How much therapy is enough

In his chapter "The efficacy and effectiveness of psychotherapy" , Michael Lambert reviews relevant publications and concludes p. The RCI was developed over twenty years ago Jacobson and Truax and it compares pre-treatment and post-treatment assessment scores while taking into account the precision of the assessment measure being used.

If you've continued to read this far without developing a headache, it's probably helpful to underline that "reliable improvement" is the most widely used measure of "appreciable benefit" and Michael Lambert's comments about "reliable improvement" in the previous paragraph largely refer to the "reliable change index RCI ".

Now what about "recovery"? How many sessions will it take to achieve full recovery? By "full recovery", we mean here "indistinguishable from 'normal' peers". Trying to attain "full recovery" rather than just "reliable improvement" is important for the obvious reasons that we feel better and function better after full recovery than we do after reliable improvement.

It's also important because the chance of relapsing is considerably less after full recovery than it is after reliable improvement - see, for example, " Recovery and subsequent recurrence in patients with recurrent major depressive disorder ". Some therapists achieve better results than this and others worse. Commenting on one of the relevant major studies, Lambert p. Unsurprisingly clients also make a big difference to the number of therapy sessions they need to make progress.

For example, human subjects with impaired grasp-and-release after stroke performed more than repetitions per day 1, total of a finger-tracking exercise and demonstrated significant cortical reorganization and functional improvements.

Thus, clearly, one item of focus for rehabilitation professionals should be the number of reps and type of activity performed in each session. Current research, however, shows that most therapy sessions do not contain the proper amount of repetitions per session to cause actual changes in the brain. Typical therapy sessions, whether physical, occupational, speech, or behavioral , last about one hour per session with the therapist employing various tasks and exercises throughout the session.

Not surprisingly, the number of repetitions observed for upper extremity work was between repetitions per session — far below the hundreds required for neuroplasticity.

Such practice has been effective in recovery of balance, gait, and ambulation after stroke 4,5. For more information on massed practice post-hemispherectomy, see Intensive Mobility Training.

As for how long you may want to continue sessions for, that relies on several factors. How long you struggled with a particular set of issues or feelings, how much they are impacting your day-to-day life, and how motivated you are to resolve them are all components that influence the appropriate number of therapy sessions.

Cost, scheduling availability and transportation can all be important factors as well, and should be considered in advance as you work out your overall ability to commit to your therapeutic process. Reliable improvement - meaning noticeable positive effects - has been found to be achieved in a relatively short amount of time.

Full recovery, then, further depends on the depth and nature of your particular situation and varies pretty widely. As in most areas of our lives, commitment and hard work make a big difference.

With cognitive and behavioral therapies, clients who actively work on relevant challenges or homework between therapy sessions add considerably to the effectiveness of therapy.