Reasons to attend therapy more than once a week?
June 18, 2019 9:08 AM   Subscribe

I've been assessing various therapy options in my area, as there's a bunch of issues I want to work on now my 40th birthday is approaching. An initial consultation with the director of one therapy centre has led to him recommending either a TWICE-weekly group psychotherapy session or a THRICE-weekly individual psychotherapy session - both with a two-year minimum commitment. Have you found benefit from such intensive programmes? How do the outcomes differ from regular weekly sessions / shorter term commitments?

I'm paraphrasing as I don't remember quite the wording he used, but in the meeting the director said that he felt I could 'handle' these schedules and that the increased frequency leads to a more in-depth analysis and thereby greater insight.

His main recommendation was that I join the twice-weekly group therapy sessions (led by himself). Second recommendation was the thrice-weekly individual psychotherapy. Because I asked, he also stated that he could refer me for once-weekly psychotherapy if I specifically wanted that.

I've done a long stint of group therapy around ten years back and found it useful at that stage of my life, but I'm hesitant about signing up for sessions of such high frequency and for such long periods. Mainly because of the £££, but also because I feel like they could become a bind schedule-wise. But is this resistance some kind of self-sabotage? If these sessions would be life-changing then it would make sense to stump up and show up.

Your thoughts? I'd especially like to hear from anyone who's done high frequency therapy sessions or any therapists or counsellors out there. Thanks in advance.
posted by doornoise to Health & Fitness (28 answers total) 3 users marked this as a favorite
During a very challenging mental health spell, I went to individual therapy twice a week and it was invaluable. That said, once the crisis passed I felt like two days was excessive. I don't think you are sabotaging yourself if you listen to your gut, but I do think that being open to multiple sessions is important. Would it be possible to reach back out to the director to get a clearer sense of the rationale?
posted by jeszac at 9:20 AM on June 18, 2019 [4 favorites]

You say £££, so I assume you're in the UK, but on this side of the pond you might not be able to get insurance to cover more than one session a week except in a dire emergency. So, for what it's worth, the opinion of the American Insurance Industry is that once a week is plenty for out-patients. I would also be very worried about the two-year commitment. Is he saying you need at least 300 sessions before you even start to improve? That seems very odd to me. All of the therapists I have ever had were delighted when I felt I had advanced far enough to stop therapy.
posted by ubiquity at 9:24 AM on June 18, 2019 [3 favorites]

Not threadsitting, but just to clarify my current position. I'm not in a crisis, just looking to work on accepting some sadness around the ageing process and associated issues (singlehood, childfreedom/childlessness, impending menopause, for example), plus letting go of some fairly common unhelpful thoughts and old patterns of behaviour.
posted by doornoise at 9:29 AM on June 18, 2019

The words "two year minimum commitment" send up red flags for me. I'd clarify what that means before moving any further. Is he, by any chance, a Freudian type psychoanalyst? Like the lay on the couch and recall your dreams kind? Or is it just really intensive dig deep into all of your issues and talk them to death without an action plan or coping strategies? To me, that would make a difference.

As for me, yes I've done multiple sessions a week. Around 2000, I saw my therapist M-F because I was struggling so much. Mostly it was aimed at keeping me out of the hospital (which didn't work). In my latest round of therapy, I spent about a year going twice a week. It was a good choice at the time. I was dealing with heavy duty trauma issues. It was totally intense. But it eventually it was too much and I switched back to once a week.

Group therapy has been hit and miss for me. One time, it made me significantly worse (a trauma group). Another time, it was mildly useful (a DBT group). Group therapy in a hospital setting was the best for me, but obviously that isn't going to apply to most people.

But, that being said, it is useful to listen to yourself. You don't say what kinds of issues you're dealing with. IMHO, that makes it harder to give a good answer. That, and you don't mention the intensity of your issues.

Also, don't be afraid to get a second opinion. I ran into one bad therapist and two psychiatrist. I wish I had listened to my gut with them. Like any other medical issue, it's not absolutely necessary to go with the first treatment plan.
posted by kathrynm at 9:31 AM on June 18, 2019 [17 favorites]

Thanks for more information about what you're there for. It would be interesting to know what modality of therapy this is.

The long and frequent group therapy is something I associate with DBT and it makes a lot of sense because of the highly structured focus on learning and practicing skills.
The group goes through different modules or units, one at a time, and it takes a while to do all of them. These kinds of programs also tend to have fairly set start dates (e.g. once every three months) so that you're starting at the beginning of a module and so that the therapist can deal with onboarding / group leaving with the health of the group in mind.

