The Question of Frequency in Therapy: How much and how often

Has it ever occurred to you how counsellors or clients decide on how often they will have their sessions? How often does one need to set aside time to explore, grow awareness, and practice feeling in a safe environment?

Before I became a counsellor I somehow had an idea that therapy, for some, might be weekly. In university, and I was in my thirties while in university, I distinctly remember a teacher telling our class that having a week between sessions gives a client time to reflect and potentially learn from the session.He also said that space of time is really needed for healing and that ¬†without it further healing can’t really take place.

I have found this to be true in my own, personal experience and in my professional practice. I have found a few exceptions to this. The first being if my client is in crisis then support, with more frequency, through the initial trauma symptoms is highly recommended, whether that be professional support or that of friends and family. A sense of safety and normalization of trauma symptoms is key to swift and long-lasting recovery from any trauma. The second is when dealing with addiction a higher frequency of support, opportunity for learning and practice is preferred, as it the concept of “rehab”. Individuals are immersed in support and learning opportunities, you might say.

In my private practice, the type of addiction I deal with most is that of eating disorders. This includes any type of focus on food or body that is interfering with elements of daily life needed for healthy living or that produce anxiety as a result of their practice. Because the need for food and your body are always with a person, any negative thoughts or behaviours associated tend to be happening many times through everyday, hence, more frequent intervention helps clients build strategies and self-knowledge to put into practice between sessions. A shorter amount of time between sessions helps clients attain a sense of “getting on top” of their negative strategies and begin to build new ones.

When checking in with clients I generally find I have a sense of what level of support they many need and I ask them what is feeling right for them. As we move through therapy, in the majority of cases there tends to be a natural feeling of wanting to space sessions out more and more and eventually we have no need to meet anymore. The client has greater sense of well-being, understanding and control of their world, at least for the time-being. Ultimately, I try not influence my clients, as much as possible, on the pace of our sessions and let them choose, although I have found that some clients want me to recommend a frequency and in this case I tell them what my gut feeling is and the reasons for my thoughts, putting the decision in their hands because I respect their ability to take care of themselves, even if checking in with me initially, is part of their journey to feel more comfortable in the knowledge that they can take care of themselves.

In regards to how long therapy might continue, again, my clients are very much in charge of that. Money can be a determining factor and I try not to let that get in the way but, money aside, the duration of counselling varies greatly from client to client. I have clients who come in to see me when they are going through something difficult and want room to process what is going on. This tends to help them gain clarity and move forward with confidence. I have other clients whom I am helping with more deeply entrenched patterns like eating disorders or chronic depression whom I will see intensely for awhile (3-6 months) and they may go away for a while and return when they have new thoughts or ideas or progress to add to their healing work.

Some clients come to therapy hopeful but in what might be called a state of readiness that is less established. That is, in “Transtheoretical” model language (“Changing for Good” book summary) , these clients are trying to take action to create change but they are still “contemplative” and not quite there yet, you might say. In these cases, therapy is part of the getting there and I meet them where they are at, trying to create an environment for success and acceptance in case they want to come back later. Working on “Preparation” is also involved in these cases.

I was prompted to write on this topic today because I came upon an article, a blog posting, written by a counsellor who lives in Exeter, Devon. Her name is Amanda Williamson (reg. MBACP) and she wrote about an informal survey she took while at the Exeter Respect Festival, which I believe, would have likely had many people interested in wellness, including professionals from many areas of the wellness field. It got me thinking and checking in about how I do things. Amanda brings up some very interesting ideas to consider. Have a look and see what you think…

Counselling РThe Frequency of Therapy and the Question of Client Autonomy РAmanda Williamson

Dawn Cox does individual and couples counselling in person in Victoria BC or online anywhere in the world. You can find her at


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