What Kind of Therapy Schedule Should I Expect with a Therapist
July 28, 2016 3:09 PM   Subscribe

Every three or more weeks is not cutting it, Everyone I have spoken to at the therapist office acts like I'm unique in my feelings and is at a loss for any answers/solutions.

Hello,

I am struggling with anxiety and overthinking, and have been attempting to see a therapist for it. The problem I am having is I keep having 3 or more weeks between appointments. This is really frustrating.

I struggle to remember or keep in mind things during that time scale, if there are even any things put to me to practice or keep in mind. And heaven forbid I am sick or otherwise unable to attend an appointment, that exacerbates the problem.

Am I crazy? Has media given me false ideas about what therapy with insurance is? How does one find a therapist they can see once a week? At least for a few months at the start. Do I need to pay more? Why is the place I'm going not offering that?

I'm at a point where I'm struggling with really difficult thought patterns and I need more support. My go-to analogy for explaining my feelings is to compare it to discussing philosophy with a 10 year old for 45 minutes, and then saying "see you in 3-4 weeks!" and expecting them to remember everything next session.

I know therapists are busy, and that it's a very tough job. But I don't understand how this can be effective treatment. I can't remember what was upsetting me in the days following my last session when it was 3 weeks ago.
posted by OwlBoy to Health & Fitness (27 answers total) 1 user marked this as a favorite
 
Best answer: I have NEVER had therapy where the norm wasn't to meet once a week, and I've been through a ton of (useless, unfortunately) therapists. I am in a major city in the US, but it was the same when I lived in a small town.
posted by Violet Hour at 3:22 PM on July 28, 2016 [13 favorites]


Best answer: I am a clinician in training, but I am not your clinician in training. I would never see a new patient/client once per three weeks, for many of the reasons you describe. I know nobody in my program or my entire University system who would do this with a new client. I would personally find it unethical to offer such an arrangement to a patient... it fits no evidence-based standard of care for face-to-face therapy for which I am aware. Indeed, more frequent sessions per week are related to a higher likelihood of depression alleviation, and that's just moving from 1 session/week to 2/week.

As for pragmatic advice with regard to how to find an affordable therapist in your area who can see you on a real therapeutic schedule: if your MeFi information is up to date, I might recommend the psychological clinic at the University of Wisconsin. There is no evidence that training clinicians who are supervised are "objectively" worse than full-fledged therapists; some studies actually find a small effect in favor of training clinicians, in part because training clinicians are highly motivated to succeed, are closely monitored and advised, and have a lower case load than the average clinician.
posted by Keter at 3:22 PM on July 28, 2016 [5 favorites]


Response by poster: I'm currently going to Wisconsin Psychiatric Institute and Clinic. It's part of UW Health. I forgot to mention that part. It seemed to me like that would be the best bet in town, being University affiliated and stuff.

I have also been very direct about my feelings, both to my therapists (I have had two here now, same issue with both) and to to front desk people. I'm always told they just don't have room in the schedule.
posted by OwlBoy at 3:29 PM on July 28, 2016


Am I crazy?
Nope.

Has media given me false ideas about what therapy with insurance is?
Possibly. No one in media talks about copays and the actual number of sessions insurance clears providers for. with less than awesome insurance you can sometimes be limited to a few visits a year to be covered under insurance.

How does one find a therapist they can see once a week?
You call up a bunch of therapists that deal with your particular therapy needs, and you ask them if their scheduling would allow for you to see them once a week. Hopefully those therapists will work well with you. Finding a good therapist that gels well with you can be difficult, and can sometimes require a few months of bouncing around before you get down to business.

Do I need to pay more?
Possibly, but not probably? Therapists have an oddly wide range of payrates. Some of the better ones do indeed charge more.

Why is the place I'm going not offering that?
Have you asked them directly that question?

The 3+ week gap in visits might have several reasons behind it happening with this one therapist. This might have to do with your schedule vs. the therapist's schedule. I know an inordinate amount of therapists socially who have private practices, and their scheduling requirements are all different. Some work weekends, some don't. Some only have one or two evenings they work, some don't.

If this is a private practice situation, some therapists don't schedule well, and slightly overbook themselves. Some therapists do this on purpose because of no-show rates. Sometimes therapists with a really good reputation have too many clients and have a hard time turning people away.

