Shared decision-making in ongoing psychotherapy: Negotiating frames, preferences and meaning

Objective: Shared decision-making (SDM) is pivotal in healthcare to enhance patient involvement in treatment decision-making. In mental health, SDM is increasingly also recognized as a key approach for tailoring psychotherapy to patients’ individual needs. Although research on SDM in mental health care has documented the impact of SDM on patient involvement and activation, little is known about the implications of SDM in psychotherapy. Method: To investigate how SDM is enacted in the therapeutic encounter, this study draws on audio-recordings of ten SDM dialogues in psychotherapy. Patients in the age-range of 18–55 years participated in group-based Cognitive Behavioral Therapy (CBT) for depression, and took part in individual SDM sessions, during which the therapist and patient collaboratively decided on the content of individualized add-on sessions. We analyzed data through a structured qualitative approach. Results: We identified three forms of negotiations that shaped SDM in the therapeutic encounter: (1) negotiating frames; (2) negotiating preferences; and (3) negotiating meaning. Conclusion: The findings show that SDM is not straightforwardly enacted in the therapeutic dialogue. Rather, it is a complex endeavor due to the ongoing interactional process of psychotherapy.