Practices of personalized treatment selection among German psychotherapists: A preregistered mixed methods study

Objective: Despite growing interest in personalized psychotherapy research, little is known about therapists' current practice of personalizing psychotherapy. This study aimed to examine the extent to which psychotherapists engage in personalized treatment selection (PTS), i.e., recommending the presumably best-fitting treatment package to a patient, as one way of personalizing psychotherapy. Method: This is a pre-registered study using open- and closed-ended questions in an online survey among German psychotherapists (N = 557 started, N = 392 (70.4%) completed). We applied logistic regression analyses to investigate predictors of PTS and qualitative analyses to investigate therapists' subjective reasoning for and against PTS. Results: 78.7% (N = 437) of the therapists stated that they had practiced PTS in the past. Therapists trained in psychodynamic approaches were more likely to engage in PTS than cognitive-behavioral therapists. Therapists named a variety of patient characteristics that can lead to the recommendation of specific treatment approaches, most notably diagnostic factors and patient preferences. Therapists not engaging in PTS most often referred to the effectiveness of their own approach as explanation. Conclusion: The majority of psychotherapists provide personalized treatment recommendations to their patients. In light of our findings, we discuss challenges for the implementation of data-driven clinical support tools for PTS.