Frequency and Continuity of Sessions

Maintenance of continuity and consistency across sessions is also particularly important when treating more severe depression. Typical research protocols with such patients have specified the use of twice-weekly sessions for the first half of a 4-month protocol (DeRubeis et al., 2005; Dimidjian et al., 2006). Frequent sessions early in the course of treatment can maximize patient engagement with treatment and ensure success with initial homework assignments. In addition, such frequency helps the therapist to monitor the severity of the patient's depression on an ongoing basis and to intervene early if the patient's condition deteriorates or does not improve. If twice-weekly sessions are not pragmatic given financial or scheduling considerations, it may be advisable to schedule brief, check-in phone contacts with patients. Moreover, with respect to the duration of treatment, in one study in which patients were randomly assigned either to brief (8 weeks) or extended (16 weeks) CT, results suggested that more severely depressed patients improved significantly more with extended treatment (Shapiro et al., 1994).

Although assigning homework is a standard part of CT, it may be particularly important with more severely depressed patients. Given the importance of producing rapid and significant change with more severely depressed patients, assignment of regular homework is strongly advised. Toward this end, homework should be reviewed consistently each session and tailored to ensure that patients experience success.

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