HOW MANY SESSIONS WILL I NEED?
Susan Rochow, Registered Psychologist
When I first meet with counselling clients, a common question asked of me is, “How long will this take? How many sessions will I need?” This is a very fair question, and an important question to consider when embarking on a counselling journey, especially when one must consider budgetary constraints on time and money. However, this is a very challenging question to answer.
Many people talk about being in therapy “forever.” They view counselling as an essential service in their health care management, similar to their massage therapist, chiropractor, dentist, naturopath or personal trainer. The frequency of their sessions likely varies depending upon current life events and stressors, but they view their counsellor as a long-term member of their health care team. In fact, I have one client who told me, “I told my husband that if I die, he needs to make sure our kids keep coming to Eckert Centre.” For her, and many like her, it is considered an essential service.
Others may view counselling as a temporary resource. For such clients, we work with them for brief periods of time, usually until their current crisis is resolved. In these cases we may only see a client for a few sessions and they never return. Alternately, we may have a longstanding relationship with a client, but our sessions are few and far between, as they come in only during times of crisis.
Most clients, however, come in with a specific goal in mind. They don’t want to do therapy “forever,” but they also are not in crisis. Instead, they may have been considering counselling for a while and have finally decided to take the plunge. For these individuals there is a specific issue they want to work on: a problem they want to solve, a wound they want to heal, a pattern they want to change, a relationship they want to improve, etc. When a person has such a goal in mind, they want to know how long it will take to achieve that goal.
Although it is impossible to accurately predict how much psychotherapy a person may need, there are a few key things we consider when making our estimates:
How long has the problem existed? If the problem is long-standing (e.g., depressed mood), more sessions will likely be required than if the problem is of short duration.
How many traumatic events/wounds has the person suffered? If the client has a long history of emotional injuries, more sessions will be required. In fact, many “small” wounds may be more challenging to heal from than one or two “large” wounds.
Were their emotional injuries caused by someone close to them? Research is clear that when an emotional injury is caused by someone close to us, the wound tends to be more profound than if it is committed by a stranger. Thus, wounds by parents and siblings, or by a trusted person like a coach or teacher, tend to be more painful than wounds by a stranger or mere acquaintance.
How old were they when the wounds occurred? A child who is raised in a loving, supportive home will be far better equipped to manage critical events later in life than a child who grew up in a home where there was abuse, neglect, exposure to violence, shaming, frequent criticism, etc. Thus, if there were few emotional wounds in childhood or adolescence, brief therapy is reasonable to expect.
Were the emotional injuries chronic or infrequent? A child who gets the message that they are “stupid” or “worthless” nearly every day will have much more difficulty challenging this belief than will the confident adult who gets yelled at by their boss for a “stupid” mistake. Repeated emotional injuries are much like scabs that keep getting ripped off, never allowing the skin to heal. Thus, a one-time event is less apt to result in a negative core belief of self.
What is their family’s mental health history? It is clear that mental health challenges run in families. How much of this is biological versus learned (i.e., nature vs. nurture) is not entirely clear and, in part, depends on the type of mental health illness. Either way, the more challenges within one’s family of origin, the more therapy the client will likely require.
What therapeutic approach would the client prefer? Some therapeutic approaches focus on problem solving while others are more introspective. Likewise, some provide coping methods while others emphasize healing. Thus, the type of therapeutic approach selected will affect length of therapy.
How ready is the client? Some clients are 100% ready to dive in to therapy, while others may have mixed emotions and still others may feel pressured into seeking help. Thus, the emotional readiness of the client is a critical factor in determining the rate at which therapy can proceed. If defenses are high, trust has to be carefully earned as the client develops a relationship with the therapist. Only then can therapy proceed effectively.
So how many sessions are required? Tough question. After working with a therapist for a few sessions it should be possible to get a rough idea of how long it will take to achieve your goals. But the longer I work with clients, the more I have learned to expect the unexpected. We are complex human beings. New problems sometimes arise during the work, or a client may share something (sometimes after years of therapy) that they never felt comfortable to share before. Conversely, sometimes clients experience benefits much sooner than might have been expected.
Susan is a Registered Psychologist providing assessment and counselling services at Eckert Centre. Susan makes a unique contribution to the Centre as a Certified EMDR Therapist, counselling those dealing with the effects of big and “little” traumas in their life, including adoption, accidents, loss, abuse, neglect, bullying, infertility, academic challenges, imperfect parenting, phobias, addictions, etc. She also provides faith based counseling services to our clients seeking counseling from a Christian worldview, and works with individuals, couples, and families.