Caseload of Therapist a Major Factor in Treating Depression

Newswise — A word of advice to the chronically depressed: When you are choosing a therapist, one of the most important factors to consider is their caseload. Those who have a light or moderate number of psychotherapy patients tend to get significantly better results than those with a heavy caseload.

That is the finding of a breakthrough national study of therapists and patients led by Carina Vocisano, associate professor of psychology at Southern Connecticut State University. Vocisano served as the principal investigator of the 16-person team that included faculty, students and medical staff from throughout the country. The research began in 1996 and concluded last year. A total of 37 therapists, 12 therapy supervisors and 173 patients were part of the final result, although some 681 patients at 12 academic centers participated in the study.

Vocisano said that while 'therapist burnout' has been researched for many years, she believes this is the first time that a study has documented the relationship between caseload and treatment outcome. The results were announced in the Sept. 1 edition of "Psychotherapy," a journal produced by the American Psychological Association. Caseload proved to be the second most important factor in determining treatment outcome. Such variables as age, sex, experience of the therapist and even psychotherapy techniques were among the factors tested, but resulted in less of an impact than therapist caseload, or none at all. "It's the first study that quantifies 'burnout,'" Vocisano said. "We have known that having too many clients can be stressful on the therapist, but we now have evidence that it translates to a poorer outcome for their clients. That really has been an overlooked factor in psychotherapy research."

The caseloads of the therapist included psychological problems of various sorts. She noted a significant drop off in treatment effectiveness when a therapist had a caseload of 25 patients or more per week. The trend was even more dramatic with caseloads of 30 or more per week.

And while the study looked at treatment outcomes only for patients suffering from chronic depression, Vocisano believes that the consequences of a heavy caseload could affect patients of other types of psychological problems, as well.

"I'm fairly confident that our findings could be applied to patients suffering from psychological problems across the gamut."

Vocisano said she was surprised, but excited, by the link between caseload and success of treatment.

And while caseload was a significant factor in treatment outcome, the study found that the relationship between therapist and patient was the most important factor. Those therapists who were willing to discuss their relationship with the patient, particularly if the patient had a concern or problem with the therapist or the treatment offered, scored higher in terms of eliminating or dramatically reducing the depression level of the patient.

But that part of the study was less surprising than the caseload connection, according to Vocisano.

The study examined only those who received psychotherapy alone, rather than those who took anti-depressant drugs. Their treatment outcomes were measured 12-14 weeks after psychotherapy began. Treatment was considered successful only in cases in which at least a 50-percent reduction of depression level was recorded and the patient was left with either mild or no symptoms.