Session Frequency and Treatment Outcome: How often should I attend?

Author: Rose Overland

Session frequency is an important factor in predicting success for individuals who are presenting to therapy. The first phase of treatment, which is usually defined as the first three to six sessions in which a person presents to therapy, is critical for one’s prognosis, with the largest improvement of symptoms occurring during that initial stage of treatment. Any improvement or lack of improvement, that is seen within this first phase, is largely predictive of treatment outcomes later, and how those initial sessions are spaced out becomes important (e.g., Tiemens et al., 2019).

For example, when looking across a diverse range of presentations (e.g., anxiety, depression, and personality disorders), a higher frequency of sessions during the first three months of treatment led to greater symptomatic improvement and recovery (Tiemens et al., 2019). At a one-year follow-up, 25% more patients had improved, in the highest frequency group (a maximum of one session per week, compared to the lowest frequency group (a maximum of one session per month). Not only this but a reduced frequency during the first phase of treatment was shown to lead to a weaker prognosis for the participant (Tiemens et al., 2019). 

Another study examined the frequency-outcome relationship for 21,488 university students, engaging in the first phase of therapy. The first phase here refers to either a participant’s initial presentation to therapy or their return to therapy following a break of 90 days or more. The researchers explored session frequency and its relation to the participant’s speed of recovery and the amount of recovery. They found that higher session frequency resulted in greater recovery. There were minimal differences between a weekly versus fortnightly attendance schedule in the total amount of progress made overall, however, the speed at which this progress occurred was faster for those attending their sessions weekly (Erekson et al., 2015). This is similarly seen in studies investigating clinical outcomes in private practice for patients with depression, finding that by spacing the first six sessions one week apart, patients experienced the greatest changes in their health, as a reduction of depressive symptoms (Bugatti et al., 2023). This has also been found in the literature for people with post-traumatic stress disorder (PTSD), in which reductions in symptoms are found with treatment courses involving weekly therapy attendance early on (e.g., Gutner et al., 2016)

So why might this be?

The literature details several ‘mechanisms of change’ which are proposed to influence treatment outcomes. Factors such as the therapist-client relationship, recall of previous session content, therapy-specific skillsets, compliance, and motivation, are considered some of the mechanisms of change, enabling treatment success (e.g., Bruijniks et al., 2015). The theory goes, that the more frequent those initial therapy sessions are, the more that the client can strengthen their therapist-client relationship, and consolidate those neural pathways used in the session, to lead to better treatment outcomes (e.g., Bruijniks et al., 2015)

Researchers rightly acknowledge however that therapy differs depending on a multitude of factors, and session frequency needs to be tailored to everyone’s requirements (Lin et al., 2024). Here at Lilley Place, we recognize the importance of accommodating each person’s unique presentation and needs, and how often you attend therapy, should be something you discuss with your provider and may change depending on where you are in your journey. 

Reference List:

Bruijniks, S. J. E., Bosmans, J., Peeters, F. P. M. L., Hollon, S. D., van Oppen, P., van den Boogaard, M., Dingemanse, P., Cuijpers, P., Arntz, A., Franx, G., & Huibers, M. J. H. (2015). Frequency and change mechanisms of psychotherapy among depressed patients: Study protocol for a multicenter randomized trial comparing twice-weekly versus once-weekly sessions of CBT and IPT. BMC Psychiatry, 15(1), 137. https://doi.org/10.1186/s12888-015-0532-8

Bugatti, M., Owen, J., Reese, R. J., Richardson, Z., Rasmussen, W., & Newton, D. A. (2023). The effectiveness of psychotherapy for depression in private practice: Benchmarking and trajectories of change. Professional Psychology: Research and Practice, 54(5), 327–335. https://doi.org/10.1037/pro0000518

Erekson, D. M., Lambert, M. J., & Eggett, D. L. (2015). The relationship between session frequency and psychotherapy outcome in a naturalistic setting. Journal of Consulting and Clinical Psychology, 83(6), 1097–1107. https://doi.org/10.1037/a0039774

Gutner, C. A., Suvak, M. K., Sloan, D. M., & Resick, P. A. (2016). Does timing matter? Examining the impact of session timing on outcome. Journal of Consulting and Clinical Psychology, 84(12), 1108–1115. https://doi.org/10.1037/ccp0000120

Lin, T., Anderson, T., Erekson, D. M., & Ogles, B. M. (2024). Trajectories of change in weekly and biweekly therapy. Journal of Counseling Psychology, 71(1), 77–87. https://doi.org/10.1037/cou0000711

Tiemens, B., Kloos, M., Spijker, J., Ingenhoven, T., Kampman, M., & Hendriks, G.-J. (2019). Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course; a naturalistic cohort study. BMC Psychiatry, 19(1), 228. https://doi.org/10.1186/s12888-019-2214-4