Abstract

Findings from previous psychotherapy research suggest that the majority of improvement takes place in the initial phase of treatment with the relative effectiveness dropping at a negatively accelerating rate. However, the evidence for this pattern of change comes from investigations of short-term treatments and it is unclear whether this also holds for more flexible and long-term psychotherapy. We provided open-ended treatments under routine-care conditions for a representative sample of 362 patients, including a large proportion characterized by severe psychopathology. Patients attended 52 sessions on average (SD = 59, range = 1-364, Mdn = 36). Our results indicated that the degree of improvement was linearly associated with time spent in psychotherapy and contingent upon the severity of psychological problems at intake. The least severely afflicted received the shortest treatments, experienced the most rapid change but demonstrated smaller overall magnitudes of improvement. More severely suffering patients received longer treatments, had slower rates of change but in general received greater overall benefits. We argue that previous suggestions of psychotherapy dosage have been less appropriate for patients suffering from moderate to severe psychopathology.

摘要

先前心理治疗研究的结果表明，大部分改善发生在治疗的初始阶段，相对有效性以负加速的速度下降。然而，这种变化模式的证据来自对短期治疗的调查，目前尚不清楚这是否也适用于更灵活和长期的心理治疗。我们在常规护理条件下为 362 名患者的代表性样本提供了开放式治疗，其中很大一部分以严重的精神病理学为特征。患者平均参加 52 次会议（SD  = 59，范围 = 1-364，Mdn = 36）。我们的结果表明，改善程度与心理治疗所花费的时间呈线性相关，并取决于摄入时心理问题的严重程度。最不严重的患者接受的治疗时间最短，经历了最迅速的变化，但总体改善幅度较小。更严重的患者接受了更长时间的治疗，变化速度更慢，但总体上获得了更大的整体收益。我们认为，先前关于心理治疗剂量的建议不太适合患有中度至重度精神病理学的患者。