Personalization of structured group psychotherapy through add-on interventions: A potential for active engagement

Routine Outcome Monitoring (ROM) in group psychotherapy has shown varied results, as personalizing therapy for multiple patients is challenging. This study explored the impact of ROM and individual Add-On Interventions (AOIs) for patients with depression who were not progressing during Group Cognitive Behavioral Therapy (GCBT). We followed the research question, "How can individual AOIs contribute to patients' therapy courses?".

We interviewed patients and therapists involved in GCBT with ROM and individual AOIs prompted by Not-On-Track alerts. Thematic analysis was used to generate themes related to participants' experiences. Three cases were selected to illustrate the structure of the themes.

The main theme, "AOIs: Potential for active engagement," was constituted by seven subthemes concerning the influence of ROM, therapeutic collaboration, shared decision-making, allowing for person-tailored interventions, and the dynamic between group and individual sessions. The potential for active engagement was nurtured through flexible awareness, as patients shifted between a first-person perspective and an external perspective on their therapy process.

Individual AOIs, prompted by patient feedback, could create opportunities for reflection and engagement. However, the impact was shaped by the therapeutic relationships, the shared decision-making process, and the extent to which the AOIs offered complementary approaches to group psychotherapy.