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The Dose Effect Relationship in Psychotherapy. Howard, Kopta, Krause, & Orlinsky. American Psychologist, Feb ’86.
20 years later this remains one of the most cogent statements against managing psychotherapy. Logically reasoned and excellently researched, this article was trying to tell us long ago that therapy (no matter what kind) needed time to work. Why would anyone want to start with 8 sessions when it is assured that only one half of the population will be improved at that time?. Why not simply go straight to 26 prior to management, where we attain three-quarters of the population showing improvement.. We can then work from there. We bought a bill of goods when we began filling out OTR’s (but then again, what choice did most of us have). Try pulling out this article the next time a “care manager” (what a crappy euphemism!) tells you you have to apply for more session!.
As good as Seligman’s Consumer Reports research. The abstract is reprinted below (italics are from the Editor, for emphasis).
“In order to specify the relationship between length of treatment and patient benefit, probit analysis was applied to 15 diverse sets of data from our own research and from research previously reported in the literature. These data were based on over 2,400 patients covering a period of over 30 years of research. The probit model resulted in a good fit to these data, and the results were consistent across the various studies, allowing for a meta-analytic pooling that provided estimates of the expected benefits of specific “doses” of psychotherapy. This analysis indicates that by 8 sessions approximately 50% of patients are measurably improved, and approximately 75% are improved by 26 sesssions. Further analysis showed differential responsiveness for different diagnostic groups and for different outcome criteria. Implications for research and practice are discussed.
Countertransference. British Journal of Medical Psychology. (1960), Vol. 33, 16. P. 17-21.
In this seminal article about the meaning of words, Winnicott takes back the word “Countertransference” from the purview of the analysts scolding others for having “bad feelings” in psychotherapy and returns it to it’s rightful place as a tool for treatment and a natural human experience. Though steeped in psychoanalysis, this article is for all, as it lets us understand that it is our very humanness that most often aids us most in our treatment. It cautions us too that this can be taken too far, and that treating by “gut feeling” (I cringe when I hear colleagues say “I do what my gut tells me”. How do you know your gut is right or any less distorted than that of your patients?!) is dangerous.
Requests for reprints can be sent to the Editor at romaedl@juno.com or contact info on inside front cover.
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