15 Sep Individual Therapy Sessions: How Often? How Long?
In his June 2014 blog article posted on thefix.com, Lydon Aguiar, Clinical Director at Williamsville Wellness, discusses the length and frequency of one-on-one therapy for individuals in addiction recovery treatment programs. Aguiar claims that the standard “… one hour a week is not enough.” He goes on to discuss a New York Times article written by psychiatry professor Richard Friedman, who points out that not enough research has been done on the optimal length and frequency of individual therapy sessions for people in addiction recovery. Clinicians, he said, have simply defaulted to a 50-minute session per week, even though it may not be best for addicts.
How Much Therapy Is Best for Addicts?
As it turns out, the research on optimal frequency and duration of individual therapy is spotty, and the one definitive work that attempts to answer the question, a therapeutic manual published by the National Institute on Drug Abuse (NIDA), focuses primarily on in-patient cocaine treatment programs. Simply put, not enough research has been done to validate or verify the old standard. People seeking therapy as part of addiction recovery almost universally do so for one hour a week, or even less often. But would more often be more advantageous?
The Williamsville Approach
Aguiar makes a compelling case for the model adopted by Williamsville Wellness in Virginia, where a person attends several short therapy sessions each day, with every session conducted by a therapist with a specific focus. This model allows the recovering addict time to digest the sometimes challenging personal issues which arise during a session, and enables the therapeutic work to be done one step at a time, one issue at a time—which can make it more manageable. The Williamsville approach also gives recovering addicts the opportunity to form a web of supportive relationships, which are proven to buoy people through any recovery process.
Other Modalities for Therapy Frequency
For in-patient recovery programs, The Williamsville approach seems ideal, but what about out-patient recovery programs? The NIDA Manual, An Individual Drug Counseling Approach to Treat Cocaine Addiction, recommends two, one-hour sessions per week, but discusses the fact that even this may be challenging for those who work full time, or have significant family commitments. Other individual therapy modalities for outpatient recovery programs recommend some variation of the following: 12 weeks of once-a-week, one-hour sessions that taper to one-hour sessions once a month, and end with quarterly refresher sessions. However, as Freidman points out, these models are nothing more than the default practices borrowed from standard psychotherapy courses of treatment, and are not supported by research specific to addiction recovery. They may not meet the needs particular to people in recovery.
Next Steps: Research Opportunities and Relapse
Aguiar’s article, which on the surface is an advocacy piece for the therapeutic modality espoused by Williamsville Wellness, may reveal a void in addiction recovery research. No one really knows how often or how long individual therapy sessions for people in recovery should be. This void presents an opportunity for the research community to address these fundamental questions, thereby tackling one of the thorniest problems in addiction recovery—relapse. If our approach to individual therapy has been flawed all along, based on practices borrowed from treatments with nothing to do with addiction, then perhaps researching, refining, and outlining best practices for therapy sessions might prevent people in recovery from returning to the behaviors that brought them into treatment in the first place.
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