The dose‐effect model is good enough

Schuler, Keke; Kilmer, Elizabeth D.; Callahan, Jennifer L.; Dziurzynski, Kristan E.; Swift, Joshua K.

doi:10.1002/capr.12337

Cited by 5 publications

(5 citation statements)

References 41 publications

(97 reference statements)

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“…In fewer than 10 sessions, ROS change estimates indicated that some clients experienced the same level of change as the average client who completed additional sessions. These results support the Good Enough Level (GEL) model, an idiographic description of psychotherapy processes (Barkham et al, 2006; Schuler et al, 2021). As described by Schuler et al (2021), the GEL model indicates that (a) clients who improve quickly will terminate sooner than those who evidence slower rates of change and (b) those who terminate sooner will experience the same amount of improvement as those who terminate later.…”

Section: Discussionsupporting

confidence: 75%

“…These results support the Good Enough Level (GEL) model, an idiographic description of psychotherapy processes (Barkham et al, 2006; Schuler et al, 2021). As described by Schuler et al (2021), the GEL model indicates that (a) clients who improve quickly will terminate sooner than those who evidence slower rates of change and (b) those who terminate sooner will experience the same amount of improvement as those who terminate later. In the GEL model, while rate of change and length of treatment vary by client, outcomes remain the same.…”

Section: Discussionsupporting

confidence: 75%

“…In the GEL model, while rate of change and length of treatment vary by client, outcomes remain the same. Schuler et al (2021) concluded that “some clients will recover after only one or two sessions and many clients may need longer treatment” (p. 12).…”

Section: Discussionmentioning

confidence: 99%

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A partial test of the early therapeutic environment model: Association of working alliance and distress with client attendance variables.

Meier,

Seidel

2024

Journal of Psychotherapy Integration

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Research on attrition consistently finds that dropout can occur early in psychotherapy and involve a substantial proportion of clients. This study investigated hypotheses based on the early therapeutic environment (ETE) model, a common factors theory that predicts that working alliance, client distress, and client expectancies (outcome and efficacy) influence client attendance and engagement. Using archival data from 350 clients in a private practice setting, two constructs of the ETE model (working alliance and client distress) were available to evaluate client attendance variables (session count [SC], therapy length [TL] in days, and weekly frequency [WF]). The expected positive correlation was found between SC and length of therapy in days; analyses also indicated a negative correlation between therapy frequency and both SC and length in days. Study findings provided partial confirmation of the ETE model, with higher alliance scores and moderate distress scores associated with longer attendance in the entire sample. These relations were absent, however, with clients who completed fewer than 11 sessions. Overall, results suggest the presence of a variable duration effect where attendance length relates to differential therapy outcomes. Individuals who participate in therapy for a relatively small number of sessions, occurring frequently, often achieved measurable distress reduction. For longer-term clients, results suggest that a combination of moderate distress and an established working alliance form a therapeutic environment that sustains client attendance. Findings suggest two basic guidelines for enhancing client attendance: As early as possible, maximize the client's experience of the alliance and modulate the client's level of distress. Public Health Significance StatementAttrition is a significant problem in counseling and psychotherapy, requiring the development of theory and methods to identify clients who are more likely to drop out. This study evaluates a model identifying factors that may influence attrition, including the working alliance between client and therapist and level of client distress. Results indicate that alliance and distress predict client attendance, particularly for clients who attend short-term therapy.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 75%

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A partial test of the early therapeutic environment model: Association of working alliance and distress with client attendance variables.

Meier,

Seidel

2024

Journal of Psychotherapy Integration

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“…IRB granted a waiver of consent for disclosure of limited educational records with personally identifiable information removed. Examination of prominent models of psychotherapy within the context of trainee clinicians indicates that, on average, the largest amount of change is associated with early sessions in any given course of treatment (e.g., Callahan & Hynan, 2005; Schuler et al, 2021). Thus, trainee competency data anchored to the initiation of a course of treatment were selected for inclusion (rather than anchoring trainee competency data to termination of client’s course of treatment).…”

Section: Methodsmentioning

confidence: 99%

Further validation of competency assessment: The practicum evaluation form.

