4 - (OP23) Participation for All: A Framework for Shared Decision-making in Psychotherapy

Aim: The presentation aims to raise awareness towards the importance of Shared Decision Maiking in the realm of Psychotherapy. The development and empirical evaluation of a systematic framework will be illustrated.

Background: Psychotherapy is inherently interactive, yet the otherwise well-defined concept of Shared Decision-Making (SDM) is rarely mentioned in this field. First, we propose a comprehensive framework for relevant decisions in the course of outpatient psychotherapy. Second, we demonstrate the usefulness of the framework and examine which decisions are deemed accessible to SDM in a survey with therapists.

Methods: The comprehensive decision-making framework was developed in successive iterations: Potential decision categories and themes were identified and then evaluated through consultations with an expert panel of therapists. In addition, literature and relevant research on therapeutic decision-making were reviewed to identify specific decision-making steps. Next, a two-round Delphi panel with certified therapists was conducted to integrate practical insights. Finally, an online survey was conducted with experienced therapists (N = 63) to validate the framework. Participants rated the relevance and frequency of decisions. They also evaluated whether the decisions are accessible to SDM and if tools are needed to implement SDM effectively.

Results: The Mannheim Decision Model for Psychotherapy encompasses the full spectrum of decisions in outpatient psychotherapy and is agnostic to therapeutic approaches, including those for child and adolescent psychotherapy. The empirical pilot assessment proved the relevance and frequency of its components in the therapeutic process and demonstrated the framework's usability for SDM research. The results indicated that not all steps have the same implications. Key decisions in the framework, such as Treatment Type, Setting, Therapist, and Treatment Goals, were rated as particularly well-suited for SDM. While no decision section was rated as the sole responsibility of the patient, diagnostic decisions were generally seen as therapist-led. Notably, most therapists reported that they do not require systematic support to implement SDM in clinical practice.

Conclusion: Although psychotherapy is a complex interactive process, it is possible to identify a specified set of decisions that are made in the course of treatment. The Mannheim Decision Model for Psychotherapy offers a structure for future research on SDM in psychotherapy. For example, it helps to identify which decisions are suitable for SDM according to therapists. Assessing patients’ perspectives will be an essential next step. Furthermore, the proposed framework can serve as a template for decision-making aids in clinical practice.

Keywords: Shared Decision-Making, Outpatient Psychotherapy, Participation, Collaboration, Decision-Making Framework, Clinical Implementation