One question that almost always gets asked when I meet a new client is ‘How many appointments will I need?’. There are lots of different motivations for asking this question all rooted in the emotions of starting counselling or psychotherapy, such as anxiety, uncertainty, and urgency. It can also be a practical question as working with a Psychotherapist on a weekly basis is a significant personal, and financial commitment.
My experience is that, most of all, it’s partly a way of seeking assurance that something can be done in the time we have to address the concerns a person brings. I always appreciate the seriousness of this, as there are lots of steps people take before feeling able to make an appointment, let alone sitting in front of someone to fully explore why they’ve requested them.
Close-Ended vs. Open-Ended Psychotherapy & Counselling
One obvious point to make is: the more time available to work together means there is more space to address multiple concerns, work at depth, and ensure that any positive changes are maintained before the work ends. However, that isn’t to say that this doesn’t happen in close-ended, or shorter pieces of work with a Psychotherapist. It can be amazing to see how much can be achieved in a short space of time including changing the way we think, and feel.
The ultimate goal of psychotherapy is to enable people to manage everyday life well, in ways that are fulfilling to them. Therefore, ways to do this should be practised throughout the work to the best of the person’s ability. This can feel incredibly difficult if basic tasks are un uphill struggle, or if certain aspects of our lives feel unsafe places to be in. Having psychotherapy or counselling as a space to explore new ways to be, think, and feel allows you to have an arena to practise building the life you want for yourself – whatever that looks like.
This brings us to the idea of endings, which might feel premature given we’re talking about what it’s like to start psychotherapy or counselling! Working in a close-ended way where the number of appointments is agreed upon at the beginning, means that an ending is in sight throughout. For open-ended work, this is decided upon during the process of working together.
There are lots of reasons why some people choose to work in an open-ended way, for practical or personal purposes. For some there is so much uncertainty about making the changes they want to make that having to set a limit on therapeutic support feels overwhelming amongst everything else they are holding. In this way, making a decision about this at the start doesn’t feel straightforward, or easy.
For others it’s about needing some time to feel comfortable enough to open up, which is a big step in laying the foundations in talking therapy to allow for the things that have been said to be fully addressed together with a professional. Wherever you find yourself at the start is absolutely fine, and uncertainty is normal.
A Psychotherapist’s role is to facilitate any conversations about what you need, including the number of appointments. What’s important is the time to create a strong enough collaborative relationship with your Psychotherapist, so that you have a solid foundation where challenging work can be done. This is easier for some people than others, but wherever your starting point is can be worked with so you feel accommodated.
Regardless of whether you choose close- or open-ended psychotherapy/counselling, it’s helpful to pay attention to where an ending might be as your appointments go by. This is because endings are often a process in themselves, and mean different things to different people.
Although lots may have been achieved in the work, endings can bring up unexpected feelings such as loss. This in itself can be quite jarring if things have been going well for a while, so letting your Psychotherapist know about this can shed more light on how you manage things in life, which offers another opportunity to practice handling difficult situations.
A Semi-Structured Approach
As a Psychotherapist working from a relational framework, I understand the importance of using the working relationship as a base by which to make desired changes. Enhancing this is an empowerment-based approach to collaborative working, which means actively taking steps to promote choice for my clients at every stage. It can be really hard to make decisions when our mental health isn’t where it should be, or if we struggle to recognise ourselves amongst all the things we’re trying to deal with.
Meeting a client for the first time includes figuring out with them how much space they need to speak freely, and how much structure they require to take steps towards improving their wellbeing. Due to this, my approach is semi-structured in that I’m an active participant in the process, and am also open to hearing whatever needs to be expressed. This includes thinking about how best to pace our work, and can make deciding how many appointments are needed a little bit easier.
Often, psychotherapy is needed at specific points in our lives. This means that we’re able to consider how much support is needed, in line with what needs to be addressed at the time. For clients who want to look at how their past impacts their present, this can include feeling stable enough in their current life to be able to cope with the challenges of opening up the past.
Wherever you are in the process of thinking about or seeking therapeutic support, give yourself the time to explore what you need – whether on your own, or with a Psychotherapist/Counsellor. Together you can make use of the time you have, and start making the changes you need to see in your life.
If you’d like to arrange an initial meeting to see whether we could work together, I’d be pleased to hear from you. Just get in touch.