Clinics can sometimes be overloaded, and can't hire to keep up with demand. Organizations like Kaiser are/were kind of infamous for this. Sometimes it would be two months between visits.

You should be straightforward with your therapist and the office staff (if there is any) and ask them these questions. They should be able to clear up if there's a legitimate reason why they cannot see you more frequently. If this is unacceptable, you should find a new therapist.
posted by furnace.heart at 3:30 PM on July 28, 2016 [1 favorite]


This seems very strange to me--in my experience the default is definitely seeing a therapist once a week. Are you seeing the same therapist each week? In my experience usually the client and therapist work together to find a weekly time slot in the therapist's schedule that works for both of you and you get that same time each week, unless the therapist is away or ill that week.

If your therapist isn't willing to do that, I would look elsewhere. You might have better luck at someplace that is not a clinic. Psychology Today has a therapist-finder database, and some insurance companies have searchable databases of providers too.
posted by needs more cowbell at 3:37 PM on July 28, 2016 [1 favorite]


Best answer: This has been the frustrating norm of my experience. However, I've either had a) crappy insurance where the therapists who took that insurance were not that great or were overworked or there was some arbitrary limit on how many sessions we could have so they would space them out or b) been part of a weird system where in practice, you're only allowed to see the therapists directly employed by the system and they are totally overbooked. Especially if your therapist is one of the "good" ones--then you're looking at a month or more to get into see them the first time.

If you can't see a different therapist, maybe it would help you to keep a little therapy notebook or a file on your phone? Write down the "homework" they give you and take notes in between sessions on your progress and anything you'd like to discuss with them.

ETA: You're not crazy for thinking this is totally unreasonable and not good care.
posted by purple_bird at 3:56 PM on July 28, 2016 [3 favorites]


Your update is really funny to me because I got to it just as I was thinking, "Huh, all these people are emphatically saying this is uncommon, and yet that therapist they sent me to at UW was just like that..." So I guess we should both find new therapists!
posted by teremala at 4:05 PM on July 28, 2016 [3 favorites]


One point is that the Department of Psychology clinics are often different and separate from Psychiatry, so you may have some luck at the referral I sent you, even if UW-Psychiatry has some bizarre practices. Yikes!
posted by Keter at 4:13 PM on July 28, 2016


I used to see a therapist at a very busy clinic. The trick was to book multiple appointments at once. They'd start booking October on August 1st and you'd call the first week of August (ideally on August 1st) and book weekly for October and repeat September 1st for November. I will say that the people at the front desk were quite up front about the fact this was the best way to get consistent appointment (especially if you wanted a consistent appointment time) and would always offer to book you multiple appointments. If you like who you're seeing, it's worth asking whether they'll book multiple appointments.
posted by hoyland at 4:14 PM on July 28, 2016 [1 favorite]


That seems really weird to me.

Do you have strong schedule constraints, or are you open to taking any appointment? If you were trying to fit it in around normal work hours, most practices have a couple of evenings they work late, so it's totally possible - but I could see those hours being high-demand, such that it's hard to schedule for *every* Thursday at 6:30 pm, and they could only offer you 2 Thursdays from now, if Thursdays are the only time they have late hours.

But if you really want a weekly appointment at any time the therapist is free, and the therapist is just not free more than once every 3 weeks, that's not good. And if the practice thinks that this is normal for their doctors, then it's time to find a new practice, because it's not the norm outside of UW.
posted by aimedwander at 4:15 PM on July 28, 2016


On lack of preview, yes, you ought to be able to advance-book multiple/recurring appointments. If the scheduler thinks this is weird and will only let you book your next visit, that is when it's time to find a new practice.
posted by aimedwander at 4:17 PM on July 28, 2016


My go-to analogy for explaining my feelings is to compare it to discussing philosophy with a 10 year old for 45 minutes, and then saying "see you in 3-4 weeks!" and expecting them to remember everything next session.

