From Birmingham to Beijing, from Osaka to New York, from London to Johannesburg, therapists, counsellors, coaches, psychologists and all of those working in the helping professions are often asked how many sessions clients should attend to resolve their problems. Answers vary from six, fourteen, twenty-one, thirty-two, one hundred and thirty-two and so on. You can also hear that the number of sessions depends on the complexity of the problem or that no one can tell you how many sessions you need.
The basis for this disparity is that there are about four hundred different approaches in counselling, coaching and psychotherapy, and each approach has its own set of core values, principles, rules, beliefs and procedures, including the assumption that people need to attend a minimum number of sessions for counselling to be effective. A practitioner trained in Cognitive Behavioural Therapy may say you need a minimum of 12 sessions, whereas another trained in Psychodynamic Therapy at least 25 sessions.
Private practitioners don’t like when you stop attending before they expect you to. Not only does it go against what they think you should do, but it also affects their finances. How can they make a living if you get better and leave earlier than expected. Although practitioners are not very good at predicting how many sessions you will attend, research shows that counselling is effective regardless (1).
Non-government organizations (NGOs), the National Health Service (NHS) and Employment Assistant Programs (EAPs) (2) are alternatives to getting mental health support. Unlike private practice, the number of sessions you are told to attend is fixed. This figure is based on three factors: 1) their understanding of how much support they think you need following an initial assessment, 2) the organization’s budget, and 3) recommendations from the National Institute for Care and Health Excellence (3).
People seeking help are led to believe they have to attend all sessions offered to see results. This can be problematic, as some clients stay in counselling longer than needed. NGOs and the NHS will get funding if you attend all your sessions and positive results are achieved. If not, they will lose money and risk closure. No pressure!
An alternative to a fixed number of sessions
We all know there is not enough funding to meet people’s needs, and that means long waiting lists in mental health services and beyond. To manage this, some organizations in the UK and abroad offer the option of attending Single Session Therapy (SST)(4) within a week rather than to be placed on a waiting list. Should you choose SST but feel you need more sessions, you can be placed on the waiting list. Interestingly, at least half of those who attend SST say they got what they needed and decide not to have more sessions (5).
The Parkinson law: a case against open-ended counselling
In November 1955, a naval historian named Cyril Northcote Parkinson published an article in the Economist magazine highlighting the unreasonable increase in British Civil Service employees over the years. Year by year, no matter how many more people were added to the payroll, exactly the same amount of work was achieved. Parkinson argued that work was artificially expanded to fill the time available for its completion.
It can be argued that more is always better and there should be no limits on how many counselling sessions people can have. However, due to limited resources, this is not a realistic option. If counselling were to be open-ended, there is no guarantee clients and practitioners would use time effectively and be focused on the work.
Much research has shown that the most critical factor for positive change is not the number of sessions you attend, the practitioner’s qualities or their psychological approach. What is more crucial is client’s commitment to change (6). Even when you are told how many sessions to attend, you decide if this suits you and when to stop.
How many sessions you actually need
An ethical practitioner should put clients in the driver’s seat rather than see themselves as the ones who know better and should make decisions for you. Practitioners are the experts in their field, but you are the expert in knowing how resilient and resourceful you are and your readiness to change.
Since “one” is the most common number of sessions people attend in counselling, it makes sense to consider this might be the number of sessions you need. Some practitioners spend precious time doing assessments, building rapport and defining treatment plans, rather than doing therapeutic work, but what if clients attend only one session? We know there is no guarantee clients will come back for a second or third session. My mindset is to treat each session as it is the last one, and make sure clients take away something valuable from it. As a limited number of sessions are available, it is a good habit for practitioners to ask clients how long they are prepared to attend to see positive changes. Most agree they want to see changes as soon as possible.
To sum up, I don’t believe you need anyone to tell you how many counselling sessions you need to attend. You are doing the hard work, so it is fair that you decide how many and when to stop. Mental health practitioners and policymakers are likely to offer a biased answer. If you must ask, consider it a suggestion to be discussed and see if it sounds reasonable.
References
(1) (6) Cooper, M. (2008) Essential Research Findings in Counselling and Psychotherapy: The Facts Are Friendly, London SAGA.
(2) Employment Assistant Programs (EAPs) are private work-based programmes, offering free well-being services including counselling. Employers sign a contract with an EAP provider, to support employees who face personal or work-related problems affecting their mental health.
(3) The National Institute for Care and Health Excellence (NICE) is a UK government organization that offers guidance and recommendations to healthcare practitioners on the best procedures and treatments for people’s well-being.
(4) Single Session Therapy is an agreed meeting between a person or persons who require emotional or psychological help and a practitioner who offers this help. Both parties intend to work on making this meeting sufficiently helpful to bring about the desired change. Although SST offers an excellent alternative for supporting people who otherwise won’t be able to access help, SST is not offered widely. Practitioners wrongly assume one session is not sufficient to produce lasting change. However, extensive research contradicts this.
(5) Young K, Dick M, Herring K, Lee J. From waiting lists to walk-in: Stories from a walk-in therapy clinic. J Syst Ther. 2008;27:23–39.