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Getting the Most Out of Psychotherapy

Session Frequency

The frequency of sessions helps balance cost, intensity, and emotional containment. Clients most often attend sessions weekly to balance cost and effectiveness and settle into an emotional rhythm provided by attending at the same time each week. If you see your therapist weekly, you’ve had some time to integrate the effects of the previous session, which is recent enough that it will have continuity with your next session.

Seeing a therapist less often costs less but may be less effective if you aren’t meeting often enough to accomplish changes at a steady pace. Clients immersed in intense emotional or life changes may see their therapist twice a week or more to help keep them be emotionally centered and assist them in activating coping skills.

Clients also meet more often in psychoanalysis, which is a specialized type of long-term therapy designed to restructure the personality through a thorough exploration of life history and issues. [5]

Client and Therapist Roles

In the therapy room, there’s a power differential between client and therapist, because this is the arena of the therapist’s specialized knowledge. Clients are seeking the therapist’s advice or expertise to solve difficult problems, discover new things about themselves or make important decisions. Because of this power differential, it’s the therapist’s responsibility to explain the psychotherapy framework and ground rules, and to act in the best interests of the client.

The psychotherapy relationship may feel imbalanced because clients talk about themselves, and their issues come first. The goal of therapy is to meet the client’s needs, and other than the payment required to make a living, the therapist is responsible to keep the work focused on those client needs.

Therapists often differ in how much they reveal their own emotions or thoughts, which anyone new to therapy may find unsettling. There are reasons for what is called therapeutic neutrality and ways that I believe it can be a barrier to natural relating.

The therapist neutrality concept began with the psychoanalytic idea that if the analyst remains unknown, the analysand uses the analyst as a blank screen for projecting attachment responses to early caregivers. These responses are often the basis for relationship difficulties today, so it can be very helpful to have them revealed for client and therapist to see.

The attempt to offer oneself as a blank screen can be a barrier to successful therapy if it is rigidly practiced without awareness of the client’s individual needs. It can also be an obstacle if the therapist remains emotionally cold and distant as a defense against revealing unwanted thoughts or feelings. Said another way, the blank screen becomes a barrier if it prevents the client from experiencing support from the therapist for healing. My own approach is to find a balance where clients have the opportunity to discover their own thoughts as the therapist does more listening than talking.

Not all schools of therapy use the blank screen. Some, for instance, encourage the therapist to reveal personal responses to model emotional openness. Psychoanalysis may explicitly use neutrality in a disciplined way for clients who are sufficiently secure that they are ready to discover the depths of early childhood emotions and thoughts without distraction. I find that such depths can be revealed in therapy anyway by exploring our interactions here and now, when it’s appropriate in terms of timing, trust, and client capacity.

My own therapeutic style is to attune my senses to a client’s uniqueness by sometimes emotionally detaching from my own memory, desire and understanding. [6] This helps me tune into your thought processes in the moment, including your model of healing. If I’m not open to your ideas about healing and our work doesn’t cooperate with them, we’re not likely to succeed. [1] I balance neutrality with the discussion of therapeutic goals and such safety issues as substance abuse that may be endangering wellbeing or preventing change.

Getting the Most Out of Psychotherapy

Gary Seeman, Ph.D

Gary Seeman, Ph.D. is a psychologist in private practice in Corte Madera and San Francisco, CA. He works with adult individuals and couples, specializing in addictions, bereavement, creativity, life transitions, personal fulfillment, relationships and spirituality. He maintains a website at

APA Reference
Seeman, G. (2018). Getting the Most Out of Psychotherapy. Psych Central. Retrieved on October 18, 2019, from
Scientifically Reviewed
Last updated: 8 Oct 2018
Last reviewed: By a member of our scientific advisory board on 8 Oct 2018
Published on Psych All rights reserved.