A good (professional, well trained, educated) therapist should be taking notes during their session with you. If they aren't, and they're expecting you to do the heavy lifting re: what you've been discussing with them thus far, that alone is cause for concern.
posted by Hermione Granger at 4:17 PM on July 28, 2016 [1 favorite]


Best answer: The problem is that insurance companies are terrible, and it's relatively easy to stay competitive while not accepting insurance. So the doctors who accept insurance are likely to be overburdened. There's a fair amount of litigation going on now because insurance companies are haven't ramped up their resources with sufficient providers after mental health coverage requirements were expanded. I'm looking at you Kaiser. *shakes fist*

Once I bit the bullet and resigned myself to doing the out-of-network red tape, I was able to find someone great who could work with my schedule and see me regularly.
posted by politikitty at 4:24 PM on July 28, 2016


When I began therapy three years ago, I wanted to make a lot of changes quickly. I met with Doc Awesome twice a week for about two years. Very glad that I did.

Very glad.
posted by trinity8-director at 4:25 PM on July 28, 2016


Response by poster: Thanks for all the replies. Some things to add that address points brought up by answers:
• I'm totally flexible on time/day. I'm lucky to have a job/boss that understands my situation.
• I do book ahead, and that's the beast answer they have for me. The closest this ever gets me is a two week separation of appointments sometimes.
• My therapist does take notes, but it's obvious she can't quite keep it all straight sometimes. And this leads to a lack of any flow or feeling of connection.
• I don't think my therapists here have been bad, I'm more so frustrated with the scheduling, and I feel like the whole thing is working out in a very unoptimal way that impedes any sort of momentum.
posted by OwlBoy at 4:31 PM on July 28, 2016


> I forgot to mention that part. It seemed to me like that would be the best bet in town, being University affiliated and stuff.

Having the "best" won't do you any good if you can't see them in a timely fashion. The only times I saw therapists that infrequently was when we were ramping down because my need for treatment was diminishing. Otherwise, it was weekly, almost always the same day and time every week.

I think you need to start researching a new therapist (sigh, I know, it sucks, but yeah).
posted by rtha at 5:05 PM on July 28, 2016 [1 favorite]


Just to make sure: You're definitely seeing a therapist (Ph.D., Psy.D., LCSW, MFT), not a psychiatrist (MD), correct? I work with a psychiatrist and we have many clients who seem to think they're getting therapy from our psychiatrist, when really she's doing monthly med management with some general check-in-type stuff. If you're seeing a psychiatrist, what you're describing would be normal-ish.

If you're seeing a therapist, then unfortunately what you're describing can also be normal-ish, but it's generally the sign of a really overbooked clinic. I've seen similar things happen at some low-cost health centers, where there are just not enough therapists to fill the need. I don't think it's appropriate care, and if it were me, I'd find a new therapist.
posted by lazuli at 5:33 PM on July 28, 2016 [2 favorites]


Best answer: (I'd find a new therapist outside this clinic, I mean.)
posted by lazuli at 5:34 PM on July 28, 2016


I don't know squat on your health care situation, but I know my HMO offered my mom therapy sessions at something like every other week for a half hour session in the next town, which was...just not great, so she stopped. Is this some kind of HMO-type thing (I don't know squat about your healthcare and live in another state) requirement? You may have to find some out-of-network therapist willing to take sliding scale or something if this is a requirement of your HMO to go so infrequently.
posted by jenfullmoon at 5:38 PM on July 28, 2016 [1 favorite]


Ugh. I see mine twice a week and have for ten years. I couldn't imagine every three weeks. Ugh. I'm getting anxious just thinking about it.
posted by kbanas at 5:53 PM on July 28, 2016 [1 favorite]


Best answer: I work in this kind of field, but I'm not your therapist. In some settings I'm aware of, clients can access a limited number of sessions at a subsidised or free rate, and the likelihood is that most clients can't afford more sessions than that. Some therapists manage this situation by seeing the client e.g. once a month, with the idea that the client will be supported over a longer period. However, this is a different view of what therapy is from the one I prefer, where therapy helps you to improve your life in an ongoing way - lifting you up so you can keep yourself there, not just preventing you from falling further. Different therapeutic schools hold different views about what is appropriate - I wouldn't assume that weekly is the optimum frequency, but I would be suspicious of anything less than fortnightly as a usual schedule. I suspect this practice is too busy and/or not proactive enough for your current needs.
posted by Cheese Monster at 7:39 PM on July 28, 2016


My therapist is a trained analyst, so regular meetings are essential for continuity, and it gives him more to analyze. For 7 years, it was mostly once a week, but when I could afford it, I did twice a week for a few months and noticed a real difference with the more frequent meetings. (I read today in that NYT profile that Howard Stern saw his analyst 4 times a week!) I would be suspicious of a therapist who thinks they would be able to really connect usefully with their client once every three months.
posted by eusebis_w_adorno at 10:31 PM on July 28, 2016


You should definitely try to resolve this situation and get into therapy more often (probably from a different provider). While you're doing that, have you googled "anxiety support group (your city)" / "mental illness support group (your city)" etc and seen if you can get some supplementary support?

