Clinician Experiences of Identity Change When Implementing or Training in Open Dialogue: A Systematic Review and Meta-Ethnography

Abstract

Open Dialogue (OD) is a network therapy approach to treating mental health crises that demands substantial shifts in clinicians’ therapeutic stance, interprofessional interactions, and service structure. Implementation initiatives have encountered challenges, often seemingly related to clinician identity change. This systematic review and meta-ethnography explored the following questions: (a) How do clinicians implementing or training in OD experience identity change? (b) Is the Social Identity Model of Identity Change (SIMIC) a suitable model for understanding these experiences, or is another or new framework more suitable? The study protocol was published on PROSPERO: CRD42024477679. Nine databases were systematically searched for qualitative studies pertaining to clinician experiences of identity change during OD training or implementation. Eligible studies were critically appraised, with qualitative data synthesized using meta-ethnography methodology. Four overarching themes were derived, characterizing “Personal identity”, “(Inter)professional Identity”, “Intragroup” and “Intergroup” identity change processes. A line of argument synthesis was conducted, and a model of identity change during OD training and implementation was derived. Through OD, clinicians could connect with personal identities and values, and gain new professional identities, whilst simultaneously embracing a shared OD group identity. Identity change posed challenges, particularly when OD felt incompatible with—and threatening to—preexisting professional identities and hierarchies, and when intergroup polarization generated tensions within services that undermined delivery. SIMIC’s identity gain, loss and compatibility pathways provided a parsimonious, although incomplete, conceptualization of these processes. Polyphony (the interaction of multiple voices) provided a conceptual framework within which multiple identities could be held, at the individual and group level, without requiring full integration. OD implementation initiatives, and service development initiatives more generally, should attend carefully to the identity change processes identified in this meta-ethnography. When nurtured carefully, identity change processes can amplify clinician investment and enhance service delivery.