One of too many terms that have been pulled across from physical health medicine and drug treatment into the psychological realm and there is a huge literature either using the term or the idea.
Details #
In pharmacology the dose response curve is the relationship between some effect of a drug and the dose of it that has been taken. In that realm it is clearly an important issue as most drugs are, or can be toxic, if too much is taken and most are ineffective if too little is taken. The range in between those dosages is sometimes called the “therapeutic window”. For some drugs, there is huge between individual variation in the dose response curve so great care needs to be taken, equally, where the therapeutic window is tight it is necessary to monitor doses and sometimes blood levels of the drug carefully.
The term is used in the therapy realm to explore the relationship between “how much” therapy someone has and any improvement. Actually, it’s not generally used like that of course (nor, generally, is it used like that in pharmacology though for treatment of tuberculosis, duration of medication is hugely important at the individual level). It’s generally used to explore, usually to promote, the idea that there is some general dose response curve that applies, perhaps for particular interventions and particular problems. The logic, which is sound, is not that too much therapy is toxic (though I would argue it can be), it is more that if more therapy is being given than will noticeably improve the change achieved, then that extra therapy is inefficient and would be better given to others. That is becoming a very powerful rhetoric in the increasing industrialisation and commoditising of therapies particularly when state funded as in the UK IAPT service. The logic is inescapable, whether the model is sound is a very different issue.
I do, perhaps a bit naughtily, use a bit of a variant of this metaphor when I criticise the lack of evidence collection about long term trajectories in large scale, short term oriented therapy services, particularly IAPT, as, for the many clients who either don’t gain from a first therapy or do gain but later have a second episode of their problems. I completely agree that a good number of clients can gain, sometimes wonderfully: I am absolutely not against short term therapies generally. However, my experiences in a community secondary care therapy service where we were seeing more and more people who had had multiple short term therapies, was that they were clear that, generally while agreeing that the work had been helpful, they now needed something different. I argue that when someone has had two or perhaps three or more, quite short term therapies, often but not always CBT, that only offering them another such therapy is like saying that we can see that the antibiotic we are using is not working for the infection but prescribing it any way when there may be other antibiotics!
There is really much, much more could be said about the drug and dose response metaphors but this is not the place for that!
Try also #
“Good enough level” (GEL)
Linear vs. non-linear change
Multi-level models
Rupture-repair model
Sudden gains
Chapters #
Not really discussed in the OMbook, our general thrust is to support a less industrial, pharmacological model!
Online resources #
None yet.
Dates #
First created 6.v.24.
