Does therapy (or counselling) really have to happen weekly? Wouldn’t less frequent sessions be just as good?
One of the problems with going to therapy is that (in many cases) it’s a regular weekly commitment. Which can be a pain! A hassle. An inconvenience. A chunk of time out of your busy schedule. Not to mention a considerable expense.
Yet it appears that a majority of counsellors and psychotherapists recommend weekly sessions, as opposed to less often.
Why have weekly therapy sessions, instead of less often? Click To Tweet
Why do so many therapists want their clients to attend regularly once a week? Why not once every two weeks, or even once a month?
This question was recently asked by my colleague Jodie Gale, a psychotherapist in Sydney, Australia.
Therapists from around the world (including myself) chipped in with their views, which Jodie collected together and published as a blog post.
Holding, Containment and Attachment Deepen the Work
For me (and many other depth-oriented therapists) the main benefit of regular, scheduled weekly therapy sessions is to do with trust, ‘holding’, and building a secure attachment.
The frequency and reliability of week-in, week-out therapy sessions over a period of time, contributes to a feeling of safety and trust that allows client and therapist to work on a deeper, more effective level. This is often the level at which we need to work in order to allow healing, growth and restoration to happen.
Here’s what I wrote for Jodie’s article:
One reason why attending therapy weekly, as opposed to less often, is beneficial is because it helps make the work more ‘holding’. If you don’t feel ‘held’ in therapy you aren’t going to be able to build the kind of trusting and healing relationship which helps rewire your nervous system.
Therapeutic holding isn’t about touch or physical holding – instead, it’s about emotional safety. Emotional safety comes from many aspects of therapy, but having a regular, reliable session that you go to every week is one of the basics. Going less frequently can really interfere with developing emotional safety.
When you, the client, feel held and emotionally safe enough to connect to your inner self, in the context of your relationship with your therapist, then change, growth and healing can really start to happen.
Attachment in Therapy: Good or Bad?
Does it mean, though, that once you’re attached to your therapist, it’ll be harder to eventually let go and live an emotionally independent life?
No. The aim of attachment-based psychotherapy is in fact to deepen and strengthen your emotional resilience. To help you become more able to form more satisfying and healthy relationships and patterns of living in your daily life, sustainable long after your therapy has ended.
And here are some other important reasons given by counsellors and psychotherapists* in favour of weekly therapy:
Keeps Things Moving
Weekly therapy sessions can keep things fresh and moving along at a good pace.
Good for Homework
A week is just enough time to try out a homework assignment a few times, and report back [many therapists don’t give homework, but some do].
‘Use it or lose it’ – longer gaps can mean forgetting important themes and insights.
You’re Honouring Your Growth Process
Making and keeping a weekly commitment allows you to show yourself that you are prioritising your healing and growth.
Keep Open, Not Shut
It takes a lot to open up and get vulnerable; longer gaps between sessions mean you have more time to close up and harden inside, making your inner self less accessible for change and connection.
A strong therapy relationship is crucial for effective therapy, and this alliance is strengthened and deepened with a regular, predictable, frequent-enough connection.
Less Catch-Up, More Deep-Dive
A longer gap between sessions means there’s more time for stuff to happen in your daily life, making therapy sessions more about catching up with recent events rather than focusing in depth on working on a particular issue.
Keeping A LifeBelt Handy
Knowing that before too long you’ll have a session in which you can offload and discuss things, can help you manage your feelings better in day-to-day life.
Mind the Gaps
Fortnightly (two-week) sessions can easily stretch to monthly if you or your therapist have to miss a session because of being sick or away.
A Place to Land
Clients process feelings and insights after and between sessions, not just during the set therapy hour, and this can feel overwhelming if there isn’t the weekly session in which to ‘land’, unpack and express things.
Longer gaps between sessions make it easier to fall back into familiar unwanted habits of thinking, feeling and behaviour.
Practice and Repeat
Making changes involves repetition and practice, and weekly check-ins can support this.
Holding in Mind
Weekly sessions can help the therapist and client to feel connected and to exist more clearly in one another’s mind.
