# “Who blends in and why (not)?” A qualitative study on psychotherapists' patient inclusion in blended care

## TL;DR

This study explores how psychotherapists decide which patients to include in blended care, finding that patient motivation and a stable therapeutic relationship are key factors.

## Contribution

The study provides new qualitative insights into psychotherapists' decision-making criteria for blended care patient inclusion.

## Key findings

- Psychotherapists use few fixed criteria when deciding to introduce blended care to patients.
- Patient motivation and internet literacy are seen as essential prerequisites for blended care.
- Establishing a stable therapeutic relationship is viewed as facilitating blended care implementation.

## Abstract

Psychotherapists may act as bottlenecks in the integration of digital interventions into psychotherapy, known as blended care (BC). In the literature, various factors are discussed as potential inclusion, exclusion, or limiting criteria in BC.

Our aim for this interview study was to gain a deeper understanding of the factors psychotherapists consider when inviting patients to participate in BC. For this purpose, we interviewed seven psychotherapists with a psychodynamic and seven psychotherapists with a cognitive behavioral background who participated in a naturalistic trial on BC in routine outpatient psychotherapy.

Psychotherapists considered few fixed inclusion or exclusion criteria when considering which patients to introduce BC to. The basic technical requirements had to be met and the patients had to be “fit for outpatient therapy”. Psychotherapists found patients' response to BC, like their motivation, to be a decisive factor when considering BC.

Psychotherapists emphasized patient motivation for BC as a potential bottleneck in its implementation. Therefore, a successful implementation strategy should focus on strengthening both psychotherapists' and patients' motivation to engage with BC. The openness of psychotherapists towards patient characteristics suggests that BC in outpatient care may target a broad patient population.

•Few differences were found between psychodynamic and CBT psychotherapists in their decision making in introducing blended care•Psychotherapists apply very few hard inclusion or exclusion criteria when introducing blended care•Patient motivation, a safe work environment and internet literacy were seen as prerequisites by psychotherapists for introducing blended clare•Patient who are fit for outpatient therapy were generally seen as being fit for blended care by psychotherapists•Psychotherapists noted that establishing a stable therapeutic relationship could facilitate the introduction of blended care

Few differences were found between psychodynamic and CBT psychotherapists in their decision making in introducing blended care

Psychotherapists apply very few hard inclusion or exclusion criteria when introducing blended care

Patient motivation, a safe work environment and internet literacy were seen as prerequisites by psychotherapists for introducing blended clare

Patient who are fit for outpatient therapy were generally seen as being fit for blended care by psychotherapists

Psychotherapists noted that establishing a stable therapeutic relationship could facilitate the introduction of blended care