[Lrad123]

My T is a psychodynamic therapist and I’ve been seeing him for about 10 months. I have a standing appointment on the same day and at the same time every week. If I’m going on vacation or need to cancel for some reason I need to give 2 weeks notice, otherwise I pay for the session. When this was new to me it sort of bothered me, but now it doesn’t. He also gives me about 3-4 weeks notice for his vacations. We’ve talked for a while about adding a second weekly appointment, but initially I wasn’t interested and later we had trouble finding a second time due to my work schedule. I have one weekday off each week and that’s the day I see my T. The other 4 weekdays my work schedule is busy and unpredictable. I’m thinking I’d like to see him a second time/week, but ideally on different days/times as my schedule permits. I know when we talked about this in the past he said this wasn’t ideal, I’m just not sure I understand why. Isn’t it better to see him at varied times for the 2nd weekly appointment than to not see him at all? Please help me understand.

Also, I’m just wondering if his wardrobe has anything to the with the frame. He wears really plain professional clothes - either khaki or black pants and white or black dress shirt. My son’s CBT therapist is very hip and fashionable so I definitely notice the contrast and it makes me wonder if my T dresses this way to take the focus off of him.

[DP_2017]

Are you asking if you can go 2x a week and why he wont allow it or that you want to pick a second backup option in case the first usual time isn't available?

If it's the first, idk, you have to ask. My T sadly works for a place that wont allow anything beyond 8 weeks at 2x a week. All crisis stuff gets you passed on to crisis lines etc. It sucks but I've just had to learn to manage alone on the tough times.

Each T is different, it could also be an insurance issue or maybe he just doesn't think you need it that often. Some people are lucky and can do 2x a week for a long as they want, wether it's needed or not. Others can't There is no all around same thing for this, each T/company decides differently

IF its the second, no idea, again, ask but it seems odd that they would not be open to a second option unless they truly are THAT busy all week

[Lrad123]

Sorry if I wasn’t clear on my question. My T has offered me a 2nd weekly session. He usually sees people for a year or longer. I plan to keep my regularly scheduled weekly session, but am interested in adding a 2nd weekly session. In order for it to work for me, the second weekly session would need to change in terms of day/time each week because of my work schedule. I will talk to my T about it next week but I’m just trying to understand if that’s a big deal or not. I know in the past he’s said it’s important even for the 2nd weekly session to be at the same day/time each week and I think (?) it has to do with the therapeutic frame. Given the circumstances I’m just wondering if it is sometimes ok to be flexible about this.

[DP_2017]

You are lucky! That would be so great to have... yes it should be completely fine to be flexible. Therapy should be about YOU so accommodating to your schedule is what he should be trying to do

[ruh roh]

It sounds like he prefers a set schedule as part of what you call the frame, so having the second session be a different day or time each week doesn't fit how he works. Part of it could be that it's also easier for him to schedule that way. It takes a lot of juggling to work with moving pieces all the time, and if all his other clients have standing appointments, it's less likely he's going to have a second appointment for you that's different every week.

I went twice a week for about a year and a half--same day's/times--and it really was ideal to have it set. I am now trying to work back in to twice a week every other week, between weekly appointments, and it's harder to find that second appointment, as it's dependent on someone else cancelling until a permanent slot opens up.

So I guess I get his point, having been through this.

[Lrad123]

Originally Posted by DP_2017

You are lucky! That would be so great to have... yes it should be completely fine to be flexible. Therapy should be about YOU so accommodating to your schedule is what he should be trying to do

I guess I am lucky to have that as an option or at least to have a T that is willing. The reason, though, might be in part because I have some trouble holding onto the connection for an entire week. After 10 months in therapy I still have trouble feeling safe, open, vulnerable, etc. Honestly I think it might just be the way I relate to people. He thinks 2/week will help our connection. It kind of stresses me out a little!

[feileacan]

I agree with ruh roh that if your T is generally working with fixed session times then it just might not be that easy to find a time every week that would fit with your work schedule. I have standing appointments 4 times week (psychoanalysis) and if on some day I can't come at my usual time then usually he just doesn't have any alternative time to offer me because he is just booked with other standing appointments.

