Dear Therapist:

While I pushed it off for a long time, I now realize that I benefit from speaking to a therapist. I saw someone when I was in yeshiva in E'Y and now that I am back, I am trying to find someone appropriate. There is a lot that has gone on, and is going on, in my life and I need to speak to someone at least twice a week. So far it is hard enough to find someone with one opening, forget about two. Also, one of the therapists told me he does not do sessions twice a week except in certain specific situations. I think if once is good twice is better. Should I hold out for the twice a week or settle for someone that can at least see me once? Is it indeed a policy by therapist not to meet twice a week? How can I keep myself calm between sessions if there is a whole week between? I'd appreciate any thoughts you have on this.

Response:

There are various reasons that a therapist would institute a policy limiting sessions to once per week. Sometimes it relates to availability. Often, however, the concept is that therapy should not be a crutch; rather, it should be used to build the client’s capacity to resolve issues on their own. Basically, a primary goal in therapy is to negate the need for therapy.

In a sense, the once-per-week “rule” is somewhat arbitrary. Who decided that once per week is the ideal standard? Why not once in six days? Or twice in ten days? Of course, biblical references apart, the week consisting of seven days is arbitrary in itself. Since this is established, however, having therapy (and other types of appointments and tasks) based on the week makes sense from a scheduling standpoint. (It is easier for both the therapist and client to have a standing appointment every Monday at 7pm.)

Assuming that we are basing sessions on the seven-day week, why not twice a week? For many clients, having only two or three days between sessions does not give them enough time to properly process and practice the mental, emotional, and behavioral strategies that are introduced in session.

This brings us back to the initial concept of helping clients to not require therapy. Ideally, for most therapeutic modalities, the therapy session would help the client to identify, learn, and practice strategies. The bulk of the work, however would be done by the client on their own. I often liken this to training. Just as a physical therapist, for instance, teaches clients various exercises, asking them to continue on their own, a psychotherapist is not there to “do” the therapy for the client.

I don’t know what specifically was meant by the therapist who told you that they would only consider twice-a-week sessions “in certain specific situations.” Although they may have had particular types of situations in mind, you don’t appear to know what these may be. Are these exceptions meant only for severe cases? Will they only be considered when a client begs for long enough? Or would this therapist consider twice-a-week sessions initially, with the understanding that the goal is to decrease the frequency as goals are met.

This leads to the question of why you feel that you should be seen twice a week. If you are trying to use therapy as a safety net and wish to rely on the sessions alone for relief of your symptoms, this can be a red flag for you (and for your therapist). If therapists are getting this sense from you, however, they should explain their reasoning for wanting to limit sessions to once per week. Perhaps, however, you truly want to follow up and do the necessary work on your own, but you believe that twice-a-week sessions can help you achieve your goals faster and better. If this is true, you can certainly make that case to therapists. This would help give them the sense that you are introspective, and that your interest in more frequent sessions is well thought-out and considered.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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