Table 3 Examples of concepts, codes and codes for each theme

Definition of personalizing treatments / Personalizing treatments

Intuition / How to personalize treatments: methods

‘I think some therapists feel that they need to work according to their own insight and standards. And although this pattern seems less than a while ago, some therapists may still need a certain amount of freedom to do so’ … ‘for example: eclectic work, a bit of schema therapy, talking about modi, making a sociogram and talking about the past week’ (participant 15).

Definition of personalizing treatments / Knowledge about colleagues

Combine treatments from the start / Differences in conducting treatments

‘I think that there are colleagues that forget the protocol and combine different techniques to form a protocol. The danger of this strategy is that this may lead to never ending treatments’ (participant 5).

Personalizing treatments

Do you personalize treatments?

‘In patients with comorbid personality problems I will start with CBT, and if that does not work continue with schema therapy, and if there are topics I can use EMDR, I will also start EMDR, but not before discussing it with our team’ (participant 9).

Definition of personalizing treatments / Personalizing treatments

Flexible use within the protocol / Personalizing within CBT

‘There is CBT, and then you personalize: what does this person need first from the protocol?... If somebody already has an active lifestyle, I will spend less time on behavioral activation compared to someone who has no activities’ (participant 6).

How are protocols being used? / Role of the organization

Opinions / Differences between organizations

‘Both ways are not great, doing a lot of different interventions may lead to less focus, but it can be also very difficult to force people into a protocol’ (participant 4).

Knowledge about colleagues

Little knowledge

‘I would like to see that every therapist uses the protocol, but I doubt whether this is the case in day-to-day practice’ (participant 10).

How are protocols being used?

Opinions

‘That is why I like online or blended treatment, it helps you and the patient to really work through the protocol (participant 2) … while also leaving some space for topics that are not directly related to the protocol during the offline sessions’ (participant 14).

How are protocols being used?

Therapist discipline

’A therapist needs discipline to adhere to protocol, because there will always be the temptation to get stuck in a nice and friendly conversation about things that are not related to the primary goal of treatment’ (participant 11).

Solutions for better use of protocols

Experience and knowledge

‘I believe it might be the way of thinking we need to change … If you change your mindset to ‘this intervention is helpful, or more effective’, you will make yourself, or aim to, organize the circumstances that are necessary to adapt the intervention’ (participant 15).

Moderators of personalizing treatment protocols / Personalizing treatments

Patient factors / When to personalize?

‘Some patients need more space, sometimes when I try to closely adhere to the protocol the patient will tell me his motivation is decreasing. In those cases, I had to stop strict adherence to the protocol’ (participant 12).

Reasons to modify protocols

Patient factors

‘For example, patients that experience crisis all the time, or when you just haven’t been able to use the protocol yet’ (participant 4).

What is needed to adhere to treatment protocols?

Reports and evaluation of treatments and clear treatment structure

‘Regular patient evaluations in the team help to structure the treatment for the therapist and the patient, while my colleagues help to focus on the treatment protocol and notice possible distractions from the treatment protocol’ (participant 15).

Role of the organization

A lot of freedom

‘The advantage is that it is easier to do something you think is important, and sometimes that is very useful, at other times it will dilute your approach’ (participant 4).

Solutions for better use of protocols

Role of the manager and team

‘It is important that the manager is motivated and has a clear rationale for what and why we are doing what we do’ (participant 9).

What is missing but necessary for adhering to protocols?

Having the same professional vision

‘What I sometimes miss, is coming together and feeling supported by other colleagues. Having the same vision. This makes our job more difficult’ (participant 4)