Why Session by Session Therapy Is Not Used
Occasionally, people ask if they can pay session by session.
There are reasons why I no longer offer this and haven’t done so for over 7 years.
When someone seeks therapy - be that for help with anxiety (any of the types of anxiety, for example GAD, OCD etc), depression, mixed anxiety and depression, or tinnitus, hyperacusis, vestibular (balance issues) rehabilitation - they are embarking on a process of making changes. Bringing about change - if it is going to be permanent and not simply a quick fix that does not last - is a process. Any process has a beginning, a middle and an end, and this is as true for the therapy process as it is for anything else.
The 3 Reasons for Not Using Pay Per Session
1. I could offer session by session payment - which would work out prohibitively (in my view) expensive at £70-£90 per hour for psychotherapy and anything from £150-£200 per hour for tinnitus, hyperacusis and vestibular rehabilitation, compared with paying for a course of therapy at the start.
2. More importantly than cost alone, I found it also impacts the progress of therapy, as a not insignificant proportion of people need to limit their number of attendances to one or two a month. This is not conducive to bringing about changes. There is broken continuity, and what was learned in one session has been forgotten by the next. People put off undertaking new practices - “I’ll start this in a few days” and they don’t start it at all or don’t think about it again until the next appointment date looms up on them, by which time there is little point doing it at all.
Next thing is they cancel their next appointment, and then find themselves losing any motivation they had to change and then often find themselves back where they began, feeling bad about themselves and to be blunt, they even blame the therapy for not working!
3. A third and equally important factor was, if they do attend weekly to begin with - which is needed at the start of the process - they begin to feel better after three or four weeks, and so then they cancel their next appointment. Goals they set - for themselves near the start - remain unmet, but they felt better than when they started. This early improvement nearly always happens - partly because they have begun changing their ‘neurobiology’ (the first stage), and partly because the sense they are doing something to help themselves sets their mood higher than it was before they began. They do genuinely believe they are “better”, but in fact, these feelings/beliefs are short lived.
Conclusion
These outcomes actually happened; not once, or a few times, but time after time.
It was extremely concerning to me. It was a massive decision for me to make over 7 years ago circa 2012/13 to change the way people paid for their therapy. It made complete sense to stop offering “payment per session” as it did my clients/patients no favour whatsoever, and they certainly didn’t benefit therapeutically.
Ever since I put in place pre-payment - that in terms of cost to them is approximately halved; and because people attend for the whole process - beginning, middle and end - they complete the process, and achieve their goals.
I am aware that most ‘counselling services’ still use pay per session. And that’s their choice - and it’s the clients’ choice. But because of the evidence over a period of some 3 years that it did not work, it is not something I can offer.