Thanks to Sumit-Saharkar on Unsplash

COVID-19 stresses us and challenges us. To meet that challenge, we need a new model of psychotherapy and counseling. No other health profession asks clients or patients to come once per week. We go to a doctor or a dentist—or a lawyer or financial advisor—when we need to. We should be able to consult with a therapist or counselor in the same way.

You may be eating more, drinking more, or using some other chemical more. You may be engaging in some other form of semi-addictive or addictive behavior, like video gaming or online porn, to help yourself through this difficult period. You should be able to call a therapist, make an appointment, have one or more consultations (in person or by phone or online), and then see if you can adjust your behavior.

Currently, if you don’t wish to go for therapy every week, your therapist may suggest it’s because you may be afraid to get down to the deeply buried issues that are fueling your behavior; they may suggest you’re “resistant.”

Possibly, that’s correct. But it’s a little bit like your lawyer suggesting there may be some reason to suspect that you are, in fact, guilty. Why? Because you canceled your last appointment with him.

Weekly sessions may be a good business model for therapists, but not for clients, especially during this time period.

Most people don’t want to go to “therapy,” which means sessions once a week for a year or maybe longer. Few people want or can make that commitment. And who has the money now? So, even though they know their behaviors are slowly slipping in a way that they don’t like, they don’t call anyone.

The old therapy model suggested that deeply repressed and defended-against ideas were driving dysfunctional behavior. It took time and many sessions to make “the unconscious conscious” and to reconstruct a patient’s personality.

Not only may this theory be incorrect, but it also keeps people away from therapy or counseling that could be extremely helpful.

Single-session therapy is not new. Freud did a single session with a number of people, including the German composer Gustav Mahler, which reportedly was extremely helpful. Albert Ellis, the founder of the first form of cognitive-behavioral therapy (CBT), frequently did single sessions, often in front of a live audience.

Kaiser Permanente in Oakland, California, began offering single-session therapy under the guidance of Moshe Talmon in the 1990s. In England, it’s an accepted form of CBT and is covered by the National Health Service.

Unknown to many, including many therapists and counselors, the most common number of sessions is one. And in follow-up interviews, 70 to 80 percent of patients say the single session was very helpful.

If clients want to come for more sessions, they may. Many of our visits to professionals, such as internists, cardiologists, ophthalmologists, lawyers, and accountants, follow that model. If we need more “sessions,” we go for more. But sometimes one is sufficient.

Occasionally, I tell people that I specialize in “sporadic” therapy. It’s only partly a joke. I see people for three or four sessions, and then I may not see them for a month or six months. Changing behavior takes time and practice and, of course, commitment.

But people shouldn’t have to commit to once per week therapy. I have seen some clients who are grappling with bipolar disorder for over 20 years. They see me sporadically. When they need to, they call me. When the crisis has passed, I may not see them again for a while, perhaps even for months.

Therapists who work as I do also never “terminate” anyone (what a terribly unfortunate term!). Older forms of psychoanalysis and psychodynamic therapy took a very long time, and the thought was that a fairly long time should also be taken to wrap up and end the relationship.

Perhaps. I prefer to leave the file open, as my internist does.

Talking to a professional occasionally during this time of enforced confinement could be very helpful to many people. Even a phone session or virtual session by Zoom or doxy.me might be much better than nothing at all.

Therapists and counselors should change the way they offer their services. They should put a sign outside: “Come When You Want for as Many Sessions as You Want.”