Conference Agenda

Long‑term narrative and dialogical therapies are fundamentally mismatched with classical randomized controlled trials (RCTs). Healing is multi‑component and contextual, including narrative groups, dialogical meetings, community and family involvement, shifts in staff culture, and attention to spirituality and Indigenous or local meanings, all of which occur together. Trying to isolate a single manualized “active ingredient” for an RCT, in their view, distorts what actually helps people. Work that is genuinely dialogical and evolving in response to participant feedback clashes with fixed protocols and tight fidelity demands. Ethically, it is questionable to randomize people in severe distress (psychosis, suicidality, chronic coercive care histories) away from a recovery‑oriented milieu to a fixed and rigid protocol. Outcomes like identity change, agency, and community participation are poorly captured by symptom‑only scales. Instead of classic RCTs, we favor mixed‑methods and naturalistic designs: pre–post quantitative measures, comparison with treatment‑as‑usual, intensive case series, and phenomenological descriptions of change. On locked inpatient units, they reported that adding a daily narrative group produced significantly greater improvement on measures such as BASIS‑32 than comparison units, with changes they interpret as clinically meaningful. In longer‑term dialogical and largely non‑pharmacological work with psychosis, we describe reductions in hospitalization and crises, diminished suicidality, and return to education, work, and relational roles—“recovery of function in the ordinary world”—even when some symptoms persist. There is a modest but growing body of literature showing that narrative‑based psychotherapies produce statistically significant improvements in symptoms and functioning, sometimes comparable to or superior to conventional CBT, though studies are usually small and methodologically limited. Narrative/dialogical approaches have enough empirical and experiential support to be considered reasonable alternatives or adjuncts to standard care, and future research must find creative designs that preserve the relational, cultural, and community context rather than stripping it away for the sake of methodological purity.