The Psychotherapy Dose Effect in Naturalistic Settings Revisited: Response to Gray

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Gray's response (this issue) to Hansen, Lambert, & Forman (2002) suggests that, due to a number of limitations that exist in the original paper, the effectiveness of psychotherapy in naturalistic settings may be underestimated. This response to Gray addresses three of the limitations raised, including: (1) using clinical significance, it is difficult to adequately capture treatment gains made by people who are already within the functional range on an outcome instrument when they initiate treatment; (2) the end point data used to assess treatment outcome in the Hansen et al. (2002) paper does not fall at the end of the last session of treatment; and (3) for people beginning treatment in the most severely dysfunctional range on an outcome instrument, the effect size for treatment is quite large. In this response we demonstrate that, even if these limitations are accounted for, the amounts of treatment delivered and the subsequent response to treatment clearly lags what is observed in clinical trials research.

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