Dose-effect relationship in routine outpatient psychotherapy: does treatment duration matter?

J Couns Psychol. 2013 Oct;60(4):593-600. doi: 10.1037/a0033589. Epub 2013 Jul 1.


Objective: There is an ongoing debate concerning how outcome variables change during the course of psychotherapy. We compared the dose-effect model, which posits diminishing effects of additional sessions in later treatment phases, against a model that assumes a linear and steady treatment progress through termination.

Method: Session-by-session outcome data of 6,375 outpatients were analyzed, and participants were categorized according to treatment length. Linear and log-linear (i.e., negatively accelerating) latent growth curve models (LGCMs) were estimated and compared for different treatment length categories.

Results: When comparing the fit of the various models, the log-linear LGCMs assuming negatively accelerating treatment progress consistently outperformed the linear models irrespective of treatment duration. The rate of change was found to be inversely related to the length of treatment.

Conclusion: As proposed by the dose-effect model, the expected course of improvement in psychotherapy appears to follow a negatively accelerated pattern of change, irrespective of the duration of the treatment. However, our results also suggest that the rate of change is not constant across various treatment lengths. As proposed by the "good enough level" model, longer treatments are associated with less rapid rates of change.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Male
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Outpatients / psychology*
  • Outpatients / statistics & numerical data
  • Psychotherapy / methods*
  • Psychotherapy / statistics & numerical data
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Young Adult