What Works in Therapy  |  Douglas Behan, DSW, LCSW

Early Dramatic

Treatment Response

Some Clients Get Better Before they "Should"

Research has shown that up to a third of clients respond very quickly to therapy – showing dramatic improvement in the first one-to-three sessions (Bohart & Tallman, 2010; Gaynor et al., 2003). The change takes place even before any formal interventions have been used. This counter-intuitive finding raises questions about what exactly is creating the change in the psychotherapy.

What the Research Says...

Clients who respond early to psychotherapy (within the first four sessions) generally have better outcomes than those who respond more slowly (Illardi & Craighead, 1994; Lambert & Kleinstäuber, 2016). The changes are significant and long lasting, with 50-65% of the total change still in place when measured at termination and follow-up. More research is needed to form firm conclusions to explain this phenomenon. Possible explanations include client factors (e.g. readiness to change) and other common factors (e.g. mobilization of hope, therapeutic relationship). Early responders may be working more effectively with the therapist and achieving more tasks (Lambert & Kleinstäuber, 2016).

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Listen below to Michael Lambert, PhD, one of the most influential researchers on psychotherapy, discuss the early dramatic treatment response phenomenon:

Early Dramatic Treatment Response - Michael Lambert, Ph.D
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What it Means for Therapists

When clients respond to treatment before theory or research-based interventions have been deployed, it suggests that early rapid progress may be due to common factors such as the instillation of hope, client factors (motivation, social supports), catharsis, the therapeutic alliance, and/or therapist factors. These findings suggest therapists should be conscious of common factors at the outset of treatment. When clients do not respond well at the beginning of treatment there is a high risk of dropout. Barriers to progress should be explored right away instead of waiting until later in the course of treatment..