How often do I need to come to counseling?

How often do people need to be coming to counseling? In our setting, we find that many people settle into a rhythm of coming about once every two weeks. This is probably the most common frequency our clients step into, at least in the early and central phases of treatment.

Every other week, I find, is a helpful balance. It's frequent enough that you can experience momentum. You can continue to make progress and grow and build the therapeutic relationship, but you're also practicing skills and trying new things in your life, and you get to come back in just two weeks and get that support, so that things really progress and improve. But two weeks is also enough time in between for you to go live real life, experience challenges, experience the hard things that are out there, and test out what we have been working on in the room.

Ultimately, the frequency is tailored to your individual situation. There are cases where people want to meet weekly for a handful of visits, and sometimes this does make sense early in the process. If you're in a lot of pain and a lot of stress, and there are clear symptoms interfering with daily life, we want you here more frequently. When people end up coming less frequently than once a month, often those folks are already feeling better, already having life go a little differently, and they're really coming for occasional check-ins, continued growth, maintenance or support.

Again, every situation is unique. And how frequently you're coming sets up another question that's very related: how long is the overall duration of counseling? You won't be surprised to hear there's no single answer to that. It really does depend on you, your challenges and your goals: the severity of the problem, how long it has been going on in your life, and what kind of counseling we're using. There are other life circumstances and complicating factors that go into it as well.

But I don't want to just leave you with a vague answer of “it depends.” Lots of people come for some pretty common reasons, whether it's anxiety, depression, or marriage counseling due to a relationship breakdown, so I want to give you some thoughts about these most common situations.

For things like anxiety and depression, when you're coming for individual counseling, there's so much research and so many structured approaches built around an 8- to 16-session course of treatment. That doesn't mean you have to stop after 8 sessions, or that you can't go more than 16, but a lot of well-researched approaches are built around a length of treatment in that ballpark. That's especially true for cognitive behavioral approaches, and when you're working with an individual therapist on anxiety and depression. If you've been through severe, recurrent traumatic situations, it might take a little longer. It might take some time to build safety in the relationship, and you might need more continued support as you work towards health.

For couples counseling, we find that many couples improve over a course of treatment that's at least several months long. The range does vary depending on what you've been through. There's a lot of research in the world of EFT, emotionally focused therapy, suggesting that meeting anywhere between 8 and 20 sessions can be very effective. It all depends on what you've gone through. If there have been betrayals, traumas or other deep relationship injuries, it could take a little longer.

I do want to say that sometimes people benefit from a very brief course of treatment. Sometimes we use solution-focused methods or positive psychology, and our role in those modalities is really to help people have a shift of perspective and get back on track to living life in a more effective way.

What I often tell people who are new, regardless of what's going on, whether it's relationship concerns or individual issues like anxiety, depression or trauma: I tend to recommend we plan for at least five to six sessions. Usually things don't resolve after one or two visits, but you don't need to plan to be here for one or two years, either. In pretty much every counseling situation, you want to take some time to build a relationship with a therapist. You want to feel heard and understood. You want to be moving towards your goals in an effective way that's shaped by evidence and research-based treatment approaches.

But we don't need to go more than five or six sessions before we slow down on purpose, zoom out, and evaluate: is this being effective? Is this meeting the goals you originally came here for? Sometimes people are feeling very helped by that point. Other times new goals have emerged or things have shifted a little. We also want to know how our approach is feeling to you. Do we need to tweak anything? Do we need more action? Do we need more exploration? We want your feedback as well, because this is very much a collaborative process.