Increasing Your Therapy Dosage: Why Twice Weekly Therapy (Or More!) Might Be Better

How often should I go to therapy?

Imagine you’ve got a lingering cough. For a while, you figure you’ll get over it, but it persists. You give in and see a doctor, only this doctor is pretty conservative and ends up giving you a half-dose of antibiotics. It’s enough to keep the cough from getting worse—you feel a little better, but the cough lingers. 

This scenario cues up an interesting empirical puzzle. Is it the case that the cough lingers because the antibiotics don’t work? Or maybe this isn’t the right antibiotic? Or is it the case that the dosage isn’t enough for the medicine to do its job?

Good therapy is a lot of work and it often doesn’t feel good in the short term. It’s also frequently expensive. Many people take years of suffering to be open to even weekly therapy. For some, that’s enough. The dose works. But for many others, the task confronted in therapy is bigger than a weekly dose can manage.

Weekly therapy can sometimes feel like just keeping up 

Intense grief, deep historical trauma, and longstanding issues like depression, anxiety, or eating disorders can need more attention than weekly therapy. Therapy itself is also disruptive. This can seem counterintuitive (and disappointing). Sometimes emotional issues are stuck from years of being unable to work through them. At a given point in successful therapy, a patient may find themselves able to confront them and it feels terrible. A therapist can help patients hang through the discomfort and disruption that it’s caused to better tolerate the treatment.

Weekly therapy, in these cases, can feel like just keeping up—keeping the cough at bay but not fully clearing the infection from the body. A week in a busy emotional life, either because you’re struggling to get through the week or because the therapy is focused on intense historical issues or features of development, can feel like playing catch-up.

When is increasing the frequency of therapy the right move?

If you’re working with a good therapist but you’re struggling, feeling like you’re playing catch-up every week or it’s hard to cram everything into a session, increasing the frequency of therapy may be the right move. There can also be even subtler clues such as having nightmares the day before or the night after therapy, increased anxiety before a session, needing to “reach out” more than occasionally to a therapist between sessions, and “door knobbing,” the tendency to bring up heavy issues at the end of a session (or literally as you’re walking out the door, hence the term). Good therapists have a feel for these indicators and will often raise the issue of increasing therapy sessions when appropriate.