Australia operates a subsidised system of psychotherapy based largely around the claim that the therapy offered is "evidence-based." This system limits the number of sessions available, and limits who has access to practice psychotherapy under the system. There is considerable and growing evidence, however, that what is offered is insufficient to the needs of the majority of those who seek treatment.
A study by Paul Harnett, Analise O’Donovan, and Michael Lambert examined "The dose response relationship in psychotherapy: Implications for social policy." In other words, they set out to quantify how many sessions could be considered effective in a general set of cases and assessed that number against what is currently offered.
At this time, Medicare in Australia does not offer a system of subsidised treatment to the clients of Psychotherapists, but does offers 6 sessions with a Psychologist or Clinical Psychologist, and another 6 if referred by a General Practitioner. The researchers undertook this study to provide more information on the dose-response relationship and hence "shed some light on the consequences of dosage restrictions for client well being." (Harnett et. al, 2010, P. 2)
They comment as follows:
At this time, Medicare in Australia does not offer a system of subsidised treatment to the clients of Psychotherapists, but does offers 6 sessions with a Psychologist or Clinical Psychologist, and another 6 if referred by a General Practitioner. The researchers undertook this study to provide more information on the dose-response relationship and hence "shed some light on the consequences of dosage restrictions for client well being." (Harnett et. al, 2010, P. 2)
They comment as follows:
The results suggested that reliable change was estimated to be achieved for 50% of those who were treated, if clients were to undergo 10 sessions of psychotherapy. For 50% of clients to achieve clinically significant change an estimated 14 sessions were required. About 70% of clients who enter treatment with moderate or more levels of disturbance would achieve clinically significant change if they remained in treatment for 23 sessions. These estimates are fairly consistent with estimates coming out of the USA; the range for 50% of clients to attain clinically significant change is about 11–18 sessions (Anderson & Lambert, 2001; Hansen et al., 2002; Kadera et al., 1996; Kopta et al., 1994).
The implication for the Medicare system in Australia is that the treatment offered falls short of what is required for a successful outcome ("substantial benefit"). It also goes some way towards countering the claim that service provision is "evidence based" when evidence repeatedly, and again here, shows that "such guidelines leave at least half the clients whose services are reimbursed 50% under-served." (Harnett et. al, 2010, P. 6). The authors suggest that, considering the enormous social and economic cost of mental illness, their findings are "problematic."
They conclude that "the dose-response data reported in the present study as indicating that if a general session limit must be set it would be more reasonable to think in terms of 20–25 sessions for most clients, perhaps depending on initial severity of disturbance. The highest quality of care (and wisest financial decision) will be provided by monitoring each client’s treatment response and making treatment length (number of sessions) a function of treatment response and mental health status, rather than arbitrary or theory-driven limits. (Harnett et. al, 2010, P. 6).
Disturbing indeed for those clients who are under-serviced, and potentially further pathologised by the perception that they would ideally have been made well in 6-12 sessions. It is my experience that individuals can undertake many incremental steps in their journey towards mental stability, comfort, and happiness. It's not uncommon for people to have had several therapists, and to have undergone several periods of treatment. And the evidence shows that such a situation is the one to expect, and the one that will be the most successful.
The full study is available here.
They conclude that "the dose-response data reported in the present study as indicating that if a general session limit must be set it would be more reasonable to think in terms of 20–25 sessions for most clients, perhaps depending on initial severity of disturbance. The highest quality of care (and wisest financial decision) will be provided by monitoring each client’s treatment response and making treatment length (number of sessions) a function of treatment response and mental health status, rather than arbitrary or theory-driven limits. (Harnett et. al, 2010, P. 6).
Disturbing indeed for those clients who are under-serviced, and potentially further pathologised by the perception that they would ideally have been made well in 6-12 sessions. It is my experience that individuals can undertake many incremental steps in their journey towards mental stability, comfort, and happiness. It's not uncommon for people to have had several therapists, and to have undergone several periods of treatment. And the evidence shows that such a situation is the one to expect, and the one that will be the most successful.
The full study is available here.
- Anderson, E., & Lambert, M. (2001). A survival analysis of clinically significant change in outpatient psychotherapy. Journal of Clinical Psychology, 57, 875–888.
- Hansen,N., Lambert, M., & Forman, E. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 329–343
- Harnett, Paul; O'Donovan, Analise; Lambert, Michael J. (2010) The dose response relationship in psychotherapy: Implications for social policy Clinical Psychologist, Vol. 14(2), pp. 39-44
- Kadera, S., Lambert, M., & Andrews, A. (1996). How much therapy is really enough? A session-by-session analysis of the psychotherapy dose-effect relationship. Journal of Psychotherapy: Practice and Research, 5, 1–20.
- Kopta, S., Howard, K., Lowry, J., & Beutler, L. (1994). Patterns of symptomatic recovery in psychotherapy. Journal of Consulting and Clinical Psychology, 62, 1009–1016.
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