Narrative Therapy vs Open Dialogue
A side-by-side comparison of recorded mechanisms, evidence review status, related condition topics, and philosophical roots.
At a glance
Source checks, condition-specific assessments and expert review are separate steps. Each assessment applies only to its stated population and use. Topic links do not establish comparative effectiveness.
Narrative Therapy
- Tradition
- Postmodern
- Founder
- Michael White / David Epston (1990)
- Review status
- Assessment not yet completed
- Focus
- Narrative + Relational
- Format
- Indiv + Family + Community
- Duration
- Short-medium
Open Dialogue
- Tradition
- Postmodern
- Founder
- Jaakko Seikkula (1995)
- Review status
- 1 condition assessment available
- Focus
- Dialogical + Network
- Format
- Network (family + social)
- Duration
- Variable (crisis-oriented)
Condition-specific assessments
Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.
Psychosis & Schizophrenia Spectrum
Population and scope: First-episode nonaffective psychosis treated in the Western Lapland service model.
Limited evidence
Psychosis-specific evidence checked here is observational: Seikkula 2006 compared historical cohorts with no significant five-year overall outcome difference. The completed 2026 ODDESSI randomized trial involved transdiagnostic crisis presentations and found no primary relapse benefit; its psychosis-specific result was not verified. Its existence corrects the ongoing-trial narrative but must not automatically upgrade psychosis-specific evidence.
Source assessment dated
How they work
Narrative Therapy
Core mechanism: Externalizing problems + re-authoring preferred identity narratives through unique outcomes
Ontology: Dominant cultural narratives constrain identity; problems are social/linguistic constructions, not internal pathology
Open Dialogue
Core mechanism: Rapid mobilization of the person's social network + dialogical conversation where meaning is co-constructed + tolerance of uncertainty rather than premature diagnostic closure → psychotic experience becomes speakable
Ontology: Crisis and psychotic experience emerge in the relational network and can be resolved dialogically without premature medicalization: the network, not the individual brain, is the unit of treatment
Related condition topics
These editorial cross-references organize reading. A shared link does not mean both approaches are effective, recommended, or interchangeable for that condition.
0 shared · 5 Narrative Therapy-only · 2 Open Dialogue-only
Linked only in the Narrative Therapy entry
Linked only in the Open Dialogue entry
What each assumes — and misses
Narrative Therapy
Philosophical roots: Foucault (power/knowledge, subjugated knowledges); Myerhoff (definitional ceremony, re-membering, which is where the outsider-witness practice comes from); Bruner (narrative as mode of knowing); Bateson (ecology of mind; the difference that makes a difference); Vygotsky (scaffolding, in White's later work); Ricoeur (narrative identity); Derrida (deconstruction); social constructionism
Blind spots: Can feel intellectually abstract; political framing may not resonate with all clients; limited controlled research
Therapeutic voice: So depression has been telling you that you're worthless. When has there been a time when you didn't believe depression's story?
Open Dialogue
Philosophical roots: Bakhtin (dialogism, polyphony); Vygotsky (social origins of thought); Wittgenstein (meaning as use in social context); Bateson (systemic epistemology); Anderson & Goolishian (not-knowing position); social constructionism
Blind spots: Non-randomized evidence base, and the one randomized test did not replicate it; extremely resource-intensive; challenges medical model in ways that may delay necessary pharmacological treatment; cultural specificity (Finnish context)
Therapeutic voice: [To reflecting team, in front of the family] I found myself feeling uncertain just now. I wonder if that uncertainty is something the family also feels.
Choosing between them
Narrative Therapy and Open Dialogue both sit within the Postmodern tradition — they share a worldview about what suffering is and how change happens. Differences are more often about technique and emphasis than about underlying theory.
For deeper coverage: see the full Narrative Therapy and Open Dialogue pages, or use the interactive comparison tool to add more modalities to this comparison.