Multiple sessions per week also sounds DBT-ish, but could also be a psychoanalytic thing (as can the group therapy). If it were up to psychoanalysts, god bless them, everyone would be in there five days a week. It can be a very interesting and meaningful form of therapy, so I'm not knocking it, but it might not be what you're looking for if the time and length commitment is a bother for you.
posted by internet fraud detective squad, station number 9 at 9:35 AM on June 18, 2019 [1 favorite]

Also, unless you're fairly seriously mentally ill, I wouldn't worry that you are avoiding expensive and time-consuming therapy as a form of self-sabotage. Five sessions a week is a lot for someone who is functional in everyday life and it's very reasonable that you would be hesitant. It sounds like you are thinking this through well and have a good head on your shoulders, and it is more than fine to consider finances and your time.
posted by internet fraud detective squad, station number 9 at 9:39 AM on June 18, 2019 [1 favorite]

Sorry everyone, I seem to have left out all the useful information:

It's Group Analytic Psychotherapy, a form of psychodynamic psychotherapy, which incorporates elements of Interpersonal Therapy ( I.P.T.) - apparently. So not DBT. And yes, he mentioned that members of the group share their dreams from time to time. 90 minute sessions; twice weekly; one morning session, one evening session.

The individual sessions are psychoanalytic psychotherapy.

And it would be either / or, not both group and individual.
posted by doornoise at 9:42 AM on June 18, 2019

Two clichés for you: “In group there is more change and less understanding and in individual there is more understanding but less change.” and regarding 4x or 5x a week psychoanalysis, “You will be completely transformed and no one will know but you.”

Group analysis is considered to be good for depression and anxiety as well as social issues but can have its limitations outside of this. I feel group analysis is great but I think individual is better - if it’s intensive. If for instance it is between 2x a week group and 1x a week individual - strongly consider group.

From the inside, group analytic trainees are required to do 2x a week analytic group which is generally the max for group. In psychodynamic therapy, trainees are strongly encouraged but not generally required to do 3x a week or more. 5x a week psychoanalysis is obviously the gold standard. 1x a week therapy is considered to be more exploratory than anything – not that there is anything wrong with that.

It is normal for group analysts to ask for a two year commitment. Groups with lots of coming and going are less effective for in-depth transference work which is the engine of the therapy. However, no one will die if you leave before your time is up.
posted by spibeldrokkit at 10:37 AM on June 18, 2019 [2 favorites]

I've done extensive therapy for very serious mental health reasons, and I just can't see why you'd dedicate this time in this way.
I mean if you want to, it is a perfectly acceptable way to spend your time and money but I think that you can come to processes what you want to with way less time spent in session.
posted by AlexiaSky at 10:39 AM on June 18, 2019 [8 favorites]

Interpersonal therapy, psychoanalytic, and psychodynamic therapy rely on interpreting the relationship (generally through transference and countertransference) between the client and the analyst, with the therapist as less of a "coach" than in more CBT/DBT-style therapies. The goal is often a more in-depth look and restructuring as necessary of the client's overall personality structure, rather than coping with a short-term stressor.
posted by lazuli at 10:40 AM on June 18, 2019 [1 favorite]

I had a wonderful therapist years ago who I worked with when I had fairly serious issues (debilitating depression, wasn’t employed or going to school). I was seeing him once a week and asked at one point if it wouldn’t be more effective to have multiple appointments a week. He said no, reason being that putting a limit on therapy would give me more opportunities to develop supportive relationships in the real-world and give me more chances to deal with uncomfortable feelings on my own. In retrospect, I think this was excellent advice. To me, one major goal of therapy, like any other kind of treatment, is to do as much as possible to get you OUT of treatment and seeing a therapist too frequently can discourage independence
posted by horizons at 10:43 AM on June 18, 2019

Just to put the counter-point to those recommending that once a week is enough. Psychodynamic work uses the transference – the closer you are to the therapist or the group the more intensive and the more therapeutic it is. If you think psychodynamic is right for you, you should consider doing as much time as your schedule and bank account can manage.
posted by spibeldrokkit at 10:49 AM on June 18, 2019 [1 favorite]

I apologize for not reading all of the responses. I had a time that I needed more help than an hour a week. I was paying out of pocket and had a "double session" (2 hours) each week for a month and eventually went back to 1 hour a week.

Thank you
posted by kbbbo at 10:52 AM on June 18, 2019 [1 favorite]

I have done intensive therapy twice a week or more during a break and it was invaluable for me, but also I only needed it at that level for a few months. I’d be more wary of the long time commitment than the frequency.
posted by corb at 10:57 AM on June 18, 2019 [2 favorites]

I am not a therapist, but I am a woman your age working through similar issues to you. I personally would not commit to therapy that is this time consuming and designed to form these kinds of direct bonds. I would commit to working with someone to help me think through the way to form my own bonds and build my own community that can sustain me as I age that is more directly authentic to me. I think the group commitment that is being suggested here could potentially get in the way of you prioritising that, if I read your follow up right and the thing you want to work on is processing your feelings on where you are in your life.

