Do you know any paper, or official report, from any country, stating about how many patients or families should a clinical psychologist or psychotherapist be allowed to treat per day as a maximum in order to protect a good enough public healthcare quality?
The premise is that treating an excessive number of patients per day will inevitably cause a deterioration in the quality of health care, since this will affect the duration of the sessions, while clinicians can devote to reflecting on each case, the quality of the written record of each psychotherapy session, the formulation of the case, etc. My colleagues and I work exclusively for the public health system of our country. Our bosses constantly pressure us to treat more and more patients. As responsible and realistic people, we understand that it is necessary to make the most efficient use of public resources, and that is why we try to deal with as many cases as possible. But we also believe that it is necessary to limit this amount, to protect the quality of care that my colleagues and I can provide.
Hi, I am not aware of any papers on this topic. My suspicion is that it’s a bit if a taboo topic. I’ve been an individual and relationship psychotherapist in private practice for twenty years now and my recommendation is to not exceed four clients a day. Dr Irvin Yalom mentins somewhere that this has been his maximum number as well.
In part, it depends on the population that you're serving and, frankly, how dependent you are on the income from a private practice. I see up to a maximum of 8 patients a day, but my practice is only open one day a week.
Dear Linda,
Well, there you are... Season's Greetings! Was on for a moment today and saw this, and I have stuff at my other office about this... Fundamentally, in private practice its a choice, but, about 20-24 hours of billable service and then feathering out the case load of weekly, every other week, etc. Work for an organization, it is between 28-32, depending on the organization and their requirements. I'll get you more information from an email I'd sent administration about 3-6 months ago, when I researched this topic at the hospital.
Hope you're with family and friends,
Michael
An interesting question - and one that might be different for a psychiatrist than a psychologist or clinical social worker. As a psychiatrist, when I was full time, I could pretty easily see 8 patients a day, but because my practice varied from inpatient to outpatient, and had a mix of almost pure psychotherapy, through to almost pure medication management, my day had variety to it so it didn't seem too long. I had psychologist friends, however, that would see up to 10 or more therapy patients a day, and I think those in the late afternoon and evening were not getting the same energy and attention his morning patients were. Perhaps more important or at least equally important is what kind of breaks you give yourself. I think more than three 50 minute patients in a row and your focus will begin to deteriorate. At least it did for me.
Thank you very much, Avigail Abarbanel, for your answer. If you could find Yalom’s reference which you mention, it would be useful to me. Thanks.
Thank you, Linda L. Chamberlain . In my question, I am referring to the maximum number of patients that is reasonable to treat in a day so that the quality of care is not neglected, regardless the amount of money I want or need to earn. The premise is that treating an excessive number of patients per day will inevitably cause a deterioration in the quality of care, as this will affect the duration of the sessions, the time that clinicians can devote to reflect on each case, the quality of the notes of the psychotherapy session and the case formulation, etc. Therefore, regardless of the issue of incomes, what should be the limit on the maximum number of patients per day so that the quality of care for these patients is not impaired. My colleagues and I work exclusively for the public health system, after overcoming a very hard exam to access this job. Our bosses constantly pressures us to treat more and more cases. As responsible and realistic people, we understand that it is necessary to make the most efficient use of public resources, and that is why we try to treat as many cases as possible every day, but it is also necessary to set a limit to that number of cases in order to protect the quality of care that my colleagues and I can give.
Thank you José, I will look it up. It might be in one of his books. Will get back to you when I find out. Happy New Year to you and all the best. Avigail
Thank you very much, George Bussey, for your answer. You introduce a new variable that seems very relevant to me: how fatigue deteriorates the quality of psychotherapy when the therapist has been doing psychotherapy for several hours with no interruption. In our workday, which begins at 8:00, we start to treat the first patient at 9:00, and we no longer stop treating one patient after another until 15:00, and I can assure you that even when you dedicate as much effort and interest as possible to every case, it is impossible to treat the last patients with the same concentration and energy as to the firsts. That is why we try to gave the last hours to the patients with a less serious mental state and who just require follow-up, as we are aware about our growing fatigue. But, of course, this is not the fairest way of doing our job, and I think you are right: it is necesary to schedule a brake every two or three sessions.
about psychodinamic psychoterapy, i make 8 patient at day (5 days at week) but it's very hard.
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