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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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“(2001, p. 97) While research into the dose–response relationship in the psychosocial treatment context is in its infancy (Hansen, Lambert, and Forman, 2002), it has been repeatedly advocated in the UE literature that an “adequate” dose of outpatient AOD treatment requires a minimum of 3 months…”
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BackgroundAcceptability of a Social Support Intervention for Re-entering Prisoners
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Biswal, B., Gandhi, Y., Singla, D. R., Velleman, R. D. B., Zhou, B., Fernandes, L., Patel, V., Prina, M. A., Sequeira, M., Garg, A., et al. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.94 · Cited by 13
“Given that attendance is necessary for in-person therapy, any intervention that improves session attendance should be critical for therapy outcome (Hansen et al., 2002; Robinson et al., 2020).”
BackgroundSimple methods for enhancing patient outcome in routine care: Measuring, monitoring, and feedback
Lambert, M. J., & Coco, G. L. (2014) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2013.147 · Cited by 11
Self-citationEffectiveness of Psychological Interventions on Young Refugees' Social Adjustment: A Meta-analysis
Forooshani, S. A., Izadikhah, Z., Renzaho, A. M. N., & O'Connor, P. J. (2019) · Journal of Refugee Studies · doi:10.1093/jrs/fez035 · Cited by 11
Maeng, D. D., Cornell, A. E., & Nasra, G. S. (2019) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001678 · Cited by 11
Is duration of psychological treatment for depression related to return into treatment?
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“A concern with brief therapies is that patients might improve but perhaps not fully recover [13].”
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As you like it: adopting a patient‐led approach to psychological treatments
Carey, T. A. (2011) · Journal of Public Mental Health · doi:10.1108/17465721111134510 · Cited by 11
“In terms of attendance, however, Hansen et al. (2002)”
BackgroundEstimating treatment duration for psychotherapy in primary care
Carey, T. A. (2006) · Journal of Public Mental Health · doi:10.1108/17465729200600023 · Cited by 11
Johansson, H. (2008) · Nordic Journal of Psychiatry · doi:10.1080/08039480802571051 · Cited by 11
“However, other studies indicate that this number of treatment sessions may be too few to obtain a better outcome (5, 23).”
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Chen, B. C., & Keenan‐Miller, D. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.23025 · Cited by 10
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“When treatment dose is diminished by non-attendance, the positive clinical outcomes typically demonstrated in clinical trials are also diminished (Hansen et al., 2002).”
BackgroundButler, R. M., O’Day, E. B., & Heimberg, R. G. (2020) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2020.1829027 · Cited by 13
“A review of the literature suggests that at least 13–18 sessions are required for half of a sample of patients to improve from a given treatment (Hansen et al., 2002).”
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Effective Care of Treatment-Resistant Patients in an ISTDP-Based In-Patient Treatment Program
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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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