Evidence-Based Psychotherapy Shared Decision-Making Toolkit for Mental Health Providers
The evidence-based psychotherapy shared decision-making toolkit is a free clinical resource for mental health providers. It gives clinicians a structured process for guiding patients through informed treatment choice before evidence-based psychotherapy begins.
The toolkit centers on a pre-treatment shared decision-making session designed to improve treatment readiness, strengthen patient engagement, and support better outcomes across mental health settings.
This resource is freely available as a downloadable PDF. Providers can implement the framework immediately in individual practice or adapt it for use across clinical programs.
What Is the Evidence-Based Psychotherapy Shared Decision-Making Toolkit?
The toolkit was developed by Bradley E. Karlin, PhD, ABPP, and Amy Wenzel, PhD, ABPP, in collaboration with the Veterans Affairs Mental Illness Research, Education, and Clinical Center (VA/MIRECC). It gives mental health clinicians practical materials for implementing shared decision-making before and during evidence-based psychotherapy.
The resource includes a structured SDM session process, clinical dialogue examples, patient-facing decision aids, provider guidance, and implementation tools for clinical settings.
The central focus is the pre-treatment SDM session. This session helps patients understand what evidence-based psychotherapies are available, how each approach works, and which option fits their goals, values, and circumstances best.
The toolkit promotes both initial engagement in treatment and ongoing participation as therapy progresses. According to the VA/MIRECC provider toolkit page, the resource was designed specifically to support Veterans' engagement in evidence-based psychotherapies, though its principles apply broadly across mental health settings.
Who This Toolkit Is Designed For
The toolkit is intended for mental health providers who deliver evidence-based psychotherapies in clinical settings. Psychologists, clinical social workers, licensed counselors, psychiatrists, and therapists who work with patients across a range of mental health concerns will find practical, ready-to-use materials throughout.
Program administrators and clinical supervisors can use the toolkit to establish a replicable framework across clinical programs. It offers a standardized approach to how providers introduce and discuss evidence-based treatment options with new patients. Graduate-level trainees and early-career clinicians learning to deliver evidence-based psychotherapy can use it to build confidence in clinical conversations about treatment options and patient preferences.
Although the resource was originally developed with a focus on Veterans receiving care through the VA system, the underlying principles of informed choice, patient-centered care, and treatment readiness apply to outpatient community mental health settings and private practice.
What the Toolkit Helps Mental Health Providers Do
The toolkit equips providers with a structured approach to several interconnected clinical tasks.
Providers learn how to explain evidence-based psychotherapy options clearly without overwhelming patients. They gain tools for exploring a patient's readiness to engage in structured treatment before the first therapy session begins. The included decision aids help patients compare treatment approaches and identify which fits their needs and circumstances.
The toolkit also helps providers address common barriers to treatment engagement. These include skepticism about structured psychotherapy, concerns about time commitment, and uncertainty about what evidence-based treatment involves. By addressing these concerns before therapy begins, clinicians can improve the likelihood that patients commit to treatment and remain engaged when sessions become challenging.
For providers working under time constraints, the toolkit offers concise guidance that can be implemented efficiently without requiring extended pre-treatment consultations.
The Six Components of the SDM Session
The core of the toolkit is a structured SDM session built around six components. Together, these steps create a patient-centered clinical dialogue that moves from establishing trust through collaborative treatment selection.
Connect
The first step focuses on establishing rapport and an initial working relationship. Providers open the conversation in a collaborative tone rather than a didactic one. The goal is to help patients feel heard and to create a context in which honest discussion about treatment options is possible. This initial connection strengthens the therapeutic alliance before any formal treatment begins.
Motivate
This step involves exploring the patient's readiness for change and their reasons for seeking help. Providers use open-ended questions to understand what matters to the patient, what prior treatment experiences have felt helpful or unhelpful, and what concerns the patient has about entering structured therapy.
This step draws on motivational principles to surface the patient's own reasons for engagement rather than relying on external persuasion.
Educate
Providers give patients a clear and accessible explanation of evidence-based psychotherapies. This is not a lecture. It is a collaborative exchange in which patients are introduced to the rationale, format, and expectations of treatment options. Plain language is essential.
Patients who understand what a treatment involves are better positioned to make a genuinely informed choice and to engage meaningfully when treatment begins.
Explore
This step centers on the patient's preferences, concerns, and perceived fit with specific treatment options. Providers use decision aids and open dialogue to help patients consider how each approach matches their circumstances, values, and goals. The Explore step is where the patient voice plays the largest role in treatment planning.
Providers listen carefully and reflect what they hear to ensure the patient feels understood.
Set Goals
Providers and patients work together to identify treatment goals rooted in the patient's own priorities. This step translates patient values into specific, meaningful objectives that will guide the course of therapy.
Goal-setting at this stage strengthens alignment between the patient's expectations and the structure of evidence-based treatment, reducing the risk of dropout when early sessions feel unfamiliar or demanding.
