Counselling’s Million Dollar Question

I hope this article doesn’t disappoint you.  Its content is not as flashy as its title, but I’m not lying when I say that counsellors would strike it rich if they could predict, with complete accuracy, how much counselling any client would need.  And any therapist who says they know the answer, probably doesn’t.

This isn’t to say that the therapist is lying if they give you a number.  It’s usually however, just a guesstimate, based on previous experience with a particular issue, or issues.  If you have worked with the counsellor before, their knowledge of you may also be influencing their assessment. Or the therapy being proposed is modular, meaning that it is highly structured and could involve a specific format for each session and a predetermined number.

The Key Question

How much counselling will I need? is perhaps the most common question that gets asked of counsellors and it’s an important one.  Counselling can be a significant commitment of time, effort, emotional vulnerability and money, although it doesn’t necessarily have to be, as brief counselling is much more common than long-term counselling, an equally important point because it is often these factors which prevent a person from seeking counselling in the first place.

When discussing the amount of sessions needed, therapists will commonly respond with “that depends,” or they may specify “short-term therapy” or “longer-term therapy” as in many cases it would be unethical for the therapist to specify exactly, because it could lead to false promises or be based on incomplete information about you and your situation. Also, everyone’s needs are different.

Key Factors

That said, there are several factors which influence how much counselling you might benefit from, such as:

  • The issues you are seeking help with, including:  How many there are, how complex they are and how long you have been struggling with them.
  • The type of therapy that your counsellor suggests – some are known to be brief, (depending on who you ask: 0-12 or 0-20 sessions), others longer-term. Short-term therapies may include but are not limited to cognitive behavioural therapy and solution focused therapy, while longer therapies traditionally include psyhoanalytic or psychodynamic treatment, AKA “childhood stuff.”
  • Your definition of wellness, which will influence when you think your course of counselling is complete or, if you’ve requested it, the counsellor’s impression of where things are at for you. Sometimes there is a discrepancy between your sense of this and your counsellor’s.
  • Your current repertoire of coping skills and how effectively you put them into practice.
  • Your current level of support from friends or loved ones influences how resilient we are when it comes to life challenges.
  • Your decision whether or not to include mental health medication as an adjunct to your treatment.  Each person’s needs and experiences are different in this area; some attest to the difference medication has made in improving their mental health while others are clear that for them, it has made things worse.  The decision about whether or not to involve medication is a personal one.
  • Your history with counselling – it is common for those who have benefitted from counselling in the past to seek it again at other times in their lives. In some situations, a repeated experience in counselling may be briefer if learning from previous therapy has been retained.

Other Factors

While not the same question as how much counselling will I need?”, the length of the course of counselling may also be influenced by:

  • A dislike for the counsellor or the counselling methods, which may cause you to end counselling before you have reached your goals
  • An emotional dependency on the counsellor or the experience of counselling, which may make you want to “hold on” for longer than is actually necessary
  • Situational factors: geographical changes, illness, financial changes (for example, not being able to afford counselling) or changes in life circumstances (either client- or counsellor-related)
  • Unethical professional conduct, which I believe is more the exception than the rule: the therapist attempts to upsell the amount of counselling needed or carry on with the client when counselling is no longer necessary.  If you believe that this is the case, options may include: speaking with your therapist about your concerns, trusting your instincts, talking to a friend who has been through counselling before or getting a second opinion from another mental health professional.

Some Tips

But all that being said, the number of counselling sessions that you receive is not outside of your control.  If you have a specific amount of sessions in mind, here are some tips to help make this work:

  • Discuss with your counsellor what number seems sensible to you and ask for feedback.
  • If you have a budget, or are using an extended health plan that you are not able or willing to exceed, let your therapist know ahead of time.
  • Be realistic about the scope of your counselling. If you can only commit to a limited amount of sessions, you will likely get more value out of your counselling experience if you choose one issue to start.  If the issue is complex, or you are experiencing multiple areas of concern, however, this may not be suitable for short-term counselling.  Many kinds of trauma experiences will fall under this category.
  • Choose a therapist who uses an outcome measure of some kind, with some scientific validity, which will help give an objective sense about how well you are progressing and help determine, as therapy moves along, when therapy should end.
  • Dialogue with your counsellor about your progress in therapy and ask for feedback along the way – this helps create an understanding about how much more therapy you would benefit from.
  • Your commitment to and ability to follow through on therapy homework can have a dramatic effect on shortening the length of your therapy; people often get more out of therapy, the more they put in.
  • If you are seeking more intensive, or longer-term therapy, let the counsellor know that at the outset so that she or he can let you know whether there is space in his or her schedule to accommodate this.
  • Remember that you can decide when therapy ends, for any reason.  Of course, it’s always best when you let your therapist know so that they can assist you in concluding this process in a meaningful way.