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How Do One-on-One Therapy Sessions Work?  

Therapy is one of the most important parts of any rehabilitation program Working with counselors helps people who are working to overcome their addiction learn about what addiction is, how the illness may have been triggered, and how to cope with cravings or even relapse after the rehabilitation program is complete. About 93 percent of US rehabilitation programs use group therapy to treat addiction, and group counseling is currently believed to be the most effective approach for most people working to end their addictions.

While group therapy has its place in addiction recovery, one-on-one therapy, or individual therapy, is also key to substantial personal growth. With outpatient programs, individual therapy may be a replacement for group therapy; with inpatient programs, individual therapy is usually offered alongside group therapy.

Individual therapy is often vital for people with specific needs, such as co-occurring addiction and mental health problems. For example, people struggling with social anxiety, depression, bipolar disorder, schizophrenia, or another serious mental health concern will benefit from working long-term with an individual therapist. One study found that young people struggling with addiction chose an individual counselor’s help more often when they had a co-occurring disorder compared to an addiction alone.

Why Go to an Individual Counselor?

Counseling sessions, whether individual, group, or family therapy, are essentially problem-solving sessions. A person who wants undivided attention to address their specific issues may benefit more from individual counselors than from group sessions. Also, people who do not want to reveal personal details to multiple people, those who have confidentiality concerns, and those who have social anxieties may benefit more from working with a counselor on an individual basis.

Individual counseling can be used to reflect on group counseling too; people who may not share as much during group therapy may open up about their personal experiences and thoughts to the counselor on a one-on-one basis after they have had some time to reflect on the group session.

Types of therapy used in one-on-one counseling sessions include:

  • Cognitive Behavioral Therapy: This form of therapy helps a person understand the behaviors associated with their addiction and destructive thoughts that can trigger the addiction; by recognizing these issues, the person can also learn to avoid them or to stop thoughts from turning into destructive behaviors.
  • Motivational Interviewing: This involves a structured conversation between the therapist and client, designed to help the client understand how their addiction and associated behaviors influence how they are living right now; then, the therapist asks their client to decide how they want to live in the future. The two work on learning new approaches to develop the ideal future for the individual.
  • Contingency Management: Tangible incentives help replace substance abuse to trigger dopamine release through the brain’s reward system in this form of therapy. The person is rewarded for passing a drug test or making a choice to avoid a triggering situation with a reward, such as money, vouchers, or special privileges.

The Structure of an Individual Counseling Session


The point of attending therapy is for the therapist to guide their client through solving current problems, as stepping-stones to solving long-term problems. The therapist will ask the person to talk about various things, like:

  • What the person has experienced lately
  • How they feel about their experience
  • Potential solutions to solving the problem

This could, for example, involve a person’s recent drug screening. If the person has experienced a lapse – a one-time ingestion of an intoxicating substance, which does not lead to complete changes in behavior but was rooted in the addiction – then that drug may show up on a drug test. The therapist may ask the person about the situation and listen carefully to how they were triggered. The person could have been spending time with coworkers, which was stressful, and the stress could have triggered a temptation to drink or use drugs. The therapist may then work with the client on techniques to relax during stressful situations involving coworkers in the future. This is one session.

Long-term solutions involve creating a plan to help the person if they relapse and need to re-enter treatment. Short-term calming techniques, like breathing exercises, art therapy, journaling, or other self-soothing techniques, can lead the person into a daily routine, which makes room at the beginning or end of the day for a regular relaxation practice.

For addiction counseling, working with results from routine drug testing should be incorporated into the discussion without judgment. A person who is struggling with a lapse or relapse, or managing to avoid cravings, will have enough personal judgment about themselves and their actions. The therapist is there to guide the person to a solution, not to make the person feel worse.

The First Session


The first time a person goes into a one-on-one session with their addiction counselor, they will discuss:

  • Why the person needs therapy or wants individual therapy specifically
  • Current symptoms, both psychological and physical
  • Personal history involving substance abuse and mental health

This is essentially a get-to-know-you session between the therapist and their new client. It is important for the individual entering therapy to be open and honest, and ask as many questions as they need to, in order to feel comfortable with the individual therapist. The therapist also gets to know the new client, and begins devising how they are best able to help the person overcome their addiction and remain sober. This likely involves the therapist discussing their client’s long-term goals for sobriety and for life overall. Over the next several sessions, the therapist can help the client find short-term solutions to problems and then work toward the client’s long-term goals for education, work, family, and health.

Long-Term Goals of Individual Therapy for Addiction

Ultimately, working one on one with a therapist gives a person focused and personalized attention that they may not receive in group therapy. Over many sessions, a person struggling with a chemical dependency will develop the skills to:

  • Recognize their urges or triggers for a substance and refocus that experience to sobriety
  • Learn to use objective measurements, like drug tests, to reinforce sobriety
  • Develop a relapse prevention plan
  • Recognize milestones in sobriety and positive life changes to help build self-esteem
  • Understand that addiction is a chronic illness and being healthy is a lifelong process

These goals can be accomplished in group therapy, but many people benefit from additional sessions with an individual therapist alongside their group sessions. Others simply operate better with an individual therapist compared to group therapy. Treatment programs are increasingly offering both forms of therapy, to help people overcome their addiction with the help of as many tools as possible.