Why Therapy Needs to be Weekly (or more frequently)

Psychotherapy represents a significant investment of both time and money. It is because I respect the importance of this that my practice is limited to  people who are willing and able to meet weekly or more frequently.

You are probably thinking that this is a contradiction: if I recognize that therapy is time-consuming and expensive, why would I not be willing to meet with people less frequently so that more people can afford it? I hope this blog post will help you understand why meeting with your therapist at least weekly is so important.

For most of us, when we spend money or give up our valuable time, we usually expect something in return. When it comes to spending time and money on therapy, we are naturally expecting something from the experience: maybe you want to feel better, find new ways to understand yourself, reduce your anxiety, have a safe place to talk about your life, or receive some other benefit. Therapy is costly and it can be uncomfortable. Looking at ourselves and our problems is not easy! You choose to do it because you want to see results for your time and effort.

But when people go to therapy less frequently than weekly, there are things that happen or, perhaps more importantly, don’t happen, that can get in the way of seeing results and from truly seeing a return for the time and money they are spending. Here are some of the things I have observed:

• It is much harder to build a solid therapeutic relationship when you see your therapist less frequently. Almost every approach to therapy recognizes the importance of this relationship as foundational;
• Your therapist never gets to know you well enough to offer the kind of insight that can only come from knowing a person deeply–or it takes so long to get to know you that valuable time is lost before the work can deepen. You might even become frustrated and decide it isn’t worth continuing with your therapist;
• The continuity of the conversation that takes place in therapy gets lost, e.g., it is hard to hold onto the thread of what is being worked on or to keep track of important topics have come up but have not yet been discussed. Or something big came up since your last session and you never get back to what you last talked about because there isn’t enough time;
• When people come to therapy less frequently, considerable time is spent updating your therapist on the events that have taken place since the last meeting. There is a lot less time available for the deeper work of therapy;
• Some of what happens in therapy, while it can’t always be described, happens as a result of continuity–the knowledge that you have set this time aside to focus on yourself and your life. Knowing this, people can “hang on” when they are having a hard time because they know they will soon have a chance to talk about whatever is going on for them;
• You may decide–consciously or unconsciously–to avoid difficult topics because there isn’t time to talk about them and work through them;
• Or you may decide–consciously or unconsciously–to avoid difficult topics because once you open up a topic, you won’t see your therapist for two whole weeks and this is a long time to wait before you can talk about it again;
• You might find yourself frustrated with therapy because you don’t feel a connection to your therapist or because nothing seems to be happening;
• You may be thinking that every other week is just fine, but you may not be fully aware of your unconscious motivations. For example, you might be thinking that it is about finances, but maybe it is about something else. Some things to consider: are you comfortable with close relationships? What happens when someone tries to really get to know you? Does the thought of being close to someone or allowing someone to really know you feel energizing or like you want to run screaming from the room? If you see yourself in this paragraph, going to therapy less frequently may simply replicate issues in your life that do not serve you. Therapy is about looking at things in as safe a way as possible, even when they are scary;
• You may have other reasons for not wanting to meet weekly such as discomfort with spending money on yourself, prioritizing the needs of others over your own needs when it isn’t necessary, not making time for yourself, or there may be fear about what you might find out if you saw a therapist weekly;
• You might be worried that you won’t have enough to talk about every week. In fact, some of the most important therapy sessions will occur when you don’t know what to talk about. If you are working with a good therapist, these sessions are great opportunities to look “under the hood,” so to speak, to see what is happening for you when the problems and distractions of daily life are not the topic of conversation.

Many people feel that opting for every other week therapy is a way to spend less money but, in fact, it is likely that they will spend more money in the end and get less out of the experience.

Consider your own reasons for wanting to meet less frequently. Is something other than time and money standing in the way of getting the help and support you need? Are you afraid of what you might discover about yourself? Are you experiencing shame or other uncomfortable feelings when you think about the things you want to talk about in therapy? One thing worth mentioning is that enthusiastically embracing the idea of weekly therapy is not a requirement for going to therapy! When you contact a therapist to see about starting therapy, express your concerns about this and listen to the response.

