Dose-effect relations and responsive regulation of treatment duration: the good enough level.
This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.4% White; average age=40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n=1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r=-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement.
Barkham
Michael
M
Psychological Therapies Research Centre, University of Leeds, Leeds, and Rampton Hospital, Nottinghamshire Healthcare NHS Trust, Nottingham, United Kingdom. m.barkham@leeds.ac.uk
Connell
Janice
J
Stiles
William B
WB
Miles
Jeremy N V
JN
Margison
Frank
F
Evans
Chris
C
Mellor-Clark
John
J
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004739:England; D017050:Episode of Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010347:Patient Care Planning / Q000706:statistics & numerical data; D010552:Personality Assessment; D011320:Primary Health Care; D011340:Problem Solving; D011613:Psychotherapy / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D013223:Statistics as Topic; D013997:Time Factors