To show up or not to show up: the matter of therapy frequency

Lately I’ve been wondering about what it looks like when, in my role as a therapist, I invite my clients to consider how regularly they attend their appointments (or not). Therapy frequency can be a complex, nuanced, and challenging matter to discuss due to the many variables impacting what that looks like for each individual.

First and foremost, life is busy! There are many competing needs in everyone’s schedule, some of which are time with family, work, daily chores, social commitments, travel plans, and health concerns (ongoing or unexpected). Then, life is expensive. After the COVID-19 pandemic, we feel the impact of the galloping cost of living, which requires strategic discernment between what is essential, and what is optional. When this assessment takes place, mental health-related expenses are often the first ones to be cut and relegated to the “it can wait” category. Finally, people are resilient. Human beings are able to endure difficult circumstances for long periods of time until their struggle becomes unbearable. The skill that enables people to survive, is the same skill used to look past the signs of mounting stress that can lead to overwhelming struggles.

So, when it comes to show up or not show up to therapy, how does one decide what to prioritize, and when? Your choice depends on where you are, where you want to go, how long you’d like to take, and how fast you’re able to get there.

Where you are & where you want to go

Usually, at the beginning of the therapeutic relationship, clients have a clear vision of the reason that led them to seek help in the first place. The problem is at the forefront of the therapeutic work, and all resources are devoted to understanding it, deconstruct it, and start implementing tools to address it. During this stage, the priority is clear: get better, fast!

After a few sessions, clients may start expressing that they feel less pain, less discomfort, and find themselves handling life’s circumstances differently. This experience of success is encouraging, empowering, and a direct fruit of the efforts employed in the previous stage. Although, at this point, the initial therapeutic goals aren’t fully met, this is often the moment when clients feel enough relief to decide to shift their focus to other areas of their life. Clients who don’t “take their foot off the gas” after this initial relief, usually find themselves doing the deep, uncomfortable work of exchanging their old way of being in the world for a more helpful, adaptive one.

As time spent practicing new skills goes by, these changes become so engrained that clients are surprised to notice that they are now second-nature. This maintenance stage allows for less frequent sessions, and tends to culminate in terminating therapy, or setting new therapeutic goals to address other areas they’d like to change.

When you think about this moment of your life, where are you on your therapy journey?

Are you in a moment of crisis, of realizing that the way things are can’t go on?

Are you feeling some relief, good enough to put things in the back burner for a while?

Are you in the middle of deep, transformational work, often painful, and yet addressing old ways of being in the world that no longer serve you?

Are you in maintenance mode, noticing a fresh perspective, and wondering why it’s hard to remember how things used to be when you were struggling?

Or are you all done, having reached the goals you set for yourself at the beginning?

If you’re in crisis, or at the start of your journey in therapy, research shows that you’d benefit from weekly sessions. This will allow you to identify what’s getting in the way of your healing, and tackling it with the support of your therapist.

If you’ve experienced some success and are enjoying some relief, research shows that you would still benefit from weekly or bi-weekly sessions. Although you’re feeling better, if you haven’t fully reached your initial goals, it would be detrimental for you to slow down now. If you do, it’s likely that you will find yourself back to that first stage of experiencing crisis soon. And that will require your initial effort all over again.

If you’re doing the work of changing consistently and autonomously, it’s likely that attending sessions every two to three weeks could be helpful for you. This would allow your therapist to support you in maintaining momentum, while simultaneously allowing enough time to implement changes, as well as process its impact.

If you’re in maintenance after experiencing deep success, and notice a significant shift in your way of approaching the world, it’s likely that you’re at the stage where you’d benefit from monthly sessions to solidify your gains.

And if, after all this work, you find yourself needing to come to therapy even less frequently than that, then maybe it’s time to celebrate your accomplishments, and terminate treatment for the time being.

How long you’d like to take & how fast you’re able to get there

In an ideal world, where schedules, commitments and finances are perfectly aligned with clients’ current needs, people would make decisions based solely on where they are and where they want to go in their therapy journey. Unfortunately, more often than not, life is not ideal, and people express lacking the resources to do what they’d prefer.

With this in mind, it’s important to assess what’s needed, and what’s feasible for you. Now that you’ve been able to identify where you are, and where you’d like to be, what’s accessible to you? If you’re in the first stages of treatment and aren’t able to attend therapy as regularly as you’d like, it’s helpful to discuss a frequency that works for you with your therapist. After you determine how often you can attend therapy given your current circumstances, the next step is to honour that agreement to the best of your abilities. By committing to a less than ideal frequency of therapy, and even though research shows that it will take longer to experience the benefits of treatment, you’ll be taking care of yourself in the best possible way for now.

If you, on the other hand, notice that finances are not a barrier, and there are other factors getting in the way of the ideal therapy frequency for you, it is worth it to discuss these with your therapist, and hopefully come up with a plan to address it. Your resources of time, effort and finances are too important to waste, so it is paramount to tackle anything preventing you from getting better and succeeding in therapy as soon as possible.

At the end of the day, only clients can determine what works best for them when it comes to how often they go to therapy. As Elinor Greenberg expertly explains, the matter of therapy frequency isn’t about therapists “trying to get more money.” It’s about clients knowing what they need, knowing their options, and reaching their goals.

I leave you this invitation: consider yourself, consider your goals, and consider your circumstances. Then choose accordingly, as best as you can, whether to show up or not. And make no mistake. Whatever you choose, that choice is for no one else but you.