Beyond family involvement: distinguishing open dialogue from guideline-based family interventions in schizophrenia and psychosis care

Abstract

Background Open dialogue is sometimes understood by practitioners as a version of family involvement or family intervention. This assumption is understandable because contemporary schizophrenia guidelines recognise the importance of family, carers and other members of the person’s network. However, family involvement alone does not capture the distinctive structure and practice of open dialogue.Methods This article provides a conceptual and practice-focused comparison of open dialogue and family-oriented recommendations in the American Psychiatric Association (2020), National Institute for Health and Care Excellence (2014), and Australian and New Zealand Journal of Psychiatry (2026) schizophrenia and psychosis guidelines. The comparison focuses on treatment structure, form and purpose of family/network involvement, decision-making, practitioner stance and transparency.Results Guideline-based family involvement and open dialogue share commitments to collaboration, support and participation, but they are not equivalent. In guidelines, family and network involvement is positioned as one component within a broader evidence-based treatment framework. By contrast, in open dialogue, network meetings are the relational and organisational backbone of care, centred on the person, their family and other network members.Discussion The distinction between guideline-based family involvement and open dialogue is consequential because open dialogue goes beyond family inclusion: it is a dialogic network-based model of care with distinct implications for training, implementation and service organisation. Equating open dialogue with family involvement alone may lead practitioners and services to overlook the structural role of network meetings, the dialogic stance and network-based decision-making central to open dialogue practice.