Dimmick¹,

Callahan²,

Cox³

2023

Training and Education in Professional Psychology

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The Association of State and Provincial Psychology Boards (ASPPB) has asserted that validation studies demonstrating real-world associations of the Examination for the Professional Practice of Psychology (EPPP) to competency are impossible. The present study challenges that assertion via a proof-of-concept investigation. Using a reliable and valid measure of profession-wide competencies, the present study evaluated the association of trainee (N = 92) competencies to client treatment outcomes. Using data from 192 clients, two outcome metrics were examined: attrition from services and change in symptom distress severity across treatment. Each point increase in trainee competency was associated with a reduction in relative risk of client attrition by 42%. Additionally, trainee clinician competency scores explain more than 10% of the variance in symptom distress change over the course of treatment. Instead of exonerating ASPPB from validation work, the findings underscore the importance of evaluating the extent to which EPPP scores align with external referents. Public Significance StatementAs a proof of concept, the findings of this study directly challenge the Association of State and Provincial Psychology Boards' assertion that external validation of the Examination for the Professional Practice of Psychology is not possible. This study provides empirical evidence that provider competency directly impacts client treatment outcomes in health service psychology and underscores external validation as an essential step in assessing the appropriateness of any putative measure of competency.

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“…Given the high heterogeneity in individual responsiveness to psychotherapy (Baldwin et al, 2009;Barkham et al, 1996Barkham et al, , 2006, the number of CBT sessions should be predefined according to a fixed time frame, but must also leave room for flexible adaptation to the individual needs of patients who require more time to respond to psychotherapy (Bone et al, 2021;Falkenström et al, 2016). In this respect, future studies should also take into account the treatment setting in which psychotherapy takes place, as it may also influence change trajectories through various contextual factors (e.g., through financial and time constraints, Falkenström et al, 2016;Schuler et al, 2021). However, our results also suggest that longer treatments should be subject to a costbenefit assessment due to the less pronounced symptom improvement after 10 sessions and the high costs of psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

Dose–response relationship in cognitive behavioral therapy for depression: A nonlinear metaregression analysis.

Klein,

Breilmann,

Schneider

et al. 2024

Journal of Consulting and Clinical Psychology

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Objective: Evidence on the optimal “dose” of cognitive behavioral therapy (CBT) for treating major depressive disorder is sparse. This analysis aimed to evaluate the dose–response curve in CBT using a nonlinear approach, whereby “dose” was defined as number of treatment sessions. The dose–response curve of CBT was compared to other psychotherapies and pharmacological treatments for depression. Method: A systematic review and metaregression analysis of randomized controlled trials (RCTs) examining the efficacy of CBT in adults with acute depression was conducted. Treatment arms examining other psychosocial or pharmacological interventions were also analyzed. Cubic spline metaregression techniques were used to model nonlinear dose–response curves. Results: Seventy-two studies and 7,377 participants were included. Modeling the dose–response curve between change of depression symptom severity and the number of CBT sessions resulted in a nonlinear curve characterized by a strong improvement in symptom severity from baseline within the first eight sessions. Symptom reduction continues in the further course of the treatment, but at a slower pace. A similar pattern of symptom development was found for other therapies as well, although the prominence of early improvement and overall effect sizes vary across treatment arms. Conclusion: Results imply a general tendency for the strongest alleviation of depressive symptom severity in early stages of CBT treatment, thus, if aiming at symptom alleviation, speak for short CBT interventions. However, these findings have to be discussed in the light of the limited data regarding the sustainability of treatment effects in short-term therapies and effects beyond symptomatic changes.

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The dose‐effect model is good enough

Cited by 5 publications

References 41 publications

A partial test of the early therapeutic environment model: Association of working alliance and distress with client attendance variables.

A partial test of the early therapeutic environment model: Association of working alliance and distress with client attendance variables.

Further validation of competency assessment: The practicum evaluation form.

Dose–response relationship in cognitive behavioral therapy for depression: A nonlinear metaregression analysis.

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