Cited by 788Psychotherapy Techniques and ApplicationsMental Health Treatment and AccessDigital Mental Health Interventions

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The psychotherapy dose-response effect and its implications for treatment delivery services.

Hansen, Nathan B., Lambert, Michael J., Forman, Evan M.·2002·Clinical Psychology: Science and Practice

DOI 10.1093/clipsy.9.3.329

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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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“Considering that these results greatly surpass the amount of time needed to deliver most manualized evidence-based treatments (12–16 sessions), let alone the average number of visits attended by serviceseekers (M = less than 5; Hansen et al. 2002) and the average number of visits reported in the current sample (M = 4.”
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“Possible reasons for the low uptake rates of mental health care include logistical barriers, fear of stigmatization, and a shortage of actually available treatment options (Brakemeier & Herpertz, 2019; Hansen et al., 2002; Lambert, 2017).”
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“This disparity in findings confirms the importance of supplementing clinical trial findings with analyses of routine service data [31,32].”
BackgroundResult
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“Some studies suggest a minimum of 20 sessions are necessary for students to exhibit noticeable change (Hansen, 2002), while others indicate that bi-weekly sessions are more effective than weekly ones (Cuijpers et al., 2013).”
Background
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“These results are consistent with prior research on the effects of caseloads (Hansen et al., 2002), and they offer preliminary evidence for the utility of the CLI in predicting treatment effects at the system level.”
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“In adults, deterioration rates of about 8% have been reported [3] and in children and adolescents rates of about 24% have been found [4].”
Background
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“Previous studies have suggested between 13 and 18 therapeutic sessions are necessary for clinical improvement in about half of patients, and it is likely that many participants engaged in multiple therapy sessions prior to accrual in the present study (Hansen et al., 2002).”
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“This suggestion was later confirmed in meta-analyses by Grove et al. (2000) and Hansen et al. (2002), who showed that clinician judgement is substantially less effective than protocol-driven approaches in terms of patients’ outcomes.”
Result
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“It is an established fact that more sessions in general are related to larger improvements (e.g., Hansen et al., 2002; Howard et al., 1986; Lambert et al., 2001), at least within the range of sessions in the present study.”
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Duration of psychotherapy has little association with outcome
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Authors: Hansen, N. B., Lambert, M. J., & Forman, E. M.
Affiliations: Yale University (US)
Brigham Young University (US)
Drexel University (US)
ORCID: Hansen, Nathan B.
Lambert, Michael J.
Forman, Evan M.
Venue: Clinical Psychology: Science and Practice
Publisher: American Psychological Association (APA)
Published: 2002
Volume: 9
Issue: 3
Pages: 329-343
ISSN: 0969-5893 (ISSN-L)
1468-2850
DOI: 10.1093/clipsy.9.3.329
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
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 4991 d)
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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The psychotherapy dose-response effect and its implications for treatment delivery services.

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