better understanding and clarifying the principles underlying its efficacy. To do this, we do a conceptual analysis of the OD literature. We introduce the basic principles of the OD approach and focus on the dialogical process, which stands out as a core healing factor of this practice. In particular, we shed light on one element that yields and sustains dialogue: the dialogical therapeutic stance. We systematise and disentangle different descriptions of the dialogical therapeutic stance and derive some of its essential properties. Based on this, we finally propose a clear-cut definition of the dialogical therapeutic stance as comprising two necessary and constitutive aspects: openness and authenticity. We believe that this conceptualisation might usefully inform the OD practice and theory, and eventually contribute to advance research on the treatment of schizophrenia.