At the very least I think you should talk to some other therapists and see what they recommend and then see what sounds more inviting and helpful to you!
posted by pazazygeek at 10:57 AM on June 18, 2019 [12 favorites]

Without considering anything else, just the two year commitment is reason enough to shop around a bit more.
posted by doctor tough love at 11:34 AM on June 18, 2019 [8 favorites]

You sound like a member of the worried well. I suspect this therapist sees you as a potential whale, i.e. someone easy to work with who is willing to pay big money over a long period of time. No wonder he wants to lock you down for two years.
posted by crazy with stars at 12:48 PM on June 18, 2019 [2 favorites]

I'm not speaking from experience here but this sounds like an upsell, especially from a single consultation. That's not to say that it's not beneficial, but shop around more. Since you're not in crisis, I see no reason why you can't do something requiring less committment upfront. What if you don't actually like this therapist or therapy method? Shop around and look at more options. You can always scale up to this level of therapy but it sounds like from your description that you wouldn't really have the option to scale down if it's not working for you.
posted by acidnova at 1:11 PM on June 18, 2019 [8 favorites]

Personally, after having had some bad experiences I would stay very far away from any type of therapist who required a minimum commitment of any significant length. I think it demonstrates a truly cavalier approach to the well-being of the person seeking treatment, because not everyone responds to treatment in the same way and any therapist worth their salt should know that. Some people have a severely adverse reaction to specific kinds of therapy. Some people don't have this kind of traumatic reaction but don't see any improvement either because it turns out the form of treatment in question isn't an effective one for them. Some people just don't have a good rapport with a specific therapist or group, and there is a great deal of research on the importance of having that rapport. Some people's financial situation, living situation, or physical availability changes over a period of time. Anyone who tries to lock you in to a predetermined commitment for what is an expensive and potentially emotionally intense treatment is failing to acknowledge all the various reasons for which someone might legitimately benefit from leaving that treatment, or suffer from staying in it. It's one thing to encourage people to stick with a treatment because you truly believe that will give them the best results; it's another to actually require it. So unless this center actually does make it possible to exit the treatment at any point you find it necessary, I would stay away from them and find someone whose chief priority is working in a partnership with you in a way that is continually attentive to your needs and to the effects of the treatment. That person should do their best to help you using their own approach, while acknowledging there is no such thing as one-size-fits-all in therapy.
posted by trig at 1:20 PM on June 18, 2019 [4 favorites]

I think everything else about this sounds great; I've done groups and more-than-daily individual therapy at various points, and gotten a lot out of both.

But add me to the list of people saying a two-year commitment sounds bonkers. Would the commitment be enforced in some way? Would you be penalized financially if you had to drop out for some reason, or if you found it wasn't working for you? That seems completely unmanageable, regardless of how stable you are and how beneficial it might be.

(FWIW, my understanding and my experience has been that groups often require a commitment like "I'll give a month's notice before I quit the group, so that other group members can process me leaving; and if I leave without a month's notice, I'll still be charged for the rest of the month." That seems normal and useful. But two years is just absurd.)
posted by nebulawindphone at 1:27 PM on June 18, 2019 [1 favorite]

Great therapists want to make you a former client as efficiently and effectively as possible. I would be very suspicious of anyone who required a time commitment beyond twelve weeks or so.
posted by suncages at 1:41 PM on June 18, 2019 [4 favorites]

I think the modality sounds very intense for your needs based on the way you talk about the stuff you want to work on. Is this something you chose to investigate because the type of therapy really appealed to you, or because it happened to be one of the options available? Are you drawn to the idea of radical personal change or of ironing some things out that bother or dissatisfy you? If the former, then it might be the right approach. If you only checked it out because it's an option locally and you're not sure what you need, I think this probably isn't the right approach (with some caveats later on).

I'm still wary of the length of commitment, even though it makes sense based on the description of the modality that other commenters have given, because I have a history of being controlled or in low-agency situations and part of what has made therapy work for me is knowing that I'm a consumer paying on a per-session basis and I can walk away at any time if anything about it isn't working for me. If this doesn't give you pause, however, then again this might be a good approach for you.

There have definitely been times when I thought twice-weekly therapy would be more helpful than weekly (though I never took the plunge for financial reasons), but I was in crisis during those times. If I had unresolved issues that I wanted to work on but I wasn't in crisis, I think more than weekly would definitely have been too much. There were times when I had unresolved issues that I wanted to work on but I wasn't in crisis and even weekly therapy felt too frequent, at which point I scaled back to once a fortnight.

