Determining the Number of Therapy Sessions: A Guided Approach for Effective Outcomes

Whether you are seeking assistance through physiotherapy, occupational therapy, psychotherapy, radiotherapy for cancer, chemotherapy, or speech therapy, the number of sessions required can vary widely. This article provides a comprehensive guide to help you understand the factors influencing the frequency and duration of therapy sessions.

The Initial Session and Beyond

The first session is primarily about getting to know your therapist and setting goals. Based on the goals and recommendations, the therapist may suggest anywhere from 4–5 additional sessions. However, the optimal number often lies between 6–7 sessions. The success of these sessions hinges on the application of learned techniques outside of formal therapy sessions. Failure to implement these techniques could result in an extended therapy process.

Brief Therapy vs. Long-Term Treatment

The duration and frequency of therapy sessions depend significantly on the specific goals you are aiming to achieve through therapy. Brief therapy, such as the “I-D-E” evaluation method developed by Simon Budman and Alla S. Gurman, can be effective for individuals looking to self-assess and create a plan. This approach typically involves three sessions and focuses on the following five axes:

Interpersonal conflicts or losses Developmental conflicts or losses Existential issues (e.g., coping with a cancer diagnosis) Symptomatic focus (e.g., smoking cessation or dietary changes) Characterological focus (e.g., personality disorders)

Brief therapy is designed to tackle these issues in blocks of three sessions, allowing for re-contracts as needed. This method is particularly useful for recurring issues, such as seasonal depression linked to cultural or personal events. On the other hand, treatments for posttraumatic stress disorder (PTSD) often range from 10 to 20 sessions, while formal treatments for personality disorders can be almost endless.

Long-Term Commitment

A notable case is that of Otto Kernberg, MD, a renowned expert on personality disorders. Kernberg used psychodynamic treatment to successfully "cure" a young woman with borderline personality disorder over a period of nearly 13 years, starting in the 1970s. This example underscores the long-term commitment required for certain psychological issues.

Challenges and Benefits

There are instances where therapy sessions are ongoing and necessary, especially for clients with severe and persistent mental disorders like schizophrenia or bipolar disorder. For such clients, medication is often critical, but talk therapy can still provide significant benefits. During the pandemic, I had the pleasure of working with three clients who needed frequent sessions—up to hundreds each—to avoid acute suicidal episodes or rehospitalization.

Implementing a “virtual intensive outpatient program” with regular telehealth sessions helped these clients remain stable and out of the hospital. In one particularly impactful case, twice-weekly and as-needed video calls led to the client's full remission from bipolar disorder with a previous episode being depressive. The last billing diagnosis for this client was “bipolar disorder in full remission most recent episode depressed.”

Understanding the importance of therapy sessions and the variations in their duration and frequency can empower individuals to make informed decisions about their psychological treatment. Whether it is brief therapy or long-term treatment, the key lies in finding a provider who aligns with your goals and supports your mental health journey.