Understandably, people who are considering initiating psychotherapy want to make plans for the amount of time and money that will be required to achieve their goal for the therapy. Many potential clients for psychotherapy think of the process in much the same way as they do for visiting a medical doctor, say for a sinus infection or a rash. In this medical model, the physician does an exam, renders a diagnosis, and prescribes a treatment–sometimes with a follow-up appointment. (Yet even in the medical model, the patient is often referred to a specialist for further testing before a diagnosis and treatment are given. How disappointing if the referral is to a physical therapist who assigns a discipline of exercise, or how frightening should the referral be to a surgeon!)
Frequently, when I ask a client during an initial appointment what their goal is for therapy, they respond, “I just want to be happy,” as if the adverb “just” suggests that the goal of happiness should not be unreasonably difficult or exceptionally aspirational. Even if the initially stated goal for therapy is to no longer feel anxious or depressed or to get along better in a committed relationship, honest exploration usually reveals that there are more than just a few factors contributing to the symptoms that have brought the patient to my office.
While psychotherapy does have things in common with medical treatment, it has other qualities that more closely parallel the process of hiring a personal trainer to help guide you in losing weight or accomplishing a physical feat. For example, if your goal is to lose twenty-five pounds, a personal trainer may work with you in establishing a training schedule which involves regular exercise, a healthy diet, and moderate or no consumption of alcohol. (It would require much more knowledge and discipline to lose twenty-five pounds and keep it off for 10 years!). If you want to run a 5K, a marathon, or complete a triathalon, your training will be tailored to that particular goal. Careful consideration is given to your current physical shape. You are very unlikely to achieve your fitness goal if you do not stick to your daily training schedule. This personal trainer-client model is much like the psychotherapist-patient model; it requires a daily discipline on the part of the patient under the guidance of the therapist, whereas, in the medical model (that most of us are accustomed to), an occasional “check in” with our primary care physician is generally all that is required of us.
A bi-weekly training schedule with a personal trainer and little or no exercise between sessions will result in disappointing progress. The parallels between reaching a fitness goal with a personal trainer and reaching a psychological goal with a psychotherapist extend further. In each, you must reach a higher level of competence or accomplishment to understand the true state you were in when you began. You also must work to appreciate what discipline is required of you for progress.
Finally, as you advance in fitness or in psychological growth, you gain a vision of what potential your life holds as you move toward your goal.
For example: if you begin biking with the goal of improving your cardiovascular condition, you will likely discover that your legs get extremely tired before you achieve what feels like a challenging“aerobic effect.” That is, your leg strength cannot endure long enough for you to maintain an increased heart rate (accompanied by deep breathing) and feel that you have accomplished a good workout. However, as you faithfully persevere in your regular biking workouts, your legs become conditioned enough for you to pedal longer, you begin breathing harder, and your heart rate is sustained at an increased level. You are aware that you are able to push yourself harder and for longer periods and that you are getting into better cardiovascular shape. This brings a sense of accomplishment and self-efficacy, you are delighted with the physical results, and you may even adjust your sights for a higher goal.
A similar phenomenon occurs in psychotherapy: after the initial relief of telling someone what is troubling you and gaining hope that you can survive it, you may be surprised or even somewhat immobilized in subsequent sessions by the force of your emerging fears, shame, hurts, anger, or embarrassment. You didn’t want all of this; you just wanted to be happy!
Many people terminate therapy at this early stage because the therapy is working! The awakening to one’s own life, which includes awareness of our feelings, often arouses emotions that we learned “long ago” to avoid or suppress because we feared being overwhelmed and we had no one in our lives to teach us how to regulate those emotions. As we better learn to regulate affect, we often discover that there was much more “beneath the surface” than we consciously knew, and we can develop the ability to recognize our projections, distortions, minimizations, blaming, and rationalizations. That is, as you grow stronger, you become more competent in recognizing and addressing psychological dimensions that need attention and further development. Put
simply, you have to get better to get better. The resulting sense of accomplishment, integrity, self-efficacy, and improvement in your relationships (even at work), may even inspire you to a higher goal than you originally identified.
So, the question “How Many Sessions Do I Need” is answered vastly
differently based on the needs and desires of the person seeking psychotherapy,
and quite frankly, on the expertise of the therapist. Some patients who have come to me for psychotherapy got what they wanted in one session. Others have come for many years. Still others have come for a handful of sessions and returned at a later time for more. The number of sessions from which you would benefit will ultimately be determined by you. Consultation with your therapist on this topic, of course, is usually the best way to decide, but learning to tune into yourself deeply and to make decisions is often a goal of therapy itself.
Copyright © 2011 William E. Spaine, Psy.D.