What Impact Does Your Case Load Have On The Effectiveness Of Your Treatment For Depression?

Question: What impact does your case load have on the effectiveness of your treatment for depression?

Answer (1) I assume you are asking how a therapist's case load may impact on the therapist's effectiveness in working with clients with depression. Ethically, I would need to ensure that I limited my case-load to a number I could confidently manage. In private practice this is do-able. Therapists working in the public health sector sometimes have less say.

Answer provided by John Hunter, Counsellor

Answer (2) I'm not sure if being overloaded would affect one's treatment of depression any more than any other problem but being physically and emotionally overloaded per se, can certainly reduce one's concentration and memory and therefore, effectiveness. I personally find a relaxed, unhurried pace of work, conducive to thoughtfulness and creativity in seeing my patients. However, being in private practice, I can choose to see a sensible number of people to ensure my optimal performance. Unfortunately, not all therapists have this luxury.

Answer provided by David White, Psychotherapist

Answer (3) A case load of no more than 20-25 client sessions a week has been the cut off point in my experience. Anything more than that and I, and those whose work I supervise start to lose our freshness and authenticity and begin to sound like automatons with depressed and other client groups as well. This has been confirmed by these findings. The researcher 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. 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, without the use of medication during treatment.

At age 57 I can afford to limit myself to 10-12 client sessions a week but in earlier days, at my worst I worked 35 sessions a week. I dreaded some of those sessions with the suicidally depressed, still did competent work but neither inspired nor lively. During that time, I found I was spending more time and money on clinical supervision for myself, receiving peer support, massage and therapy for me to keep the show on the road than was worth the effort to earn it. Even more troubling was the adverse impact on my family's health and well being. The 6 figure income never made up for those losses. I can't imagine how some of my colleagues are coping with more than 35 sessions a week. Ironically the only client I have lost to suicide in 35 years occurred when I was working the more sensible hours. That raises other issues, which air traffic controllers also report - that the most frequent near collisions occur during their quietest periods.

Answer provided by Peter Fox, Clinical Psychologist