If that's the only way it works with your working schedule then it makes sense to try but with the way your T practices it might just not work out very easily.

[maybeblue]

I often have trouble understanding psychodynamic therapy and what the rules are. Personally I can't see why it matters what day you have appointments on. I generally have appointments on about the same day, but it isn't always weekly and it isn't always consistent. I think that there is definitely a point for me when there is "too much" therapy. I run out of stuff to say if I'm not in crisis or acutely distressed about something. Then I know it's time to back off on the number of sessions I have. When I'm very stressed and am doing things like calling crisis lines or emailing my therapist at 2 in the morning, then I know that it's time to increase them.

I'll be really honest, I bet that your therapist's scheduling fussiness has a lot more to do with his own personality than anything empirically based. But if I otherwise liked him, I'd put up with it, I wouldn't count on him being flexible with the second appointment sometimes and not others though. Sounds like that might stress him out.

I am curious about the two week cancelation policy: what if you have the stomach flu or bubonic plague or something? Does he still want you to show up?

[Ididitmyway]

For me, personally, the structure that your T has set for therapy is horrible. It's very unhealthy to me because it creates behavioral conditioning. Setting specific times for specific activities in general evokes a certain physiological response, as it was clearly demonstrated by the famous Pavlov dog's experiment. When you train yourself to eat, sleep, exercise and do other things on the same hours, your body, after some time, starts anticipating the activity you are supposed to do at this hour and tunes itself into doing it for better results.

While such consistency may have many benefits in our daily life because it helps us acquire healthy habits if our activities are health-oriented and our schedule is well thought of, I think, it's a bad idea to apply it to therapy because it creates an addiction to the process that can bring some big problems later when therapy stops working (which it will at some point).

When you see your T at the same time and the same place and even wearing the same clothes style every week, that conditions you to form a habit a.k.a addiction to having those meetings. If and when your T comes to his limit when he will not be able of help to you any more, you might be unable to break a habit of going to the same place at the same time even if you know you are not getting anything there anymore.

This might work well for the T though, as it would keep his income coming. Two weeks (!) cancellation policy also works great for him. Plenty of time to arrange his schedule so he won't lose any cash flow. I don't see how such draconian policy would work for a client. Such policy requires that I arrange my entire life around my therapy and don't allow myself any flexibility that is necessary to live my life.

Sorry, but, in my view, such framework makes life convenient for a T and not only inconvenient but unlivable IMO for a client. Given an already existing power imbalance in the therapy relationship, this structure gives the T so much power that it becomes oppressive.

That said, there is no such thing as "is this ok to have such a frame". It's okay for a T to have any frame they want to have in a sense that, as long as it doesn't violate any laws or ethical standards, Ts can set up whatever policies suit them. You, as a client, need to decide if their policies suit you. I'd never agree to the policies your T has, but that's me. If they work for you, fine. If some of them work for you and others don't, that's something to discuss with your T. If he refuses to change any of his policies, then, once again, you have a decision to make if you are ok with that or not. There is no such thing in psychotherapy as which frame is ok and which isn't. Within ethical and legal limits anything goes, so, as long as the T doesn't break laws or ethics, they can do whatever the hell they want. You decide if what they do is ok with you.

[SarahSweden]

I think this has to do with his therapeutic orientation and that he thinks it´s important to meet at the same time every week. I see my T different days and times every week but my T always aims for us having six or seven days between each session as we see each other just once a week.

If you don´t see any problems with seeing him different days and times I would say that to him and perhaps ask him if there is some special reason he doesn´t seem to be willing to do that. If it depends on him having a tight schedule with almost every patient seeing him the same time and day every week that could be an explanation and perhaps something that´s hard to do anything about.

The clothing thing I think has more to do with how he prefers to dress. It´s like in another job, some dress more casually and some like more of suits, ties, shirts and so on. I´ve met with T:s within the same orientation and some dressed in a bohemian style while others were more dressed up.

