The Case for Weekly Therapy



In the early days of Psychoanalysis, patients attended sessions three or four times a week for several years. Analysts believed (and those who practice this way still believe) that the intensity of relationship, momentum and often conflict that could form with multiple weekly sessions over a significant period of time was the best way to effect lasting significant change in a person.

Not many of us have the luxury of time or resources to support such an endeavour now. It's probable that not many of us did then either. Analysis was for the privleged class. However, there is value in the idea of consistent longer term engagement with a therapist if you are looking to effect a particular type of lasting long term change.

The most common methods of counselling in present day is a shorter term modality. A course of Cognitive Behavioural Therapy is 6-24 weeks. A course of Solution Focused Brief Therapy is supposed to be 3 sessions. There is value in time limited approaches. It focuses the work and the parties to the work. The sense of urgency may promote client engagement and client engagement is linked to better outcomes. If a person has never worked with a therapist before and never had the opportunity to be self-reflective in any way, there are gains to be had and they have been documented by studies over and over again.

However, having been at this work for a long time, I can't help but feel (and see and know) that this is not the entire picture. I trained originally in a long term modality and orientation with the Toronto Institute for Relational Psychotherapy. When I got out into my own practice I fundamentally worked this way. I also took a lot of courses and workshops. I did a Masters degree. I worked with Employee Assistance Plans and through third party insurance. In each of these domains, the push was always to work less with client, push the work along quicker, find efficiencies.

I'll admit that I have done good work in a short term frame. But if I had to describe what I was doing, I would say it was "low hanging fruit". Someone comes to therapy and for the first time, another human compassionately hears a story. They feel better. Someone comes to therapy and the therapist helps them shift a few communication habits. They go home and it works. They feel better. Someone comes to therapy with panic attacks and learns a few self-regulation skills they can practice at home. They feel better. A therapist suggests that anger is a flip side of sadness and lightbulbs go on. That is measurable success. I could go on with examples of how my shorter term compassionate, psychoeducational, directive interventions have helped people who didn't have the time or financial resources to see me more than 3-6 times at once.

It has been about 17 years since I saw my first client and interestingly these days, I am coming full circle. I was recently contracted by my original program to be a teacher there. That has been immensely exciting and enriching. It has also been illuminating regarding how my practice is functioning and what I am doing with my clients. Although the principles and ways of being of Relational Psychotherapy have always been present, I have been reluctant to push for people to see me weekly and to commit for six months or maybe a year. This enlivenment of my Relational practice through teaching it in profoundly experiential ways has also shifted how I am with my clients and it is changing things for the better. I'm seeing work get unstuck and deepen. I'm seeing breakthroughs in different more profound ways. These things are happening with my longer term client relationships and in the places where I work weekly most often. I have come to realize more solidly that while the low hanging fruit is tasty and necessary to pick sometimes, the fruit we access with more investment and more time is more satisfying. Much like analysis, it gets at the core of what is wrong and holds out the hope for fundamental healing and change. I may know that sadness is the flip side of anger but if sadness was never tolerated in my family, how will I know how to be with it? It is that sort of work that longer term weekly therapy can give us access to. It's what my training gave me the opportunity to do and what the students I'm working with now are experiencing. It was and is so very very worth the investment.

Maybe you are interested in learning more about how long term work makes fundamental lasting change in your life. Give me a call or contact me through my site.