Kate: We have already looked at how online therapy is making therapy more accessible. Another change that we have noticed is a move away from fixed weekly sessions. I work with a lot of clients who don't have predictable availability - freelancers, students, and those working shifts. Some of those have requested that we move to biweekly or even ad hoc appointments.
Kim: Yes, Kate, I have had a similar experience. When this comes up, I generally point out to my clients that there has been extensive research in the Therapeutic community on how often therapists and clients should meet, and the consensus has landed on weekly sessions. This offers both continuity and a realistic opportunity to successfully build a trusting relationship, as well as giving clients the chance to talk while things are fresh on their mind.
Kate: Some clients would counter this by saying therapy every other week gives more time to reflect on what has come up in the sessions. [1]
Kim: I do prefer to see clients weekly particularly in the early stages of our work. I feel the upfront investment of time is reflected in the development of the client/therapist relationship which is the foundation of the work. Likewise, therapy requires commitment from both sides.
That being said there are circumstances where once a week is not ideal. I have found that for some long-term clients, as they look to finishing therapy, a gradual tail-off is appropriate. I also always leave the door open for ad hoc sessions on request. Furthermore, we may discuss the option of intermittent therapy which allows a client to book a couple of sessions when required. From my experience those who do return appreciate that I know their history.
Kate: The cost of living crisis has added another complication with some clients finding it difficult to commit to weekly therapy for financial reasons. These clients are looking for more flexibility in booking sessions to keep therapy affordable.
Kim: That’s true, and, as you know, we have always offered a number of places at a reduced rate for those in need, which I’m pleased to see have proved popular. I have also let people know that there are also several specialist charities that offer free or reduced rate sessions, with qualified or training therapists who give their time for free. It can also be worth reminding clients that some employers offer therapy as part of a benefits package.
Kate: We’ve both been flexible with clients who would not be able to fit a fixed counselling session into their working patterns and so wish to "float", only booking one week at a time. I'm familiar with odd working hours from previous jobs – I would have struggled to make a regular slot too.
Kim: I, too, have clients in a similar position, and I try to be flexible, however this can lead to challenges above and beyond the benefits of consistency, for example booking therapy rooms, and scheduling conflicts. I try to get clients to commit to a regular session, and only to make changes if absolutely necessary. I do ask my clients to avoid last minute changes and as a courtesy given 48 hours notice if they cannot make a session
Kate: When I decided to become a counsellor, I wanted to be able to contribute to making therapy accessible and flexibility seems to be a key to that goal. It is also about giving the client autonomy to make their own decisions based on their needs. But as Kim says weekly therapy as the gold standard is based on theoretical research and we can offer flexibility and accessibility in other ways such as concessional rates and volunteering.
So how do we balance the belief that fixed weekly sessions provide the best model of support for clients with the belief that it can also limit the ability of some to access therapy? At Lifespace Therapy we offer a free online introductory session (30 minutes as opposed to the usual 50 minutes) to potential new clients. This gives the client an opportunity to experience how we work in practice and also to ask any questions around the practicalities of therapy. It offers a way to balance the needs of the client with our ability to explain what we think works best.
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