The Cost of Coping

When couples ask, “Can we afford to come to therapy every week?” they’re asking an important question.

Weekly couple therapy is expensive. Add up four sessions a month over several months and the sticker shock is real. Every-other-week appointments can immediately feel like the more financially responsible choice.

But that is only one way of looking at the math.

I recently took stock of the 50+ couples I’ve worked with over the past few years, and one pattern stands out: many of the couples who gain momentum, move into deeper healing, and begin changing their relationship sooner are the couples I see weekly.

That’s an observation from my practice, not a promise. But research on psychotherapy frequency points in a similar direction.

In a large naturalistic study of more than 21,000 clients, greater session frequency was associated with faster recovery (Erekson et al., 2015). More recent research comparing weekly and biweekly therapy found that weekly therapy increased the likelihood of early improvement and shortened the duration of suffering—while also emphasizing that frequency should be individualized (Lin et al., 2024).

That distinction matters.

The research does not tell us that every person—or every couple—will ultimately get “more healed” simply because they attend weekly. What it does suggest is that how closely we space therapy may influence how quickly improvement begins to take hold.

And that brings me back to the cost.

Costs that don't show up on a statement

We tend to notice the visible cost of getting help: the therapy bill, childcare, time away from work, and the inconvenience of protecting an hour every week. 

The costs of not getting help are harder to put on a statement.

Relationship distress doesn't just sit quietly in the background of our lives. We have to find ways to live with it.

Another bottle or gummy to take the edge off.

Another Amazon package because buying something feels good for a moment.

More ordering in because nobody has the emotional bandwidth to cook.

More coffee after staying up late arguing or catching up on missed work.

More scrolling. More work hours. More avoiding. Another night out or weekend away because the stress is too much.

The receipts add up.

None of these things are inherently bad. Ordering dinner isn't a symptom. Neither is buying something you enjoy or having a glass of wine. But it might be worth asking: 

“What job are we asking our coping to do for us?”

Coping with relationship distress has a price tag. 

Some of it is measured in dollars. Some of it shows up in lost sleep and productivity, less patience with our children, evenings spent recovering from arguments, hours spent avoiding each other, and mental energy consumed wondering whether the relationship will ever feel different.

Think of it as your coping economy: everything you spend—in money, time, energy, attention, sleep, and connection—to manage something that still isn't getting better.

Once you start counting those costs, the price of therapy is no longer the only number that matters. Time matters too.

Twenty hours aren't simply twenty hours

Twenty weekly sessions take roughly five months. Twenty every-other-week sessions stretch toward ten. But there is something even more important to understand:

Therapy is not simply 20 interchangeable hours that produce the same result regardless of how far apart we space them. 

There is momentum to your work.

Every session has some amount of re-entry. What happened since I saw you? Where are you in the relationship right now, today? When 14 or more days pass between sessions, a lot of life happens. The cycle you're trying to break has 14 days to reassert and reinforce itself.

This is particularly relevant to the kind of Emotionally Focused Couple Therapy (EFCT) I practice. We aren't simply teaching better communication skills or using each appointment to review the latest version of the same argument. EFT is grounded in attachment science. I help partners recognize the protective cycle that has become automatic between them, access the more vulnerable emotions underneath it, and create new experiences of reaching and responding differently.

We are trying to make something new more available than something old. And those new experiences need opportunities to build upon one another.

Repetition and continuity matter when you're trying to change patterns that have been rehearsed thousands of times for years.

This is where the frequency research becomes clinically interesting. It doesn't prove that weekly couple therapy is superior to every-other-week couple therapy, nor were the Erekson and Lin studies specifically trials of EFT. But their findings give us good reason to take frequency seriously.

Having sessions closer together may give the work more opportunity to build from one session to the next, helping change happen sooner, which means less time spent living with the distress that brought you to therapy in the first place.

Putting all costs on the table

This doesn't mean every couple should attend weekly therapy. Finances, childcare, work schedules, health, and life circumstances are real constraints. Every-other-week therapy can still be meaningful and effective.

But perhaps weekly therapy deserves to be considered differently. Not as an indefinite expense, but as a concentrated season of investment in changing something that may have been costing you for years. Sometimes the less expensive choice isn't the one with the smaller monthly bill.

So instead of asking only: “What will couples therapy cost us?”

put another question beside it:

“What is continuing without the healing we're seeking already costing us?”

Look at the whole coping economy.

The money. The time. The energy. The sleep. The attention. The connection. The impact on your family. The hours of your life you don't get back.

Doing this work has a price. So does remaining stuck.

My invitation is to put both costs on the table—and decide together where you want to invest from here.

Ciao for now,

David Byers, LMFT 162286

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References

Erekson, D. M., Lambert, M. J., & Eggett, D. L. (2015). The relationship between session frequency and psychotherapy outcome in a naturalistic setting. Journal of Consulting and Clinical Psychology, 83(6), 1097–1107. https://doi.org/10.1037/a0039774

Lin, T., Anderson, T., Erekson, D. M., & Ogles, B. M. (2024). Trajectories of change in weekly and biweekly therapy. Journal of Counseling Psychology, 71(1), 77–87. https://doi.org/10.1037/cou0000711