How often should I have appointments?

Like this whole article, this is just my opinion but I have found that for most of my clients, it is helpful to at least start on a weekly basis.  I am not oblivious about the cost of weekly appointments or the availability of clients, so sometimes this frequency may simply not work but it seems to create a good basis for a strong relationship between therapist and client.   Back in the days of Freud, it was common to go to therapy 3 times a week, so some folks might see weekly as a reasonable commitment.  Another consideration is the severity of the client’s condition.  For example, a client with minor anxiety in social situations but has no particular distress in her home or working life may not warrant weekly treatment.  On the other hand, a severely depressed client at high risk for self harm might require what I call a higher level of care (higher than what I can provide), meaning that they have at least weekly therapy one on one with their therapist, weekly group therapy, and access to a 24/7 support line where they can speak to someone in the event of distress.  When you are finding a therapist, I suggest you ask them their opinion on how often you should meet to see if they can meet your expectations.  I imagine a therapist would probably not want to begin a working relationship with a new client knowing that the client wanted/needed more services than they could provide.

How does therapy help?

Well, I could share my opinion on the value of therapy but I think it might be better to ask your own therapist this question.  People have different approaches and it might be helpful to set expectations upon commencement of treatment.  Some types of therapy are very structured and consist of a specific number of sessions but the duration of most therapeutic relationships is, in my opinion, a function of the degree of morbidity or severity of the client’s presentation, the strength of the alliance and therapeutic fit between therapist and client, and the ability and willingness of the client to engage on difficult topics and try to apply skills learned outside of sessions. I would simply ask my therapist: “What can I expect from therapy?”. 

How do I know when I am finished?

I suggest you consider two measures – your own self-assessment of your mental health and whether you have met your stated treatment goals.  Many people begin therapy following a crisis or other situation where they have had to acknowledge that they need some help.  Perhaps consider how you were feeling at that time compared to the present. Are you feeling sufficiently improved?  Are you looking for further relief and insight? Do you feel ready to end treatment?  When I have a client I have been meeting with weekly and they are making good progress, I may suggest reducing frequency, to say, every two weeks, so they can taper down their appointment frequency rather than make a dramatic change to end services all at once. 

Treatment goals:
When I work with a client, I always create some treatment goals and monitor progress towards those goals over time.  Some therapists work very transparently with clients on their treatment goals, where others may take a more discrete approach.  I would suggest that you ask about your therapist’s approach on setting therapeutic goals and monitoring progress.  This could provide you some insight into the therapist’s thinking about your treatment.  I have frequently found such direct discussion of a client’s treatment to be helpful, and sometimes prompts a frank discussion that might not naturally arise otherwise and can redirect the course of your work together.

Candidly, clients often find it difficult to tell their therapists that they want to terminate treatment.  My impression is that they often worry about hurting the therapist’s feelings but that is just a guess. Your relationship with your therapist is likely a unique one-it is particularly close and sometimes feels almost like a friendship, although I think it is important to keep things on a professional level.  For some clients, they have been working with their therapist for months or maybe years, and they may have told their therapist things they have never told another person before, and this often results in a sense of closeness.  However, it is very important to keep the relationship focused on the client’s treatment rather than sliding into a nebulous and possibly exploitative situation that could ultimately result in a client paying for services that feel like a friendship.   Many people find it difficult to explain that they feel that treatment should end, whether they met their goals or not but I would like to think that your therapist should be able to accept your reasoning, even if they disagree. It is ultimately the client’s choice to end therapy for any reason they choose and that there is often much to be gained from attending those final sessions.

Summary

There are a lot of mental health care professionals that may be able to offer therapy but there are some important distinctions, such as level of education, ability to prescribe, training for formal assessment or other specialty treatment.  You may need to reach out to many providers before you find the right person for you; I wish the process wasn’t so disjointed.  Once you have found a provider, you should expect to complete a fair amount of paperwork and feel free to ask questions about the paperwork or anything else that you don’t understand.  It can be helpful to ask your therapist about their approach to addressing your concerns and about your progress towards those goals over time.  This can help you determine if therapist is in fact helping you achieve your objectives and give you a sense of how long you should remain in treatment.  Ultimately, the more empowered a client feels in their therapeutic work, the more likely they are to have difficult discussions and make lasting changes. 

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