“Could we do every other week?”

Sometimes the question seems out of the blue. Other times, it’s not a surprise.

You may immediately think they are doing better. Or pulling away. Or worried about money. You may wonder whether you missed something in the last session.

You may also think about the opening this will leave in your schedule. If your income depends on attended sessions, that thought is likely to arrive quickly.

You do not have to pretend it did not arrive. You do have to keep it from answering the client’s question for you.

Ask before you interpret

“What’s prompting the change?”

It is a short question. Then you need to listen.

The client may be feeling better and want to see how they manage with more time between sessions. They may be struggling with a copay. They may be too busy. They may feel stuck in therapy, or uneasy about something that happened between you.

Perhaps they do not know. The request may have seemed straightforward until you asked.

You can explore it without turning the conversation into an investigation of their motives. “Is this about our work?” may be a useful question eventually. It need not be the first one.

If cost is the reason, believe them. A financial limit is not automatically a defense against intimacy or change.

Frequency is a clinical question

Your job includes considering what a longer interval might mean for the work. Are you beginning a difficult process that depends on continuity? Has the client been in crisis? Have they been using the time between sessions to practice and integrate what happens in therapy?

A study of psychotherapy session frequency and outcomes found some advantages for weekly sessions early in treatment in a university counseling setting. Its findings do not establish that every client needs weekly therapy or that reducing frequency later is a mistake. They do give therapists a reason to think about timing rather than treating frequency as a purely administrative choice.

You can tell a client what you think and why. “I’m concerned that we have only just begun working with this, and two weeks may feel like a long gap right now.” That is different from “You need to keep coming weekly.”

The client may see something you have missed. Keep listening.

If you disagree

Sometimes the client wants a schedule you would not recommend. You can be honest without making them defend their decision.

Explain your concern in ordinary language. Ask what they think. Consider whether there is a way to try the new frequency and review it after a few sessions. Make clear what signs would prompt another conversation.

There may also be a point at which you cannot offer the work as requested. If so, say that plainly and discuss other options. Do not agree to an arrangement you consider clinically unsound, then spend each session trying to persuade the client to undo it.

And do not use clinical language to disguise your worry about losing income. That worry needs another place to go.

If the answer is money

Ask what is workable. If there are options you can actually offer, explain them. If there are none, you can still treat the client’s circumstances with respect.

A person who cannot afford weekly therapy has not failed to prioritize their mental health. You may wish the options were better. They probably do too.

Talk together about what can reasonably be accomplished with the frequency available, whether another form of care would fit better, and when to revisit the plan. Avoid promising that an arrangement will work when you do not yet know.

What did the request stir up in you?

After the session, notice your own response. Relief? Rejection? Concern? A quick calculation?

That reaction is worth bringing to consultation or supervision. It may tell you something clinically useful. It may tell you something about your financial life. Often you will need to sort those apart before the next conversation.

A client asking to come less often is telling you what they want or what they can manage right now. You can respond with judgment, honesty, and curiosity. You do not need to turn the request into a verdict on your worth as a therapist.

About the Author

Anne Lindyberg, LMHC (Iowa), LCPC (Illinois), integrates the experiential therapy of Virginia Satir with Deep Brain Reorienting (DBR) and the Alexander Technique. She specializes in helping adults with complex and developmental trauma create lasting emotional change through therapy.

This article and other informational content on this website are provided for educational purposes only. They are not a substitute for individualized professional care, do not constitute advice specific to your circumstances, and do not establish a therapist-client relationship.

This work is created on the traditional and unceded lands of Indigenous peoples; a fuller acknowledgment of the land, its history, and its peoples is available on this website.

References

“Psychotherapy Session Frequency: A Naturalistic Examination in a University Counseling Center.” 2022. https://pubmed.ncbi.nlm.nih.gov/34780207/