On Increasing Session Frequency in Psychoanalytic Couple Psychotherapy: Some Clinical Considerations

In this paper I explore the issue of session frequency in psychoanalytic couple psychotherapy. I describe the origins of a model of psychoanalytic psychotherapy that has influenced practice and training at the Tavistock Centre for Couple Relationships (now Tavistock Relationships), and consider reasons for departing from the usual practice of seeing couples once weekly. Through case illustrations, I suggest that in some circumstances increased session frequency bolsters the therapeutic container, widening the scope for improving the capacity of the couple relationship to contain unconscious anxieties. These circumstances include cases where there is a powerful unconscious projective system impeding individuation in the couple, especially when these evoke feelings of shame couples struggle to link conscious manifestation of their problem with unconscious anxiety. I also present a case where a discussion around increasing session frequency resulted in the therapy ending prematurely. Finally, a case where an increase was discussed, but not implemented, is referred to. I conclude with a discussion of other factors that might indicate or contraindicate an increase in session frequency.