Psychotherapy session frequency: A naturalistic examination in a university counseling center.

Abstract

With increasing demand for psychotherapy services, clinicians are carrying increasingly large caseloads (Bailey et al., 2020). As the number of new intakes exceeds the number of clinical hours available each week in some settings, psychotherapy is delivered on an attenuated schedule for returning clients (rather than the traditional weekly frequency); there is, however, little support for the efficacy of this practice. The present study explored the effect of session frequency on psychotherapy outcomes using a quasirandomized controlled design. In a working university counseling center, we assigned therapists to either a treatment-as-usual (TAU) group (attenuated session frequency) or an experimental group (weekly session frequency). Clients were randomly assigned to a therapist in either condition. Using hierarchical linear modeling and survival analyses, we examined psychotherapy outcomes (measured by session-by-session Outcome Questionnaire 45 scores) for 1,322 clients (3,919 individual sessions). We found no differences between groups when examining the full sample, but also found limited fidelity in the experimental group. When identifying individuals who were seen weekly in at least the first three sessions after intake (sensitivity analysis), we found the following: (a) weekly therapy resulted in faster trajectories of change over time, (b) weekly therapy resulted in a greater likelihood of achieving recovery, and (c) weekly therapy resulted in a greater likelihood of achieving recovery sooner. We discuss the importance of including session frequency when considering the dose of therapy, as well as the implication that prioritizing weekly therapy may increase therapy efficacy and efficiency in routine practice. Public Significance StatementThe present study suggests that session frequency may affect both the efficacy and efficiency of psychotherapy in working clinics. It highlights the importance of including session frequency in both research applications and clinical considerations. This may be particularly important in the context of increasing demand for mental health services.

Adapting stepped care: Changes to service delivery format in the context of high demand.

“…Specific adaptations needed to achieve this included a waitlist, session limits, and the innovation of a one-time consultation (Quick Care) to ensure access to the system, including when clients needed to wait for initial consultations. The Erekson et al study (2021) used between-group comparison, splitting the center into two clinics to compare the adapted service delivery model with treatment as usual. By comparing evidence from before and after Erekson et al, the present study found evidence to support the effectiveness of implementing the model over the entire center over an extended period.…”

“…Adapting a service delivery model to the ever-increasing demand for services has been shown to be effective (Erekson et al, 2021). As described in our introduction, we adapted an existing stepped care model (Stepped Care 2.0; Cornish et al, 2017) to our purposes (Adapted Stepped Care, or ASC), including making several steps of care available and encouraging clinicians to focus on treatment planning and lower-intensity tracks.…”

“…Therapists at the UCC were marriage and family therapists, psychologists, or supervised psychologists-in-training (doctoral students in counseling or clinical psychology). The side-by-side comparison of treatment models (Erekson et al, 2021) occurred during winter 2019 and therefore these data were not included. The fall–wintercycles before and after this semester (Winter 2019) provided the data for analysis.…”

“…At this point, with the ASC defined, half of the center worked under treatment as usual guidelines while the other half used the ASC. The side-by-side comparison was examined by (Erekson et al, 2021) and found evidence for increased effectiveness in the model, in terms of increased likelihood for clients achieving clinically significant improvement during the period of the study.…”

A mixed-methods look at college student well-being during COVID-19: the power of positive psychology

“…In fact, nationally there is a trend of UCCs transitioning to what is known as stepped care models (Bailey et al, 2021;LeViness et al, 2018), which have been shown to be effective at getting students more rapid access to a variety of mental health care supports (Erekson et al, 2021;Reetz et al, 2014). A stepped care approach to mental health services recognizes that traditional 50-minute, weekly therapy appointments are the most resource intensive offering at UCCs (LeViness et al, 2018); thus, the stepped care literature stresses that not all students seeking services require weekly, 50-minute therapy appointments to address their needs (Bailey et al, 2021).…”