It takes a lot of energy to sustain the kind of focus that intensive therapy over a non-trivial committed period of time aimed at catalysing significant personal change involves. I'm not saying don't do it, but I am saying only do it if you believe deep down that you need the kind of change that this type of therapy experience is designed to produce.
posted by terretu at 1:59 PM on June 18, 2019 [1 favorite]

I would never make a extended commitment without trying the therapy first. I understand that they don’t want clients coming and going in group, but I’d want to at least sit in a couple of times. With individual tererapy it can take a few sessions to know if you feel good about it.
posted by wryly at 2:53 PM on June 18, 2019 [1 favorite]

Have you read reviews of this place? That's such a huge ask. A two year commitment to twice a week -- are you paying for this yourself? -- is so much time and money. Like, it almost seems like a scam.
posted by bluedaisy at 3:12 PM on June 18, 2019 [2 favorites]

2ndig that a long commitment (6-12+ months) with both group and individual sessions makes sense for DBT (which is an intensive approach to helping people with significant problems with emotional regulation. It’s very skills-based and hands-on, it’s like a class in managing extreme emotional dysregulation).

What’s being proposed to you sounds like classic psychoanalysis, which isn’t practiced so much in North America these days, because (or so I understand) it’s not been shown to be as effective (for many issues) as more behavioural/skills-based approaches like CBT, DBT, ACT, which could prove helpful for the common problems you mention.

The other stuff (which I get) - being around 40, the child question, menopause - these are questions you can look at through different analytic perspectives. They’re existential questions.

You’ve gone off-script; discovering what it is to face real biological (and other limits) in the face of strong norms, accepting those limits, facing (potentially) the permanent loss of opportunities like children and family (grief!), deciding for yourself what you want your life to mean, given you’re countering culture - I think feminism can help with much of this. Ditto pazazygeek - talking to others who share your experiences, building community, this can be so helpful. Making sense of your life so far, exploring what could have been or might be - writing can be so helpful here (I mean autobiographical writing, I wonder if there’s a class on this that you could benefit from). Generally coming to terms with mortality, this is existential, philosophical, maybe religious. I think many of us work and rework it out over time, through again writing, reading, talking to others, engaging in contemplation... for dealing with these big things, I personally am highly suss about investing too much in a dynamic with any single person. There are critiques of psychoanalysis out there, specifically about the power dynamic (sorry, can’t remember specific texts, but a search for that would give you an idea).
posted by cotton dress sock at 3:38 PM on June 18, 2019 [4 favorites]

What’s being proposed to you sounds like classic psychoanalysis, which isn’t practiced so much in North America these days, because (or so I understand) it’s not been shown to be as effective (for many issues) as more behavioural/skills-based approaches like CBT, DBT, ACT, which could prove helpful for the common problems you mention.

Agreed, it's not evidence based medicine I my opinion, and results of research struggle to demonstrate it is more effective than just shooting the shit with someone (as opposed to dbt and cbt, which have decades of clinical research validating their modalities).

This is not to say psychotherapy can't help you, it's just the evidence suggests it's not that much more helpful than a lot of other, cheaper, stuff.

Medical practitioners, or anyone with a responsibility for wellbeing, should always take their patients whole wellbeing into account, and this includes financial wellbeing. This counsellor appears to me more concerned with their approach, rather than your needs. If they aren't prepared to change the former to meet the latter, you can do better.
posted by smoke at 6:00 PM on June 18, 2019

"Evidence-based" is not really an opinion-based thing. There are studies showing that psychoanalysis is effective long-term. The originators of CBT have done an extensive PR campaign denigrating it, and it's harder to study than short-term models, and US insurance companies have decided they'll generally only cover short-term treatment which likely has a lot to do with not wanting to pay for longer-term treatment and not with altruistic concern with clients' wellbeing -- all of which means Americans, at least, tend to think poorly of psychoanalysis. This site, in particular, has been "CBT or nothing" for as long as I can remember. That doesn't mean long-term therapy ineffective or a scam. A lot of the recent brain studies on attachment are coming from the same theoretical framework as psychodynamic therapy, for example.
posted by lazuli at 6:19 PM on June 18, 2019 [3 favorites]

Oh indeed, but the evidence that it's more effective than shorter term therapy (or other activities for that matter, like having a pet, talking to people) - at least, that I've seen - is lacking, in my opinion. Many of the studies are poor and most have been done by advocates. It's older now but I still love the rigor of this meta analysis .

A lot of stuff is effective long term, and it doesn't cost anywhere near so much money or have anywhere near so many question marks as psychoanalysis.
posted by smoke at 8:12 PM on June 18, 2019

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