Although I have given many reasons why you should consider weekly therapy, finances are real and important and cannot be ignored. Therapy is expensive. What do you do if you want to see a  therapist but money is an obstacle? Rather than settle for every other week, consider the following:

• If you have insurance, find a therapist who accepts your insurance. Be cautious and make sure you understand what your plan covers so that you don’t end up with unpleasant surprises. Some of the risks of going this route are:
  • Your plan may only cover a certain number of sessions, which may be less than what you need or want. This could get in the way of digging deeply into the issues you are bringing to therapy;
  • Your therapist may decide to stop taking your insurance (insurance typically involves considerable paperwork for the therapist, along with significantly reduced payment from insurance companies, which is why many therapists choose not to accept insurance) or you may change jobs and end up with a different insurance plan that your therapist doesn’t accept;
  • When you use insurance, your therapist has to give you a diagnosis. It is possible that this could cause problems down the line if an insurance company decides to call your diagnosis a “preexisting condition”;
  • While therapists are legally and ethically obligated to maintain your confidentiality (with certain very specific exception such as if you are danger to yourself or someone else), insurance companies are under no such obligation;
  • Because accepting insurance requires considerable additional paperwork and pays therapists a very low rate, many experienced therapists do not accept insurance. This may mean that it will be difficult for you to find someone with openings, the therapists who accept your insurance may be less experienced, or the therapists who have openings may not feel like the best fit for you. Unfortunately, when you use your insurance, you may have fewer choices.

Here are some other  options for paying for therapy:

• Check with your insurance for out of network benefits and ask your therapist to provide you with a “superbill.” A superbill is a type of receipt for services. In most cases, you would pay your therapist directly and then receive the superbill and submit it to your insurance company for reimbursement. Most therapists are willing to provide a superbill upon request. Or use the money in your flexible spending account, if your company offers this. Some downsides to these options include:
• • • You will have to pay your therapist directly and then submit the superbill to your insurance company. This means you might have to wait for the reimbursement;
    • You will likely be reimbursed for a percentage of the actual cost of your sessions, which means that you will have to pay for more of the actual cost of the therapy;
    • Your plan may have a high deductible that needs to be met before you will see any money from your insurance company;
    • Your therapist will have to give you a diagnosis which could be seen as a preexisting condition;
    • Your insurance company may not reimburse for out of network providers;
    • If you use your flexible spending account, this will help offset some of the cost of your therapy, but the rules will not allow you to set aside enough money to cover everything.
• Look for a training center. There are many training centers in the Bay Area that provide excellent services. Some of the places I routinely suggest include Access Institute and the Marina Counseling Center, both in SF; and The Psychotherapy Institute in Berkeley. Your therapist will likely be someone who is gaining experience towards licensure and is working under an experienced, licensed therapist. Some downsides to this approach are:
  • Your therapist will eventually leave the training center when they have completed the program and you will be assigned to someone new;
  • The fees vary and are based on your income. The fee can often be surprisingly similar to seeing a therapist in private practice;
  • You will likely be assigned to a therapist, although most places will ask if you have any preferences, e.g., a male or female therapist, a therapist of color, etc., and try to match you IF there is someone on staff who meets your requirements AND has openings. Again, you will have less choice.
  • Be sure that the training center you choose offers individual supervision for each of their therapists in training. This way, you can be sure that your therapist is getting appropriate guidance so that he or she can be helpful to you. There are a surprising number of training centers that do not offer this.
  • If you request a sliding scale fee, you may have to provide documentation regarding income before your fee can be determined.

Ultimately, only you can decide what you can afford to pay for therapy and what will work for your budget. Before you decide to meet with a therapist who is willing to work with you every other week, please consider whether this is really what you want and whether it will help you get to wherever you might want to go. For most people, a much better option is to try to find a therapist with fees you can afford so that you can attend weekly.

Questions about psychotherapy or about my approach to psychotherapy? Please see my website at www.marlacass.com and contact me at: 415-218-2442 (phone link works from smartphones only) or at info@marlacass.com.