Rate of change in psychotherapy: A matter of patients : A study contrasting the dose-effect model and the good-enough level model using the CORE-OM in primary care and psychiatric care

Sammanfattning: Studies on relations between number of sessions and effect of psychotherapy have usually assumed a constant rate of change across different lengths of therapy, explained by a model called the dose-effect model. This assumption has been challenged by the good-enough level (GEL) model, which makes the prediction that the rate of change will vary as a function of total number of sessions. This study aimed to compare these models. We also assessed the relationship between reliable and clinically significant change (RCSI) and total dose of therapy. Participants were drawn from two datasets in the Swedish primary care (n = 640) and adult psychiatric care (n = 249). The participants made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel analyses indicated a better fit using the GEL-model, with some reservations concerning RCSI and patterns of change. The results may indicate a general lawful relationship that may have implications for future research, as well as psychotherapy practice and policy making.