Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy

Abstract

Psychotherapies hold clear potential to alleviate mental health problems, yet there is no scientifically-driven consensus for how long treatment should last, how intense sessions should be, or how frequently sessions should occur. In practice, once-weekly therapy is the dominant outpatient service available to youths and adults alike, largely due to long-held beliefs and insurance companies’ limiting reimbursable treatment-time to 50-minute, weekly sessions. But ubiquity cannot be mistaken for clinical or practical superiority. Indeed, weekly therapy sessions are among numerous treatment structures that can help patients achieve clinical gains, with numerous trials supporting the utility of brief, intensive, and concentrated treatments for widely-varying problem types. Further, existing psychological services—dominated by weekly, outpatient options—fall short of meeting population-level mental health needs. Most youths and adults with psychiatric disorders never access care due to financial and logistical constraints, and among those who do, premature drop-out is common. Despite repeated calls to diversify treatment options, the “weekly therapy hour” remains the practical default. Given limited accessibility of, and significant dropout from, weekly outpatient therapy, and the established efficacy of alternative treatment formats, our field’s continued overreliance on the “default” of once-weekly therapy cannot be considered benign. As clinical scientists and therapists, we assert that it is our field’s ethical obligation to retire and rebuild the longstanding “default” to once-weekly treatment. To be clear, we do not endorse eliminating weekly psychotherapy as an option for patients; many once-weekly, evidence-based treatments, if delivered as intended, may benefit patients greatly. However, repositioning weekly therapy as one of many treatment options, and diversifying available service types, may strengthen the accessibility, flexibility, and potentially the effectiveness of treatment overall.

Development and Feasibility of an Online Brief Emotion Regulation Training (BERT) Program for Emerging Adults

“…Additionally, BERT is sensitive to a health equity framework (74), attempting to circumvent traditional barriers to care and provide equitable care to vulnerable populations. The brief and intensive nature of this program is designed to be more immersive than traditional interventions (42). Each component was designed to mimic face-to-face evidence-based treatments.…”

“…Intervention efforts are shifting to brief and electronic formats to combat costs and address growing needs for treatment (41)(42)(43). Electronic formats for treatment are increasingly popular for youth raised in a digital world (44).…”