Originally Posted by Lrad123

My T is a psychodynamic therapist and I’ve been seeing him for about 10 months. I have a standing appointment on the same day and at the same time every week. If I’m going on vacation or need to cancel for some reason I need to give 2 weeks notice, otherwise I pay for the session. When this was new to me it sort of bothered me, but now it doesn’t. He also gives me about 3-4 weeks notice for his vacations. We’ve talked for a while about adding a second weekly appointment, but initially I wasn’t interested and later we had trouble finding a second time due to my work schedule. I have one weekday off each week and that’s the day I see my T. The other 4 weekdays my work schedule is busy and unpredictable. I’m thinking I’d like to see him a second time/week, but ideally on different days/times as my schedule permits. I know when we talked about this in the past he said this wasn’t ideal, I’m just not sure I understand why. Isn’t it better to see him at varied times for the 2nd weekly appointment than to not see him at all? Please help me understand.

Also, I’m just wondering if his wardrobe has anything to the with the frame. He wears really plain professional clothes - either khaki or black pants and white or black dress shirt. My son’s CBT therapist is very hip and fashionable so I definitely notice the contrast and it makes me wonder if my T dresses this way to take the focus off of him.

[Lrad123]

Originally Posted by maybeblue

I often have trouble understanding psychodynamic therapy and what the rules are. Personally I can't see why it matters what day you have appointments on. I generally have appointments on about the same day, but it isn't always weekly and it isn't always consistent. I think that there is definitely a point for me when there is "too much" therapy. I run out of stuff to say if I'm not in crisis or acutely distressed about something. Then I know it's time to back off on the number of sessions I have. When I'm very stressed and am doing things like calling crisis lines or emailing my therapist at 2 in the morning, then I know that it's time to increase them.

I'll be really honest, I bet that your therapist's scheduling fussiness has a lot more to do with his own personality than anything empirically based. But if I otherwise liked him, I'd put up with it, I wouldn't count on him being flexible with the second appointment sometimes and not others though. Sounds like that might stress him out.

I am curious about the two week cancelation policy: what if you have the stomach flu or bubonic plague or something? Does he still want you to show up?

Yes, all the rules that come with the whole psychodynamic thing can seem strange, can’t they? So maybe his scheduling has less to do with the psychodynamic frame than his own personal preference. I guess I understand that. I think he said something once about it feeling safer or something if you know you have the same time every week, I just don’t know if I really buy that.

As for the 2 week cancellation policy, I’ve actually never been sick in the 10 months that I’ve been seeing him, but I contemplate cancelling all the time and this probably keeps me from doing it.

[starfishing]

Psychodynamic therapy does place a high value on consistency. I can understand your therapist thinking that standing appointments on the same days and times are ideal for both sessions--I feel like since going to two sessions a week I notice any departures from the normal schedule even more, and like the solid routine of predictably timed therapy is more important than it was once-weekly. I'm not an extremely routine-bound person in general, but therapy is more productive for me when I'm able to have a consistent, predictable rhythm with scheduling.

So I agree that predictable twice weekly is better than an unpredictably scheduled second appointment, but that doesn't mean that consistent/predictable once weekly is better than an unpredictably scheduled second appointment. My sessions definitely move around sometimes because of conflicts on both my end and my therapist's, and I'd always much rather reschedule but still have two sessions than just cancel one outright. Maybe your therapist would be willing to give things a trial run with adding second appointments as you're able?

[stopdog]

I don't see the therapist saying there is a second appointment open each week as being lucky (to me, I don't see anything a therapist does from a business standpoint as being lucky to a client -clients hire them - therapists are not god on high handing down favors to the lowly clients). Here, I would see it as pressure from the therapist to conform to their idea. I would not do it the way the therapist has laid it out here and not unless I felt a strong desire to have two appointments a week from the same therapist.

[guilloche]

I think it really depends on the therapist, and the client. You mentioned that you're still having trouble feeling safe after 10 months (I struggle with this too!) - in that case, the consistency is a good thing, isn't it? If your session changed times every week, it could (even if it were unconscious) give you the feeling that your T isn't really there, can't be depended on, and might make it harder to feel safe. This way helps you see that there might be an issue here worth working on, and it's not just the unpredictable schedule with the therapist.

