How often should I attend counselling?

When meeting a client for the first time, I work to a standard agreement which is provided by the practice where I work. Among the various bullet points in the document, there is a statement that clients usually attend weekly.

However, this does vary. My counselling practice is not subsidised, and clients have to pay for themselves, usually. At times, people want to have counselling but don’t feel they can afford the fee every week. Then again, a lot of people have work or family commitments that mean they can’t find the time to attend every single week.

So what is the best frequency to attend counselling?

A new client asked me this question the other day. By answering her, I found myself stating out loud what I think about this issue, and so I thought it might be worth writing this down into an article for others to see.

In my view, when first starting counselling, weekly appointments are best. When counselling is effective, it’s largely because of the relationship between client and counsellor. Therefore, when building that initial relationship, the commitment to regular weekly meetings where possible is going to be most helpful to kickstart the therapeutic process.

Depending on the nature of the issue, and the levels of client distress, a longer gap between sessions might be ok. A lot of my clients come fortnightly because of the cost. However, I would say this; if the nature of your issue is quite severe - and is causing you emotional turmoil or disruption in your life - then coming weekly is just going to be more effective.

As a matter of professional ethics, I have to make a call as to whether I think working less frequently (say fortnightly or even monthly) is going to be ineffective. As in clinical medicine, some antibiotics are effective, but only if you take them daily and correctly for a certain period. I think there are some clients with some issues where attending less often just won’t do any good. I would just be taking the client fees without having faith in the effectiveness of the work. In such cases, I would have to decline to see a client fortnightly or monthly.

Not all clients who attend counselling are in deep distress, of course. Sometimes people come because they want some space to reflect on their life, to think about the future, or let’s say, they just want to work on their personal development. In cases like these, and again, depending on the sense I have of the client, I might agree to work fortnightly. Similarly, for clients who have been attending for a while, who are in a state of recovery or rebalance having done disruptive therapeutic work together, we may agree to phase out to fortnightly or monthly meetings.

So, in my view, there isn’t a simple answer to how often people should attend counselling. However, I hope this short piece gives a sense of the factors we should consider when asked by a client whether they can attend fortnightly or monthly.