Reflections on Therapy Frequency and Considerations

As both a therapist and a therapy client, once every year or so I consider what frequency seemed most successful for my clients and as a therapist supporting them. Did it vary depending on demographics and/or the topics that initially brought them to therapy? Also, would I show up/plan sessions in a different way if everyone on my caseload saw me at that frequency? The answer is probably and contemplating that led to realizing the frequency with which I seek personal therapy differs from what I recommend to clients- not because I don't think it's beneficial but because I fall into similar traps and patterns clients name over and over again. 

As a therapist, I have found that working with the majority of my clients every 3 weeks seems to be the sweet spot of space to breathe, integrate, and explore, even as a starting point. This can be a surprise to clients who have attended therapy before and were told the therapist wanted to meet with them weekly. While in theory weekly therapy "should" create a routine, and momentum and speed up progress, often for clients with heightened nervous systems whether that's due to neurobiology, trauma, or high stress, weekly is too frequent. This is because the body and brain aren't able to catch up, process, and settle before being back in the therapy office; which can often enhance a feeling of having to catch up thus adding to stress and dysregulation. 

Reflecting on therapy frequency above left me pondering, is every 3 weeks my ideal as a client as well, and where do I think I'd be if I made that my focus/goal? Ooof did the answer hit home, yes it would be my ideal and where do I think I'd be? Hmm, definitely a profound difference of some kind the outcome of which is to be determined.

Why do we as clients often not follow the recommendations our therapists give regarding frequency? Sometimes it's an indicator that the fit just isn't there, sometimes it's that life has other plans and it's easier to prioritize the external demands on time and focus than the internal ones for ourselves. Other times it's just straight-up capitalism and cost of living. Let's be real - most benefit plans don't offer comprehensive mental health coverage if it's offered at all. For most benefits aren't provided and with the cost of living increasing disposable income is almost nonexistent making mental health care a luxury not a necessity for quite a few. Sometimes we'd rather do therapy infrequently and have a good fit/the right support. It sucks that low-cost counselling is more often than not interns, and while they are deeply appreciated and skill varies due to backgrounds going into the field - it isn't always what we're looking for or need. The low-cost options outside of this often have long waits and minimal choice in who you're matched with. 

As a therapist I notice inconsistency in my attendance due to finances, other commitments, wanting to be in the right headspace and have time and energy to do the work between sessions, or even not feeling like there's enough wiggle room, and like clients sometimes there just isn't enough feeling present to fill a session. I personally don't want to shift back into work after a therapy session for myself - this sometimes means I wait a bit longer so that I can accommodate that for myself. 

All that to say it's hard to divest therapy frequency and outcomes from capitalism and the ways the mental health system is failing us as a collective. I wish I had an answer or solution other than let's b*rn it down and start over but I don't currently and can't fix it as a solo human.

Shifting focus a bit I wanted to also touch on times when every 3 weeks be too long between sessions or too frequent. Every 3 weeks is great if there isn't anything urgent or intense happening in your life. When things feel critical, more often than not temporarily shifting to every week or 2 weeks can help course correct. Or if you're financially able to meet more often AND this isn't adding to stress on an emotional, mental, or logistical front heck yes go for it! If you're meeting your therapist every 3-4 weeks and are struggling to fill the time or are in a place where it's predominantly maintenance - less frequent may be a good fit. When considering moving to less than 1x/month it's worth checking in with your therapist to see how they handle absences longer than 2-3 months between sessions. 

As a client what have you noticed for yourself as an ideal frequency?