One of the biggest questions I get from new clients is “how often should I come for therapy?”This question can also re-emerge  after folks have been in counselling for some time, are recognizing that they have made significant gains and are wondering whether the pacing of sessions now needs to be readjusted.

Let’s Start With Some Caveats

Mitigating Factors

Therapists’ recommendations are typically specific to each individual client; a general recommendation around therapy frequency may not apply.

Some of the reasons why a therapist may modify their recommendations around frequency include:

• Client finances: can they afford what is being recommended? Do they have alternative funding sources?
• Circumstances: do they have time time to participate in therapy at the recommended frequency?
• Extraordinary circumstances: are there systemic barriers that prevent participation in the suggested therapy schedule?

The Importance of Collaboration

Also, while a therapist may have an idea in mind about what frequency is right for you, this recommendation should incorporate collaboration: What do you think? Do you agree or do you feel that a different frequency would be more appropriate? Please speak up!

The Importance of Review

Frequency of sessions changes throughout the course of therapy. A typical arc is for clients to come in more frequently at the beginning of counselling, and, as gains are made, the time between sessions increases. This is to promote client confidence and increase coping skills. From time to time, it can be very beneficial to review your therapy schedule with your counsellor. Is it still meeting your needs? Why or why not?

Therapist Factors

Therapists vary in the amount of time they take off during the year, all of which influences the frequency of sessions. Reasons can include:

• Therapists’ vacation time
• Therapist illness
• Educational leave
• Therapists’ personal life factors: e.g. childcare, eldercare, death of loved ones, other life circumstances.
• Additional factors such as statutory holidays, weather events etc.

Scheduling

Some therapists have all or most of their clients on a fixed appointment schedule while others rely on clients to make their own schedule. Some therapists offer a combination of both. Obviously, factors such as procrastinating on booking can interfere with ideal counselling frequency, as can therapists not having their schedules open far enough in advance for clients to adequately plan.

Let’s Proceed!

So, after all of this, I write this article as if there are no significant barriers, so we can take a closer look at why certain therapy schedules are recommended. Of course, what works for you may need to be modified depending on your situation and factors mentioned above. And, like almost anything in life, there are no hard and fast rules here. Everyone’s situation is unique, as are the recommendations.

Once a Week

May be recommended for clients who…

• Would benefit from more intensive counselling support, often related to intense distress/crisis, highly challenging life situations or more acute mental health concerns.
• Are looking for a more intensive approach in order to accelerate therapeutic gains.
• Are just starting out in therapy, wanting to grow the therapeutic relationship more quickly, and are seeking early therapeutic growth.
• Are going through a rough patch that would benefit from extra support.

Once Every Two Weeks

May be recommended for clients who…

• Are looking for steady, supported growth. Enough to gather momentum, but not so much support to make it difficult to assess whether or not personal coping is improving.
• May be experiencing a moderate to high level of life stress, mental health concerns or challenging circumstances.
• Are seeking to work on deeper or longstanding issues in a dedicated way.

Once Every Three Weeks

May be recommended for clients who…

• Have been attending counselling for a period of time and have made some good gains.
• Are feeling that they are coping reasonably well in-between sessions.
• Continue to have active therapy goals, but are seeking more time in between sessions to try out new ways of approaching things.

Once Every Month

May be recommended for clients who…

• Want more space to work on their goals.
• Have made changes through counselling that they are proud of.
• Are feeling more confident in their coping abilities.
• Recognize that key aspects of their situation have improved.

Once-monthly is also a common cadence for clinical supervision.

Beyond Monthly

May be recommended for clients who…

• Have achieved a number of their goals.
• Have addressed their primary reasons for coming to therapy.
• Are looking to maintain gains.
• Value their connection with their therapist in a way that helps them feel encouraged and affirmed.
• Are looking for a periodic check-in with the counsellor to ‘stay on track.’
• Are seeking sporadic and strategic problem-solving
• Are looking for a check-in, if they have hit a bump in the road.

While some clients in active therapy attend at a frequency beyond once a month, this is generally not ideal because oftentimes the first portion of the session is spent re-orienting to clients’ present circumstances, which may have changed significantly since the last session. Such catch-up leaves less time to work on current needs.

In Conclusion

Please keep in mind that the above points are meant as general guidelines only, and that your therapy schedule is unique to you, the work that you are doing with your therapist and where you are at in your counselling journey. There are no hard and fast rules. Scheduling should evolve over time, in response to your progress and should always include your feedback. If you feel like your therapist is recommending a frequency that does’t make sense to you, speak up! Ask them why they are making this suggestion. Do they listen to your rationale? If you’re not satisfied with their response, take a break or choose another therapist.