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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19453
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have had approx. 12 psychodynamic therapy sessions, and I

Customer Question

I have had approx. 12 psychodynamic therapy sessions, and I am an airline crew member and qualified work place counsellor. The sessions have been VERY useful, and as I have limited days off, I have voiced with the therapist my desire to have fewer sessions, perhaps 3 per month instead of 4, in order to USE my new social confidence, calmness and absence of anxiety, and regain a social life, utilise new friendships and LIVE my life. She is reluctant to be so flexible and has postulated that this could be a resistance to therapy, or an unconscious desire to get out of therapy. This has made me feel slightly uncomfortable and think about endings and the power dynamic in the therapeutic alliance. Any thoughts?

Submitted: 4 years ago.
Category: Medical
Expert:  Dr. D. Love replied 4 years ago.
Thank you for using JustAnswer.

This question raises a common issue in someone seeking counselling of any sort, i.e., what is the end-point to indicate that it is time to stop counselling, or in your case, to reduce the frequency of counselling.

Part of the issue is that there is no objective test of mental illness that will say that a person is better. Different people respond to counselling at different speeds, so it is not possible to say that a certain number of sessions would be appropriate. This is complicated by a variety of psychologic defence mechanisms, such as denial, wherein a person will subconsciously refuse to admit to certain symptoms or issues in their lives. We see this more often in people early in the course of counselling, but can potentially be an issue at other time.

A cynic would also say that it is also complicated by the fact that a counsellor is rewarded for continuing to provide therapy, because more visits will also typically mean more payment.

In general, you are correct - as the symptoms improve, then it would be reasonable to consider decreasing the frequency of counselling, just as worsening symptoms may indicate a need for increasing the frequency of counselling. It usually will involve a discussion with the counsellor regarding the individual's perception of improvement in symptoms, so that the counsellor can also assess the overall condition, including whether there are any defence mechanisms in place. If you truly feel that you are improving, rather than using defence mechanisms, then it would be appropriate to pursue this further with your counsellor, and ask the counsellor about what level of improvement in symptoms would indicate that it would be appropriate to decrease the frequency of visits.

If you have any further questions, please let me know.