The DOI matches its Crossref record; 114 of the 114 references it cites were found in a registry or an index.
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
Citations
Cites
Jacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770
Handbook of Psychotherapy and Behavior Change
Garfield, S. L., Bergin, A. E., & Dryden, W. (1987) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.1.4.264a · Cited by 3,998
The effects of psychotherapy: an evaluation.
Eysenck, H. J. (1952) · Journal of Consulting Psychology · doi:10.1037/h0063633 · Cited by 1,734
The effectiveness of psychotherapy: The Consumer Reports study.
Seligman, M. E. P. (1995) · American Psychologist · doi:10.1037//0003-066x.50.12.965 · Cited by 1,626
The effectiveness of psychotherapy: the Consumer Reports study
Seligman, M. E. P. (1995) · American Psychologist · doi:10.1037/0003-066x.50.12.965 · Cited by 1,608 · cited 2×
“…call for studies on psychotherapy effectiveness, or even studies integrating efficacy and effectiveness, addressing the utility and potency of interventions in real world settings (Howard et al., 1996;Klein & Smith, 1999; Kopta et al., 1999; Norquist, Lebowitz, & Hyman, 1999; Seligman, 1995, 1996).”
BackgroundUpdate on empirically validated therapies, II: (619622010-001)
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D. A. F., et al. (1997) · PsycEXTRA Dataset · doi:10.1037/e619622010-001 · Cited by 1,488
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.59.5.715 · Cited by 1,444
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.5.715 · Cited by 1,444
A component analysis of cognitive-behavioral treatment for depression.
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.64.2.295 · Cited by 1,413
What Works for Whom?: A Critical Review of Psychotherapy Research
Roth, A. D., & Fonagy, P. (1996) · Cited by 1,382
Flagged first, then by citations
Research works printed but not linked: 6
- Finney, 1971, Probit analysis
- Lambert, 1994, The handbook of psychotherapy and behavior change
- Lambert, 1996a, Administration and scoring manual for the Outcome Questionnaire (OQ 45.2
- Orlinksy, 1994, Handbook of psychotherapy and behavior change, 270
- Orlinsky, 1978, Handbook of psychotherapy and behavior change
- Wiggins, 1992, Practice guidelines: Fundamentally wrong, APA Monitor, 3
Cited by
Sorted by citations
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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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