8 Psychotherapy8.4 Service delivery and evaluation in psychotherapy
8.4.2 Sequencing and dose of psychotherapy
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Planning the course
Sequencing is the order in which you offer interventions. Base it on urgency, the problems that keep the difficulty going (the maintaining problems), the evidence and what the patient prefers.
Frequency and duration are different things. Frequency is how often sessions happen. Duration is how long the course lasts. Neither alone tells you how intensive the treatment is.
A treatment contract sets out the format, the review points, work between sessions and how you will decide whether to end or extend therapy.
Matching the sequence
Situation | What to do |
|---|---|
Immediate danger or severe deterioration | Arrange urgent treatment and support alongside the psychological work |
Several problems that affect each other | Agree which comes first and explain how the other needs will be managed |
Only partial benefit | Review adherence, the formulation, barriers and remaining symptoms |
Combined care is needed | Coordinate prescribing and therapy roles, and agree shared goals |
Planned transition | Prepare the ending and hand over responsibility explicitly |
An adequate course uses the recommended model and dose for the condition, delivered by trained staff, with real chances to practise.
When sessions are missed, explore practical and relational barriers before labelling the person unmotivated.
Comorbidity and social complexity may need adaptation or extra sessions. They are not grounds for automatic exclusion.
Review and ending
At review points, look at the person's own goals, their functioning, change in symptoms, adverse effects and the therapeutic alliance (the working relationship between patient and therapist).
Extension needs an agreed clinical purpose. More sessions will not necessarily fix a wrong formulation or a treatment that does not fit the problem.
Ending involves reviewing what the person has learned, planning for setbacks and making clear how they can get back into care if needed.