From time to time I hear from a client, or a family member of a client, or an insurance company who expects me to apply a standardized protocol from a randomized controlled trial (RCT) when I'm working with an individual in my clinical practice. Wait, if the research shows that a 12-session protocol works for the client's presenting problem, why don't I automatically use that protocol?

When one is conducting outcome research, it usually is important to develop standardized treatment protocols so that everyone in the CBT group gets the same treatment and the same amount of treatment. This makes it possible to draw clearer conclusions when interpreting the results. When the researchers test a 12-session protocol, or a 16-session protocol, or a 20-session protocol, they aren't saying that 12 or 16 or 20 sessions is the correct duration of treatment for all clients. They are trying to design a treatment protocol which has a good chance of working and which is practical given the constraints under which they are working.

In clinical practice, we have the option of tailoring treatment to the needs of the client. For example, RCTs of Cognitive Therapy for unipolar depression typically have used protocols ranging from 12 to 20 sessions of treatment. In my clinical practice, it isn't unusual to complete treatment in 12 to 20 sessions (at one point we averaged 12.3 sessions). However, some clients catch on quickly and need fewer sessions while other clients progress through treatment more slowly and need much more treatment.