Why You Might Need More Than Weekly Therapy
Evidence-based anxiety therapy for teens, young adults, and children in St. Louis, MO
Feedback Informed Treatment, Outcomes, and Tracking Our Clinical Progress
When you get started with therapy, at any therapist’s office, there’s typically a pretty standard structure. Most therapists, psychologists, and counselors will tell you, “We’re meeting for 45-50 minutes, each week.”
This can be a really helpful amount of counseling, and for some people, it’s the perfect amount. In fact, at Compassionate Counseling St. Louis, this is our standard set up, as well. You come in, work on treatment goals, and make progress. You get a good balance of checking in about the week, while working on bigger picture issues.
But sometimes, 45 minutes of therapy a week just isn’t enough.
There are times when we might recommend more than this standard, baseline 45 minutes of weekly counseling for you, your child, or your teen, and it all comes down to asking, are we really meeting your needs? Or not?
How we know that the standard, weekly anxiety therapy is working great:
At Compassionate Counseling St. Louis, we’re really focused on tracking outcomes. Each week that you come in, we have you or your child fill out a weekly Outcomes scale, where you rate on a 1-10 how you’ve been doing for the past week individually, with family, with school/social, and overall.
When we’re on a good trajectory with Outcomes, we see these scores go up and stay up, demonstrating that, even when challenges happen (which they always will!) you’re able to handle it and stay resilient:
The blue line is the Outcomes Rating Scale (ORS). This graph shows a good trajectory for outcomes.
When the standard, weekly schedule isn’t working as well as it could:
Sometimes, 45 minutes of weekly counseling isn’t enough to meet your needs. One of the first ways we can clue into this is through, again, tracking those scores.
When the ORS isn’t improving, we want to have a really solid conversation as your therapist. Are we doing enough in counseling? Are we a good fit? Are we meeting your needs? Are we focusing on the right stuff? Don’t worry, we have a research-based way of tracking this, too - the Session Rating Scale, or SRS.
If our sessions are feeling like a good fit (my listening to you feels great, therapy feels important, sessions feel useful) but those Outcomes are still not improving as we’d like, it may be an issue of not providing enough therapy.
The Session Rating Scale (SRS) is the score the client provides on our work as the therapist. The SRS is high in this graph, showing that we’re probably a good fit as the therapist, but the Outcomes Rating Scale is not showing improving. This might be an opportunity to increase therapy services to see if we’re better able to meet clinical needs with an increase in frequency.
Before we jump to increasing therapy minutes, our St. Louis anxiety therapists want to ask a few questions:
Is there a really good reason that we, as your counselor, think increasing your therapy time will actually be helpful?
We’re never going to recommend an increase in therapy just to add more hours to our schedule. Ethically, your therapist is only going to recommend an increase in therapy time or frequency if we really feel like we have a good reason.
We never take a “one size fits all” approach to counseling for our anxious, angry, overwhelmed kids, teens, and college students. For some, increasing therapy time, or therapy frequency, helps to better meet your clinical needs.
We only increase therapy when we think it’s going to help.
Are your external stressors increasing, meaning that you need more support?
Back in 2020, when Covid first hit, there was a HUGE amount of change for everyone to deal with, across the board. We’re still feeling the impacts of all of this stress due to being at home, social distancing, changes in the daily structure, and grief about all of the things they’re missing out on.
Racial injustice/trauma is another issue that compounds mental health issues, for kids, teens, and parents. As things happen in our community, our mental health can be significantly exacerbated by big stressors, and for families living in targeted communities, or families who are part of groups that are significantly impacted by racial injustice issues, there’s a really big toll that they experience mental health wise.
Other external stressors can include changes at home and at school, with family and friends, and upcoming shifts to your environment (like moving, graduation, and other big changes to your life).
Mental health wise, are your internal stressors increasing?
Has your anxiety level been even higher than usual? Are you noticing an increase in panic attacks? Have you been experiencing more thoughts about injuring yourself or killing yourself? We want to be sure you’re getting extra mental health support when you’re noticing stronger, less manageable emotions.
Feeling like you need some parent support?
Our parent coaching program is like therapy for parents! We’ll help you come up with a plan for how to handle the stress - yours, or your child’s.
Would it be better to increase the amount of anxiety therapy with us, or to add in additional therapy or support (like parent coaching) from another helping professional?
Our therapists specialize in anxiety and anger management, and we love to pull in a ton of other resources when it’s recommended. So, you as a parent may need more parent check-ins, which means we might recommend that you get parent coaching in addition to your child’s individual therapy. If you have OCD symptoms, you may continue to work with us on general anxiety and stress as you start work with an OCD specialist.