Some group sessions charge money and some don't - seems to depend on whether they are hosted by a therapist or practice or through a nonprofit.

Also, if you have any other things going on you didn't tell us about, google support groups for that as well. I've gone to various meetings for transgender people and people trying to stop addictions to harmful behaviors and they both really helped me.
posted by Juliet Banana at 2:23 AM on July 29, 2016


Best answer: IAAT,IANYT

Three weeks is always a stretch unless my clients have reached a point where things are basically rolling along well and we're doing periodic check-ins to stay on course. Initially, or while issues and progress are intense, it isn't frequently enough. Weekly, and, sometimes, every other week is more effective...(Although there have been clients that I've seen multiple times a week, but that usually is overkill and probably not healthy)

Part of what you're experiencing is a common problem in the mental health field, understaffed clinics with long waits. The strategy of scheduling a month or two out with regular dates is a good one, as a therapist I appreciate that, it allows me to plan.

Your statement "IMy therapist does take notes, but it's obvious she can't quite keep it all straight sometimes. And this leads to a lack of any flow or feeling of connection. " is more troubling than the time between sessions. This is a combination of too long between sessions and an ill prepared therapist. Will your person remember EVERY detail, nope, minor points may slip through the cracks, but if important aspects of what you're working on are being forgotten by your therapist between sessions, that's a problem.

Don't dump this therapist now, but put some energy into doing some research to locate someone that better meets your expectations/needs, and you may want to consider working with someone with an individual practice instead of someone out of a clinic, they will probably be more in tune with your needs and less constrained by a University/Governmental system.
posted by HuronBob at 3:17 AM on July 29, 2016 [1 favorite]


Best answer: I have anxiety and recently had to find a therapist. First of all, you absolutely should be going every week, if not more often at first, so you've got to bite the bullet and leave the clinic you're currently using, as it's doing you no good. Anxiety can make it overwhelming and hard to get moving on this, so I broke the process down for myself into smaller pieces:

DAY ONE:

1. Contact your insurance provider and find out what their mental health policies are--co-pay, in/out-of-network, maximum visits per year (not all insurance policies have caps, but look into it)

2. Ask how you can get a list of all in-network psychologists/therapists/analysts who specialize in anxiety (often the insurance company has a searchable online database that can be sorted by variables such as distance from home, specialties, gender, currently taking new patients, hours, etc.)

DAY TWO:

3. Look through your options and write down the names and numbers of as many appealing candidates as interest you.

DAY THREE:

4. Call several (at least three) and ask about availability, scheduling, types of therapy offered (talk, CBT/DBT, behavioral, etc.), and any specific concerns you have about your condition and treatment

5. Make an appointment with each therapist that feels like he or she might be a good match

FOLLOWING DAYS/WEEKS

5. Attend new appointments and take notes on your feelings/thoughts about each one. Be prepared to repeat yourself a lot during this phase -- tedious, but necessary. Prepare and bring a script if that helps.

6. Choose a new therapist

This is really the best way to find someone who is going to be of help to you.
posted by tzikeh at 10:49 AM on July 29, 2016 [1 favorite]


Response by poster: Thanks for all the responses! I was really beating myself up thinking I had unreasonable exceptions.

So many of these answers are great and helpful. I've marked a few that really spoke to me as "best", but everything has been very helpful.
posted by OwlBoy at 11:58 AM on July 29, 2016 [2 favorites]


Actually, I believe due to the Parity law, insurance can't put limits on the visit to the therapist - it is counted the equivalent (hence the word parity) of visiting a doctor.

It just seems you need to find a therapist and yes once a week at the start is fairly normal in my opinion, particularly because the therapist is getting to know you and your issues.
posted by iNfo.Pump at 9:12 PM on July 30, 2016


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