But, that's really about the first weekly session. I don't know about the second one. I can see how it would still apply - maybe it could signal to your unconscious that your therapist can't be trusted if your second moves around and doesn't feel "stable" or predictable.

It's something to think about for sure.

Also, if you do end up with a 2nd appointment, I'd be really curious to hear if it helps. I tried that once (decades ago!) and it didn't help me. I think the T was acting in a way that made it hard for me to feel safe and trusting, so seeing him more often didn't change that at all. But it sounds like that's not the case with your T.

Good luck!

Originally Posted by stopdog

Here, I would see it as pressure from the therapist to conform to their idea. I would not do it the way the therapist has laid it out here and not unless I felt a strong desire to have two appointments a week from the same therapist.

I guess not everyone takes an unnecessarily oppositional approach to their therapy and self-care.

[Echos Myron redux]

Originally Posted by SorryNorma

I guess not everyone takes an unnecessarily oppositional approach to their therapy and self-care.

This is a support forum. We're not supposed to be judging the way others choose to do therapy. It's unpleasant and...well...unnecessarily oppositional.

Originally Posted by Echos Myron redux

This is a support forum. We're not supposed to be judging the way others choose to do therapy. It's unpleasant and...well...unnecessarily oppositional.

It's difficult for me because I am unpleasantly oppositional and unnecessarily judgmental. I am not what I am supposed to be.

[Echos Myron redux]

Originally Posted by SorryNorma

It's difficult for me because I am unpleasantly oppositional and unnecessarily judgmental. I am not what I am supposed to be.

I'm not saying you can't be whoever you are/want to be, but I am saying that expressing that towards other people's therapy on this board is a) against the community guidelines and b) just not very nice.
So whether or not you are naturally that way inclined (I have no idea whether you are or not) it's worth just remembering that you're not invited to express those kinds of judgments about other people on here.

Originally Posted by Echos Myron redux

I'm not saying you can't be whoever you are/want to be, but I am saying that expressing that towards other people's therapy on this board is a) against the community guidelines and b) just not very nice.
So whether or not you are naturally that way inclined (I have no idea whether you are or not) it's worth just remembering that you're not invited to express those kinds of judgments about other people on here.

I am not very nice, that's true. This forum is full of judgments. If people are so vulnerable that impersonal words from a remote stranger are too threatening, perhaps a public forum isn't the place for them. Anyway, rather than you, isn't it the place of the poster to whom I was responding to tell me that I have offended them?

[Elio]

When my T was working in the clinic, I had the same time of day for both my sessions. Now I have the same time each week for each of my sessions but each one is at a different time of the day. It was easier with the same time of day. When she first suggested the same time, I asked her about it and she said that it was just ease of scheduling, since it was available. It is not available now, I've adjusted and it is fine. I am not sure how I would do if it changed from week to week. That is my personality and my personal needs.

As far as clothing, it could be part of his way of keeping things off him or just who he is. My T practices in a shared suite. She varies her clothing based on her personality and other things going on in her life. Most the times she's dress casual/conservative. Every now and then she'll dress more professional. One of the guys always wears a white button down shirt and dark slacks. One of the other women dress a bit too... well she's attractive and she dresses in a way that is nice, but shows a fair amount of skin. It would be distracting for me.

[Elio]

Originally Posted by starfishing

My sessions definitely move around sometimes because of conflicts on both my end and my therapist's, and I'd always much rather reschedule but still have two sessions than just cancel one outright.

I agree with this completely - I'd rather move my session than have it cancelled outright.

I did recently go through the first week with a holiday (thus missing a session) since moving to 3x week and that went much smoother than the previous holidays where missing a session meant I went a full week between sessions.

[starfishing]

Originally Posted by Elio

I agree with this completely - I'd rather move my session than have it cancelled outright.

I did recently go through the first week with a holiday (thus missing a session) since moving to 3x week and that went much smoother than the previous holidays where missing a session meant I went a full week between sessions.

Funny you should mention that, since one of my usual sessions this week is cancelled (therapist going out of town) and part of me is already dreading going a week in between appointments! It's not going to be the end if the world or anything, but it's hard to believe I used to routinely go a week when now that feels like a small eternity when it happens.