Clinical psychologist Marit Kool studied the effect of psychotherapy intensity in people with both depression and personality disorder. The results show that the more intensive approach has clear benefits.
Mental health care (ggz) is under heavy pressure due to long waiting lists, high costs, and a shortage of therapists. To help as many people as possible, it seems logical to make treatments shorter and less intensive. Research by clinical psychologist Marit Kool raises the question of whether this strategy is truly wise in the long term.
In a large-scale study, Kool investigated the effect of psychotherapy intensity in people with both depression and a personality disorder. She compared a treatment of 25 sessions over one year (starting with one session per week) with a more intensive treatment of 50 sessions (starting with two sessions per week).
More intensive approach is better
The results show that the more intensive approach has clear advantages. Clients who received 50 sessions recovered faster and, at the end of the treatment year, had fewer depressive symptoms and fewer personality-related problems than clients who received 25 sessions. One year after treatment ended, this difference was no longer measurable. However, people from the less intensive group were more likely to start a new course of treatment during that year.
According to Kool, this suggests that a higher therapy “dose” not only has a faster effect but may also save costs in the longer term. By preventing relapse and the need for new treatments, the burden on the health care system could actually decrease. Her conclusion does need to be put into perspective: intensive treatments require more therapist time and may place additional pressure on already limited treatment capacity in the short term. At the same time, too low a treatment dose increases the risk of a chronic course of depression and repeated use of care, which ultimately places an even greater burden on the system.
Tailored care
Kool therefore emphasizes the importance of tailored treatment. To strike a good balance between effectiveness, costs, and accessibility, more insight is needed into which patients benefit most from intensive treatment and for whom a less intensive approach is sufficient. She also recommends introducing an active aftercare phase, in which clients are monitored for some time after treatment ends and, if necessary, have a few follow-up sessions with their own therapist. Whether this actually leads to fewer depressive relapses and fewer new treatment trajectories should be investigated.
The core of the dissertation consists of a randomized study involving 246 clients. They were randomly assigned to four individual treatment formats, targeting both depression and underlying personality pathology: 25 or 50 sessions of schema therapy, and 25 or 50 sessions of psychodynamic therapy. The findings contribute to the societal debate on how scarce mental health care resources can be used most effectively and sustainably.