Building More Efficient Connection
A one-foot-in, one-foot-out pattern in therapy is more common with less frequent sessions; the consistency and commitment of weekly therapy builds connection and hastens healing and growth.
Weekly Sessions Mean Your Therapist is Supported to Help You Better
One last important point: Weekly therapy fits the financial model that many therapists rely upon.
The average therapist has perhaps fifteen** client ‘slots’ per week. That’s how we earn our living and support ourselves and our family. That’s fifteen people’s inner worlds to hold with thoughtfulness, care, presence and emotional connection. But if each client only comes every two weeks, or every month, then that’s going to have to be 30 or 60 people’s inner worlds to attend to, to remember, and to deeply consider between sessions. (Because yes, we therapists do spend quite a lot of time between sessions considering you and your needs). Personally, I couldn’t do that and still be the kind of attentive, effective, emotionally-attuned therapist my clients deserve to have.
If I want to pay my bills, and look after my family and myself, and strive to be an excellent therapist for every single one of my clients, I need to see each client regularly once a week for however long we decide to work together. (This is not to tie anyone into therapy for longer than necessary; it doesn’t matter whether their therapy lasts for a few weeks, a few months, or even a few years).
What are your thoughts?
Whether you’re a client or a therapist, what’s your experience and your view on the value of weekly therapy? Let us know in the comments below. And don’t forget to head over to Jodie’s blog post ‘Why Counsellors and Psychotherapists Recommend Weekly Therapy’ to read about the value of weekly therapy sessions in more detail.
**Many therapists and counsellors see more than fifteen clients weekly, whilst many other therapists see fewer; I’m just offering what seems to be an average, based on therapists I know.
*Thanks to my colleagues Jennifer Brady LPC, Kameela Osman MSW RSW, Alicia Hite MS. LMFT, Cindy Blank-Edelman LMHC, Rebecca Newkirk LCSW, Renee Outland OTD OTR/L, Toni Jackson, Sheryl Woodhouse LMFT, and Jodie Gale.
Love this article! It captures so well what I am trying to say every time a client inquires about coming every other week. Thanks for writing this.
Emma Cameron says
I’m so glad you like the article, Melanie. I’ve often had that experience myself, where it’s hard to find the words to explain why something is important.
I found having sessions once every two weeks worked really well for me. I was still able to develop a deep relationship with my therapist but the time between sessions allowed me to realise that I could manage anything that comes up between sessions. So for me it was more empowering and stopped me becoming dependent on my counsellor. I was very active in my own development and I continued my work between sessions by for example journaling. Weekly session would not only have been too expensive for me but also overwhelming, I needed the time between sessions to process and reflect on the previous one.
Whilst weekly sessions might benefit some people, but for me every two weeks worked better. I grew alot through my personal therapy and I believe the frequency I went for counselling was right for me.
Emma Cameron says
Thanks for sharing this! A very interesting perspective. You are the best expert on what works for you, and you clearly found enormous benefit in doing therapy this way.
Thanks for contributing Emma -I always love what you have to say x
Emma Cameron says
Thanks Jodie – likewise! 🙂
If I had weekly therapy I think I would combust!
Interesting article to know a therapist’s thoughts though … will check out your other blogs.
Emma Cameron says
Thanks for sharing your thoughts, Kathy! I’m intrigued about the ‘combustion’… but it sounds like you are in touch with what is right for you. And it’s probably worth me saying that there are indeed plenty of therapists who are happy to work with clients less often than once a week.
What about more frequently? For similar reasons you gave above, i think a week between sessions is too long for me. Most of the reflection and thought progress i make is the day following a session which i forget to discuss by the next week. Are the occasions when you can have a week of daily sessions followed by less frequent sessions if needed? I feel that would work best for me to build up the initial trust with the therapist. Are there reasons why this is avoided? Or is it simply due to easier timetabling for client and therapist?
Emma Cameron says
Thanks for your thoughts and questions, E. I can understand why you feel it could be good to work more often.
