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The psychotherapy dose-response effect and its implications for treatment delivery services.
Abstract
To date, few studies have been published on the doseresponse relationship, but there is general consensus that between 13 and 18 sessions of therapy are required for 50% of patients to improve. Reviewing the clinical trials literature reveals that in carefully controlled and implemented treatments, between 57.6% and 67.2% of patients improve within an average of 12.7 sessions. Using naturalistic data, however, revealed that the average number of sessions received in a national database of over 6,000 patients was less than five. The rate of improvement in this sample was only about 20%. These results suggest that patients, on average, do not get adequate exposure to psychotherapy, nor do they recover from illness at rates observed in clinical trials research.
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“studies consistently show that between 3 and 10% of psychotherapy clients get worse (Crawford et al. 2016; Hansen et al. 2002; Lambert 2013; Mohr 1995; Strupp et al. 1977).”
From Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples (2021) · cites this paper as Hansen et al. 2002
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ResultInfluentialMøllersen, S., Sexton, H. C., & Holte, A. (2008) · Nordic Journal of Psychiatry · doi:10.1080/08039480802576043 · Cited by 23
“Treatments of moderate duration are known to predict clinical improvement in outpatient settings (21), and we found that the client therapist ethnic matching appeared to impact outcome among these.”
BackgroundTarescavage, A. M., Finn, J. A., Marek, R. J., Ben-Porath, Y. S., & van Dulmen, M. H. M. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.018 · Cited by 21
“Wierzbicki and Pekarik (1993) conducted a seminal meta-analysis of 147 studies and found that average premature termination rates ranged from 36 to 48%, depending on how premature termination was operationalized.”
BackgroundHistorical Paths in Psychotherapy Research
Braakmann, D. (2015) · Springer eBooks · doi:10.1007/978-3-7091-1382-0_3 · Cited by 21
Riecke, J., Holzapfel, S., Rief, W., & Glombiewski, J. A. (2013) · Trials · doi:10.1186/1745-6215-14-203 · Cited by 22
“Hansen and colleagues showed that between 13 and 18 sessions of therapy in general are required for 50% of patients to improve [21].”
BackgroundGibbons, M. B. C., Gallop, R., Thompson, D., Gaines, A. N., Rieger, A., & Crits-Christoph, P. F. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000414 · Cited by 22
Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie
Gallas, C., Kächele, H. U., Kraft, S., Kordy, H., & Puschner, B. (2008) · Psychotherapeut · doi:10.1007/s00278-008-0641-7 · Cited by 22
Halvorsen, M. S., & Monsen, J. T. (2007) · Psychotherapy Research · doi:10.1080/10503300600608363 · Cited by 21
“According to Hansen, Lambert, and Forman (2002), the average number of sessions in clinical trial studies ranges from 12 to 16.”
BackgroundClore, J. L., & Gaynor, S. T. (2006) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100786 · Cited by 23
“Moreover, in a large national sample of clients seeking psychological services, the median number of sessions attended was less than five (Hansen et al., 2002).”
BackgroundMałus, A., Konarzewska, B., & Galińska-Skok, B. (2018) · Archives of Psychiatry and Psychotherapy · doi:10.12740/app/93739 · Cited by 21
Early trajectory features and the course of psychotherapy
Koffmann, A. (2018) · Psychotherapy Research · doi:10.1080/10503307.2018.1506950 · Cited by 21
“This CSI rate is lower than the 58% rate in Hansen et al. (2002), but it compares favorably with the 31% rate reported by Callahan et al. (2014) in a consortium of American psychology training clinics.”
BackgroundResultTrajectories of depression in psychotherapy: How client characteristics predict clinical improvement
Lin, T., & Farber, B. A. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23119 · Cited by 22
Dolsen, E. A., Dong, L., & Harvey, A. G. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1978295 · Cited by 23
“A review of RCTs suggests that an average of 12.7 sessions may be needed for at least half of patients to demonstrate improvement (Hansen et al., 2002).”
BackgroundInfluentialSolbakken, O. A., & Abbass, A. A. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.04.003 · Cited by 27
“For example, Hansen et al. (2002) found that as many as 65% of patients in a large scale naturalistic study of routinely delivered outpatient treatment Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective…”
Mistler, L. A., Sheidow, A. J., & Davis, M. (2015) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2015.09.007 · Cited by 21
Solbakken, O. A., & Abbass, A. A. (2016) · Acta Neuropsychiatrica · doi:10.1017/neu.2016.5 · Cited by 21
“(3) found symptom recovery rates of only 14.”
BackgroundØstergård, O. K., Fenger, M., & Hougaard, E. (2017) · Counselling Psychology Quarterly · doi:10.1080/09515070.2017.1410696 · Cited by 21
“Two of the eight naturalistic student counseling studies also reported the number of clinically significant changed clients in accordance with Jacobson and Truax’s (1991) criteria.”
BackgroundInfluentialTherapeutic Mechanisms of Suicidal Ideation
Coleman, D. K., & Casey, J. T. (2007) · Crisis · doi:10.1027/0227-5910.28.4.198 · Cited by 21
Mobile Phone–Based Mood Ratings Prospectively Predict Psychotherapy Attendance
Bruehlman-Senecal, E., Aguilera, A., & Schueller, S. M. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.01.002 · Cited by 20
Beyond the Lab: Empirically Supported Treatments in the Real World
Schneider, R. A., Grasso, J. R., Chen, S. Y., Chen, C., Reilly, E. D., & Kocher, B. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01969 · Cited by 20
Metadata
- Authors
- Hansen, N. B., Lambert, M. J., & Forman, E. M.
- Affiliations
- Yale University (US)
- Brigham Young University (US)
- Drexel University (US)
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2002
- Volume
- 9
- Issue
- 3
- Pages
- 329-343
- ISSN
- 0969-5893 (ISSN-L)
- 1468-2850
- OpenAlex
- W2114544903
- Semantic Scholar
- 1968734f94d02eb6e4d193bdfdd42f5931ab250d
- Cited by
- 783
- References
- 102
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 25 · 2023: 28 · 2022: 34 · 2021: 45 · 2020: 54 · 2019: 43 · 2018: 72 · 2017: 41 · 2016: 35 · 2015: 45 · 2014: 50 · 2013: 47 · 2012: 45
- FWCI
- 15.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Science and Practice (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- number of treatment sessions, treatment outcomes, naturalistic data, psychotherapy utilization
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