How long are we going to try increasing therapy, and how are we tracking if it’s actually effective?
It’s usually fair to give a new intervention 3 or 4 weeks to see if it’s actually making an impact. For some, increasing therapy is effective, and we want to keep doing it on an ongoing basis. For others, this is going to be a short term addition, due to that time-limited increase of external stressors.
We know this because we track those weekly outcomes scores. So instead of just trying to figure out if it feels better, we actually have data to support our hypothesis (we’re pretty nerdy about the numbers here!)
Anxiety therapy shouldn’t have to last for forever.
We want to have a really clear goal, and discuss as a group how we’ll be able to tell that you or your child are ready to graduate from therapy. We need clear goals in mind, even if that goal is just, my ORS is improving and staying steady. At Compassionate Counseling St. Louis, we check in really, really frequently about if we’re on track, and if we’re not.
Options to increase your anxiety therapy minutes:
If we know you need more than the standard, weekly 45 minute session, and we have a really clear plan for increasing support, Compassionate Counseling St. Louis has two options.
We can bump up therapy to two times a week, meeting for two 45 minute sessions.
This is a great option for people who need more regular counseling, and feel like each weekly session is just crisis management. When we meet more than once a week, we have a check in session to deal with that crisis - and then later that week, we can focus more on skills building, and the bigger picture.
We can increase your weekly therapy time.
For some of our clients, longer weekly sessions can help meet their increase therapy need. We offer 60 and 75 minute therapy options on that weekly basis. Longer sessions are good for clients who can stay focused and engaged for this longer amount of time. This is also a great option for people who feel really talkative - because we’re still giving you time to verbally process everything, without you feeling like we haven’t really engaged a lot as your therapist.
St. Louis Counseling for Kids, Teens, College Students Parents
What effectively increasing your anxiety therapy looks like in the data at Compassionate Counseling St. Louis:
We love tracking outcomes scores every single week that you come in for therapy. We also find it to be really helpful to get parental scores, too, when we’re working with your child. We want to check in and get your weekly numbers, assessing your view of how your child has been doing individually, within the family, at school/with friends, and your overall outcomes score for their week.
The below example shows a noticeable decrease in scores, due to a change in environment right between session 5 and 6. Those scores get right back on track when we increase therapy following session 8.
This graph shows the parent’s collateral rating of outcomes. At session 8, when we increased therapy minutes, both the child and the parent report a clinically significant improvement in the ORS.
Alright, final question. Is it the anxiety therapy that’s really helping, or is it something else?
As licensed clinical social workers and counselors, we focus a lot on PIE, or person in environment. We know that we’re not providing counseling within a vacuum. We only get you for a short amount of time every week. There are all of these other factors that impact your scores.
But we also know, with all of those factors, that we’re here as a support for you. So your week may have felt better because your teacher was nicer, or your friends invited you to a birthday party - but maybe it was easier to notice these things because of the mindfulness skills we’ve built in therapy.
And honestly, if it feels like things are better because of what’s changed outside of therapy, that’s awesome. We don’t need the credit as your therapist. We want to support you. What you’re doing right, what you’ve changed, and how your perspective has changed.
We tailor our approach to every single client.
As child therapists and therapists for teens/college students, we’re never a one size fits all agency. We work with kids and teens from age 4 on up - so even on just that level, there’s no way we could use the same approach with an angry four year old and a high schooler with perfectionism. We’re all about tailoring our approach to you. For some, increasing therapy may be a really great option.
We’d love to explore this as an extra resource for you - and we’re happy to talk about this further in an initial phone screening.
Schedule a call right here!
Spotlight on CBT Therapist Molly Shaffer
Molly Shaffer work with kids, teens, and families using CBT and trauma-focused interventions. Learn more about Molly.
Kelsey Torgerson Dunn, MSW, LCSW is the author of When Anxiety Makes You Angry and founder of Compassionate Counseling St. Louis.
Curious to hear more, or are wondering if an increase in therapy is something you should consider? Compassionate Counseling St. Louis provides specialized anger management and anxiety therapy for kids, teens, and college students. We work in Clayton, MO and serve kids, teens, and college students throughout St. Louis City, St. Louis County, Ladue, University City, Town and Country, Webster Groves, Creve Coeur, Kirkwood, Richmond Heights, and Brentwood. You can set up your free phone screening to see if we’re a good fit for your needs right on our website.
Thumbnail image provided by: Caroline Hernandez
This post was originally published May 15, 2022 and updated February 9, 2023.