Now this is a tough question: how long does psychotherapy last? Obviously this
is a really tough question because it depends on so many things. It depends on
on each person, it depends on how complex a case is, it depends on the patient's
motivation, it depends on the expertise of the clinician and above all it really
depends on what your treatment goals are. That said research does give us quite a
few things that we should consider. What's most important and I've said this
many times before is that you always feel free to discuss this with your
therapist. Remember you always have a right to ask questions.
Psychologists have been doing research on the number of sessions needed in
psychotherapy for a very long time and over time these research methods have
obviously improved quite a bit. Sometimes we've developed new methods to
investigate this topic. Other times we borrowed methods from related fields for
example research on medication where researchers had the same
questions in mind. For example if you take Champix, a medication to quit smoking
well at one point researchers had to determine what the optimal dose is so
how much of that medication you need to take to get the best results with as
little side effects as possible. It's almost the same thing in psychotherapy
research researchers needed to determine what kind of relationship there is
between the dose and the effect and how many sessions you need and over what
period of time to get the best effect possible in psychotherapy. Now this
effect and this is really important, it truly depends on what you're trying to
accomplish. Trying to get rid of a few symptoms is one thing and that can be
done fairly quickly to be honest but trying to change deeply ingrained
patterns that you've had for many years well that might take more time and more
therapy so everything ultimately depends on what you're trying to accomplish.
The expression dose effect was really born from research on medication so when
researchers do research on medication the term dose simply refers to the
amount of the drug that has to be taken so going back to my example with Champix
the dose could be half a milligram, a milligram or 2 milligrams for example
and then the term effect refers to our response to the medication so again with
Champix that would be a decrease in your desire to smoke or even better you
just don't feel like smoking at all so in psychotherapy it's roughly the same
thing. The dose refers to the number of sessions 1, 2, 5, 15 and so on and the
effect refers to an improvement or to a decrease in symptoms or a decrease in
symptom severity so for example feeling less depressed. You could also refer to
some kind of improvement like being able to go back to work or it could also
ideally refer to complete remission which would mean for example that a
patient no longer has panic attacks by the end of the treatment. We already have quite
a few studies including one that included 2400 patients, so a large study
and researchers found that what seems to be a curve where, as the number of
sessions increase so does the improvement seen in patients but there's
a point where this curve apparently flattens out which led everyone to
believe that early sessions, perhaps the first eight or so sessions had a huge
positive effect but then after that there would be less return on your
investment so people did continue to improve but much less than in the first few
sessions. Today the methods we used to do research like this have improved
tremendously and in the last decade we've had quite a few studies that have
been published on this topic and we're going to talk about that in a second
We do have many individual studies that are available to help us determine how
many sessions are needed in psychotherapy for example one study that
I have in mind is a study that was conducted and showed
that eight sessions were sufficient for roughly fifty percent of patients to
show an improvement and then it took 21 sessions for eighty-five percent of
patients to get better. Now this is one study and there's many many out there
and when you look at what's available what seems to be happening is that it
would take anywhere between 10 and maybe up to 18 sessions to see a significant
improvement in fifty percent or more of patients
so one thing we really can't forget is that it's not enough to talk about a
dose without giving some consideration to frequency. In other words if we go
back to my example with medication well we could wonder if taking one pill you
know over 10 days is the same thing as taking 10 pills in one day. Well you know,
chances are the answer's no, so a dose also depends on time or rather it
depends on the temporal relationship that might exist between one dose and
the next and this is an issue that's been addressed by a few research teams
including Mike Lambert in the US who studied 24,000 patients and found that
generally speaking, one weekly session is better than having a session every other
week and he found that thirty percent more patients showed improvement with
weekly sessions and did so much faster than patients who received a session
every two weeks. What was also interesting is that there were three
times more patients who got worse in the group who saw their therapists every
other week so if we had a general rule of thumb to remember here, it is that it
seems to be more useful to see our psychologist or psychotherapist once a
week rather than every other weekend so we shouldn't be surprised if in some
cases a psychologist recommends more frequent sessions at least for some time.
Now most of these studies as I said indicate that it takes anywhere between
10, 12 maybe up to 18 sessions for most patients to improve and they suggest as
well that it's better to see a psychologist once a week rather than
every other week yet somehow when we look at the large populational data
that comes out of the UK for example, where the cost of psychotherapy is
covered by the state we can see that the average number of sessions
completed by patients is a little lower than that - it's closer to five or six
sessions which is a bit less than what we see in those other studies so that
should make us wonder what is going on
Well one explanation which is very important is related to treatment goals
What exactly are we trying to achieve with this therapy? If we want to make a
few symptoms disappear and that can be done fairly quickly, that's one thing but
if we're shooting for a full symptom remission or recovery from a disorder,
well that's another thing and chances are therapy will be longer. So
effect and outcome really depends enormously on what we're trying to
accomplish. Second it also depends on the patient's diagnosis. Treating a specific
phobia like a fear of spiders for example, that can be done quickly, three-four
sessions even less but treating severe major depression or treating a
personality disorder, well that's a different ballgame so when we consider
these first two explanations, that dose effect depends on treatment goals and on
diagnosis, it already seems clear that in many cases what we're doing is we're
comparing apples with oranges and then asking how many sessions are needed in
psychotherapy in general regardless of diagnosis and regardless of treatment
goals is an absurd question. This is like asking if in general medication works
and in general how many pills we should take which makes no sense because here
too it depends on the disease we want to treat, it depends on the medication, on
the treatment goals and it depends on possible interactions between one drug
and another and so on and so forth. Finally and this is really important not
to forget, most studies, especially the early studies were based on
the idea that the number of sessions causes recovery but we
could also address this question of dose-effect the other way around and ask
ourselves if instead it might be the number of sessions, so the dose, that
depends on the speed and the magnitude or the importance of the patient's
recovery, which might also suggest that the number of sessions needed really
depends on on each patient. For example there was a study conducted
where they found what seemed to be this curve I described
earlier in the video, whereby people improve considerably at first but then
there was this diminishing return as we did more sessions, they also did find that,
but they also found, and this is more important, that there
were subgroups of patients where some got better quickly and others just
needed more time and this leads us to believe that people probably simply do
the number of sessions they need and this seems to be in fact supported by
other studies. Psychotherapy is generally not done for fun and with a good and
honest therapist people do as many sessions as they need and then they
leave. This means in turn that if an institution or a government wants to
decide how many sessions they want to cover they first have to decide exactly
what they want to achieve with therapy and if they happen to work with
diagnosis for example, if you only offer services for depression or anxiety or
personality disorders and so on and so forth, then you have to factor that in when
trying to decide how many sessions you'll offer. Treating and I've said this
before, an adjustment disorder is simply not the same thing as treating a
personality disorder just like shooting for improvement in a patient is not the
same thing as shooting for recovery so ultimately, and when it's possible, what
we need to do is rely on research that involves patients that are similar to
the ones we want to treat once again because it makes little sense to ask how
many sessions in general are needed for patients who have different diagnoses
and different treatment goals just like it makes no sense to ask how many pills
you should take in general regardless of your diagnosis or what you're trying to
achieve with these meds.