How often is often enough, how often is too much?

[cosmo]

Hi there folks. I'd love a bit of advice from you, particularly those who are therapists / are in long-term therapy and have some experience.

Background: I had two children in the last 5 years, with serious Post Natal Depression after each child. I saw a great mother/infant counsellor for 6 months with my first child, which helped. I then (finally!!) got to the top of the NHS waiting list for psychodynamic psychotherapy, and was given a year (instead of 6 months) of this with another great therapist. Unfortunately this ended at a particularly awful time for me and I fell apart, partly due to issues of abandonment, and partly bad luck. This really dented my confidence in therapists.

Having been told that I needed further therapy but the NHS couldn't fund it, I have been in long term psychodynamic-approach counselling for a year with (what I feel is) a good therapist. I am paying for this (through the nose!!), as I don't have any insurance, but I feel with my kids - it is worth it so I don't make the same (appalling) mistakes as my parents. I am back with the same therapist I saw with my son, as I already trusted her. I do NOT trust easily, it has taken almost a year to open up properly, even with someone I know.

I am now at a point that I can 'unpack' some of my issues, whilst feeling somewhat secure enough to do so. What I am finding is that 50 minutes a week is now just not enough. Not so much for the volume of what I am discussing... but the week's wait between appointments is agonising, and I find that I don't open up so much... knowing that I have to 'pack up the box' afterwards in order to cope with everyday life (the stuff I am discussing is pretty traumatic). Last week it took me a good few days to 'recover', and would have liked to have gone back the next day to a) help me process the previous evening's discoveries, and b) to explore the issues that had come up at the end of the session.

We have touched on the idea of having more frequent sessions, but as I am paying for this I don't want to jump into it, and my trust issues red-flag any concept of 'more time', however much I trust the therapist within sessions!

Do I go more frequently? Do I do 2 sessions a week, close together or evenly spaced? I won't (due to childcare issues) be able to go more frequently all year, but at least in term-time, maybe that would be enough? Am I being overly paranoid that the therapist has offered the potential of more sessions... is that for my benefit or their wallet's benefit? (see, told you I had trust issues!!).

In an ideal world, I'd go 3x a week, and get this all dealt with, and be a happier person in the long run. But realistically I have 2 kids to care for, and don't have a bottomless wallet!

Help?! Opinions?! Please?!

 

[David Baxter PhD]

There is no one size fits all in therapy. At certain times, some people do find it helpful to have more than one session a week. Others like longer sessions, if that's an option, perhaps 90 minutes instead of 50 so you feel less rushed. Over time, your own needs in therapy will vary also, so that even if you and your therapist decide to try twice a week it's not carved in stone.

 

[Marcel]

Hi cosmo

I have done my share of time in therapy (years) and have gone twice a week before. In my experience, it works well for, as you mentioned, being able to have help and feedback in processing what went on in previous sessions. And it helps to make you feel more connected with the therapist (if this is what you are looking for) - ie it builds a stronger bond so it is 'easier' (if that is possible?) to open up and talk about your issues.

In terms of changing behaviour however, for me, I found that going twice a week did not assist with that. I needed more time - the full week - to be able to tackle homework assignments. So the second appointment in the week was more just for 'talking', feeling connected, maintaining/building trust (which sounds like what you are looking for).

As for the therapist being motivated by money, you said you trust your therapist (somewhat anyway). I would say that reflects your gut feeling that you feel your therapist cares, ie that they are not just "putting in time" with you for money. In any case, even if they were in it for the money, as long as you are getting what you need out of the session - ie that it is benefitting you - that is what is important, in my opinion.

Logistically going twice a week was difficult for me - as you expressed it would be for you in terms of arranging for childcare. For me it was a question of was the pain, worth the gain (of getting myself there) - and for a period it was.

I preferred the sessions to be spread apart, rather than back to back - so I could maintain a connected feeling from session to session. However if you find the day after to be too difficult to manage, as you suggested the second session the next day might be of greater benefit to you. You could always try both ways and see which provided you with the best/most support.

Financially - yes. It is a big hit. But in the long run, if you spread out the benefit over the rest of the years of your life...

You aren't committed to staying with multiple visits per week so it sounds like it might be something for you to try so you can see if the benefits outweigh the costs. I can totally understand wanting to work through your issues sooner rather than later so you can get on with your life.