Therapy is a structured and dynamic process that unfolds over time. While the first session often focuses on intake and establishing rapport, the real therapeutic work begins in the subsequent, ongoing sessions. These sessions are where healing, insight, and personal growth develop through consistent effort and collaboration between therapist and client. Understanding what happens during ongoing therapy sessions helps demystify the process and empowers clients to engage more effectively. This essay explores the goals, methods, phases, therapeutic dynamics, and outcomes of ongoing therapy sessions, supported by research and clinical guidelines.

The Structure of Ongoing Therapy Sessions

Each therapy session typically lasts between 45 and 60 minutes and occurs weekly or bi-weekly, depending on the treatment plan and client needs (APA, 2023). Ongoing therapy follows a flexible structure that balances consistency with adaptability.

Ongoing therapy sessions typically follow a structure that involves building a therapeutic relationship, gathering information, setting goals, implementing interventions, and evaluating progress. Sessions often begin with a check-in, followed by a discussion of current issues and progress, and conclude with a summary and review of the session’s key points.

Typical Session Components

Check-in: Sessions often begin with a brief check-in on the client’s mood, events since the last session, or any urgent issues.
Review of Progress: Therapists may review goals or progress on therapeutic assignments.
Focus Work: This is the core segment, where therapeutic techniques are applied to address specific issues.
Closure: Sessions end with a summary, reflections, and planning for the next steps (Corey, 2017).

Therapists adapt this structure based on client needs, therapeutic modality, and current challenges.

Goals of Ongoing Therapy

While initial sessions may focus on assessment, ongoing sessions are more focused on:

Deepening insight into thoughts, behaviors, and emotions
Processing trauma or past experiences
Developing coping mechanisms
Enhancing emotional regulation
Improving relationships and communication
Building self-awareness and resilience (Wampold, 2015)

Therapists and clients regularly revisit goals to ensure they remain relevant and adjust as progress is made.

Therapeutic Approaches and Techniques

Therapy techniques encompass a wide range of methods used to address mental health concerns. They include talk therapies like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy, as well as techniques like exposure therapy, eye movement desensitization and reprocessing (EMDR), and interpersonal therapy. Other approaches include humanistic therapy, systemic therapy, and integrative therapy, which combines elements from multiple approaches. Different therapeutic models influence the content and process of sessions. Some of the most commonly used include:

Cognitive Behavioral Therapy (CBT): CBT focuses on identifying and changing negative thought patterns and behaviors. Sessions include:

Cognitive restructuring
Behavioral experiments
Homework assignments (Beck, 2011)

Psychodynamic Therapy: This approach explores unconscious processes and past experiences. Ongoing sessions involve:

Free association
Exploration of defense mechanisms
Transference analysis (Shedler, 2010)

Humanistic Therapy: Humanistic approaches emphasize personal growth and self-actualization. Sessions are:

Client-centered
Empathetic and non-directive
Focused on present experience (Rogers, 1957)

Dialectical Behavior Therapy (DBT): DBT combines cognitive-behavioral techniques with mindfulness. Ongoing therapy includes:

Skills training (e.g., distress tolerance, emotion regulation)
Diary cards
Behavioral analysis (Linehan, 1993)

The Role of the Therapeutic Relationship

The therapeutic relationship, also known as the therapeutic alliance, is a fundamental aspect of effective therapy and counseling. It’s the bond between a therapist and client built on trust, empathy, mutual respect, and a shared understanding of the goals of therapy. This relationship fosters a safe and supportive environment where clients can explore their emotions, challenges, and personal growth

The therapeutic alliance is a cornerstone of effective therapy. It encompasses mutual trust, collaboration, and agreement on goals and tasks. Research consistently shows that the quality of this relationship significantly predicts positive outcomes (Horvath et al., 2011).

Therapists demonstrate empathy, congruence, and unconditional positive regard. Clients who feel safe and understood are more likely to engage deeply and honestly.

Phases of Ongoing Therapy

Therapy can be understood as progressing through several stages:

Engagement and Stabilization: Focus on establishing safety, rapport, and consistency. Initial coping strategies are introduced.
Working Phase: Deeper exploration of issues. Implementation of specific interventions. Increased emotional insight and behavioral change.
Consolidation and Termination: Review of progress and achievements. Planning for future challenges. Preparing for the end of therapy (Norcross & Wampold, 2011)

Common Themes in Ongoing Therapy

In ongoing therapy, common themes include exploring difficult relationships, addressing emotional challenges like anxiety and depression, setting goals, and building a strong therapeutic relationship with the therapist. Other recurring themes involve exploring past experiences, including childhood and trauma, and identifying life patterns that may be contributing to current issues. Some recurring topics and issues include:

Relationships and attachment
Self-esteem and identity
Anxiety and stress management
Grief and loss
Trauma processing
Life transitions (APA, 2023)

Therapists help clients make connections between current struggles and past experiences, facilitating understanding and growth.

Monitoring Progress

Monitoring progress in therapy involves regularly assessing patient outcomes using both quantitative and qualitative measures to track improvement. This helps therapists and clients understand how therapy is progressing, identify areas for adjustment, and ensure treatment effectiveness. Clients can actively participate by keeping journals, reflecting on their experience, and completing self-report questionnaires. Progress in therapy is tracked through:

Regular goal reviews
Self-report measures (e.g., GAD-7, PHQ-9)
Client feedback
Clinical observations (Lambert, 2013)

Therapists adjust interventions based on what is working or not, fostering a responsive and client-centered process.

Challenges in Ongoing Therapy

Common challenges include:

Resistance or ambivalence
Emotional distress
Plateaus in progress
Therapeutic ruptures

Effective therapists address these issues through open communication, reassurance, and adjusting strategies to meet the client’s evolving needs (Safran & Muran, 2000).

Termination and Maintenance

Termination is an important and sometimes emotional part of therapy. It typically involves:

Reviewing goals and accomplishments
Discussing feelings about ending therapy
Planning for future challenges and potential relapses

Clients may transition to less frequent sessions or engage in follow-up check-ins. Some may return for booster sessions as needed. Ongoing therapy sessions are where meaningful change takes root. They provide a safe space for reflection, exploration, and action. Whether guided by CBT, psychodynamic, or humanistic principles, the process hinges on a strong therapeutic relationship, structured goals, and a willingness to engage. Understanding what happens during these sessions helps reduce stigma, increase engagement, and maximize the benefits of therapy. As research and clinical practice continue to evolve, ongoing therapy remains a vital tool for enhancing psychological well-being and fostering lasting transformation.

Dr. Randi Fredricks, Ph.D.

Author Bio

Dr. Randi Fredricks is a leading expert in the field of mental health counseling and psychotherapy, with over three decades of experience in both research and practice. She holds a PhD from The Institute of Transpersonal Psychology and has published ground-breaking research on communication, mental health, and complementary and alternative medicine. Dr. Fredricks is a best-selling author of books on the treatment of mental health conditions with complementary and alternative medicine. Her work has been featured in leading academic journals and is recognized worldwide. She currently is actively involved in developing innovative solutions for treating mental health. To learn more about Dr. Fredricks’ work, visit her website: https://drrandifredricks.com

References

American Psychological Association. (2023). Understanding psychotherapy and how it works. https://www.apa.org/helpcenter/understanding-psychotherapy

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.

Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Cengage Learning.

Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.

Lambert, M. J. (2013). Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.). Wiley.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98–102.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.

Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. Guilford Press.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.

What Happens in Ongoing Therapy Sessions?