One thought I have on reading your comment is that it’s fantastic that you can feel the therapy ‘working’ in you, in the day following a session. (It’s probably also working on the other days, too, but in a way that is less detectable or obvious to you). Could you perhaps jot things down in a journal – or make an audio recording of your thoughts and feelings after a session – then re-listen or re-read that just before your next therapy session?
Working at a frequency of more often than once a week requires a certain depth of training which many therapists have not undertaken. A therapist who works with clients twice-weekly (or more often) should also have experience of working at this frequency for an extended period as a client themselves. This is because it can bring up all sorts of stuff that may not have come up for them so much in weekly sessions, such as intense attachment/dependency issues. (Attachment/ dependency issues are not, in themselves, bad or wrong, but the therapist does need to know how to handle them so as to avoid accidentally retraumatising the client).
And to answer your question about having sessions more often for certain periods, I think I’d advise against that, because I believe that the unconscious tends to need consistency and regularity.
I hope that helps!
Jodie Gale says
Emma, I agree re working more than once a week. I often work with client 2-3 times a week but I am trained in depth psychotherapy and was also in depth psychotherapy 3 times a week for several years. The therapist must be experienced at working with dependency, and subsequently separation and individuation.
Flo Flower says
I live in Denmark, where you can have weekly sessions but the days constantly change So one week it is a Monday you have therapy, the following a Wednesday and the following week maybe a Friday.
I have had to ask my current therapist for a fixed day every week. I hope that doesn’t sound too demanding. I like knowing every week I have therapy on say Mondays. Too much day changing makes me feel uncomfortable.
Emma Cameron says
That’s interesting, Flo – I wonder if that’s a common practice in Denmark, or if it’s just your particular therapist who works that way.
Dave Anderson says
That is interesting that a strong therapeutic relationship is important for effective therapy. Maybe it would be good to get a therapist that you can build a relationship with. That is something I would want to have if I were needing therapy.
Brad Erwin says
It’s good to know that you are more able to build a strong relationship with your therapist and gain a predictable connection when you attend therapy weekly. My brother is looking into ways that he and his family can improve their mental health and enjoy life more in general so that they can grow as a family. I will be sure to recommend he look into setting up weekly individual therapy sessions for each member of his family so that they all have the opportunity to develop deep relationships and improve upon their mental health.
Greta James says
I love the point that you present about how easy it is to close up and how hard it is to gain trust and vulnerability if you are not seeing someone regularly. For the last few weeks, I have been having a really hard time getting through the day. I just feel sad and like I have no one to talk to. I wonder if I should look into therapists in my area that could help me feel like my old self.
Jane Bellamy says
Do you think it’s important for the session to be on the same day each week ? i.e is there something disruptive in the therapist changing the day and if so why would that be ?
Emma Cameron says
I think it can be important for many therapist-client dyads, and less important (or unimportant) for others. It depends on many factors: the type of therapy, the depth of the work, the particular people involved, and the issues being worked on.
Thank you this was really helpful as I experienced a pattern was just beginning to build for one client and contributing to avoidance and progress. I hear also that it suits some client but it seems to be meeting somewhere in the middle or just accepting this happens in counselling – thankfully not too often. The comments about the counsellor’s need to plan to at least some extent for financial, family reasons etc is important to me too in realising I’m not being unreasonable but will have to navigate this a bit better in future.
I have been having therapy every Monday for the last 18 months and this week my psychologist has told me we are reducing to fortnightly. Her statement was that reducing therapy may improve therapeutic gains. We have been doing schema therapy and although I feel completely rejected and vulnerable, my healthy wise side is meant to be that “therapy is not ending”. This change in therapy has destroyed me; bringing back self harm and thoughts of suicide. I’ve stopped meds, barely eating or drinking and either not sleeping or sleeping too much. I really liked knowing that on Monday I have a therapy session and look forward too it…but am I now dependent on her, and not getting any better? Now I feel let down and unwanted.
Emma Cameron says
Hi Karlee, it sounds like you’re going through some painful stuff. I can’t comment on your situation, of course, as I don’t know you and am not your therapist (also I’m not trained in Schema Therapy); but I hope you and your therapist find helpful ways to work through what’s happening.