Choose
The final step supports a fully informed treatment selection. The patient, guided by the provider, chooses a treatment path based on their goals, preferences, and the clinical options discussed.
This informed choice increases the likelihood that the patient enters therapy with realistic expectations and a genuine commitment to the process.
Why Shared Decision-Making Matters in Evidence-Based Psychotherapy
Shared decision-making is a collaborative process in which patients and clinicians make care decisions together. The Agency for Healthcare Research and Quality defines SDM as a process that draws on clinical evidence, provider expertise, and the patient's own values, goals, preferences, and circumstances. It is a foundation of patient-centered care and a standard of practice in high-quality clinical settings.
In psychotherapy, treatment engagement is one of the strongest predictors of outcome. Patients who understand their treatment options and feel a genuine sense of choice in selecting one are more likely to attend sessions consistently, complete between-session assignments, and remain engaged when therapy becomes difficult.
The pre-treatment SDM session directly addresses this by creating the conditions for informed, motivated participation before the first session begins.
For patients who are ambivalent about structured treatment, shared decision-making provides a framework for addressing that ambivalence openly.
Rather than moving a hesitant patient quickly into therapy, providers can use the SDM session to explore concerns, clarify what evidence-based psychotherapy actually involves, and strengthen the patient's readiness to begin.
What the Research Says About SDM in Mental Health
The evidence base for shared decision-making in mental health is continuing to develop. A Cochrane review examining SDM interventions for people with mental health conditions found that patients receiving SDM approaches showed some improvements in their experience of being involved in decision-making and in satisfaction with information received.
Evidence for direct changes in clinical outcomes, such as reductions in depression, anxiety, or hospitalization rates, remains less certain and is an area of active investigation.
These findings reflect the complexity of studying SDM in real-world mental health settings rather than a weakness in the approach itself. What research consistently supports is that patients value being included in decisions about their care, and that meaningful involvement in treatment planning contributes to a stronger therapeutic alliance.
The therapeutic alliance is itself a well-established predictor of psychotherapy outcomes across treatment modalities.
Providers using this toolkit can implement shared decision-making as a clinically sound, ethically grounded practice. Treating patients as informed participants in their own care is consistent with contemporary standards in mental health, regardless of where the outcome literature continues to develop.
How This Toolkit Connects to Evidence-Based CBT Practice
This toolkit reflects a commitment to bringing research-based frameworks into everyday clinical work. The shared decision-making session process is consistent with core principles in cognitive behavioral therapy: structured collaboration, transparent rationale-sharing, goal-directed treatment, and active patient involvement.
Providers who integrate this toolkit with resources on cognitive behavioral therapy techniques and strategies will find a coherent clinical framework that connects pre-treatment engagement with in-session CBT delivery. The handbook of cognitive behavioral therapy offers comprehensive coverage of CBT protocols across populations, including the evidence-based approaches patients may choose through the SDM process.
For providers focused specifically on the decision-making dimension of clinical practice, strategic decision-making in cognitive behavioral therapy provides a deeper framework for navigating complex clinical choices within evidence-based care. Those newer to CBT delivery will find Cognitive Behavioral Therapy for Beginners a practical starting point for building competence in the modalities patients may select.
A full list of peer-reviewed publications, book chapters, and scholarly contributions is available on Dr. Wenzel's publications page.
Download the Free Toolkit
The evidence-based psychotherapy shared decision-making toolkit is available as a free PDF download. It includes the full SDM session process, clinical dialogue examples, patient-facing materials, and implementation guidance for outpatient and clinical program settings.
Providers can download the toolkit using the link below and adapt the session framework to their clinical context.
Download the free toolkit PDF.
If you have questions about implementation, training applications, or speaking and consultation, contact Dr. Amy Wenzel directly.
Related Books and Resources by Dr. Amy Wenzel
Dr. Amy Wenzel's catalog spans cognitive behavioral therapy, perinatal distress, suicide prevention, therapeutic relationships, and clinical training. The following resources are directly relevant to providers using the shared decision-making toolkit.
Strategic Decision Making in Cognitive Behavioral Therapy: A framework for navigating clinical decision-making within CBT. Particularly useful for providers working with complex cases where treatment selection and progression require careful judgment.
Cognitive Behavioral Therapy Techniques and Strategies: A practical resource for providers delivering CBT. Covers a broad range of techniques applicable across the treatment approaches patients may choose through the SDM session.
Handbook of Cognitive Behavioral Therapy: A comprehensive reference covering CBT across clinical presentations and populations. Useful for providers who want thorough coverage of the EBPs discussed in SDM conversations.
Cognitive Behavioral Therapy for Beginners: An accessible entry point for trainees and early-career clinicians building competence in evidence-based psychotherapy delivery.
Innovations in Cognitive Behavioral Therapy covers advanced and innovative applications of CBT for providers who want to expand their repertoire beyond standard protocols.
Therapeutic Relationship-Focused CBT Dr. Wenzel's newest contribution addresses the integration of therapeutic relationship principles with evidence-based CBT practice. Directly relevant to providers working on patient engagement and alliance.
