The Therapy Hour That Isn’t (Really An Hour)

When is a therapy hour not an hour?, the riddle might go. The answer? Almost always.

Not a funny riddle, mind you, but true. In other words, a therapy “hour” is usually less. Was it always this way? Does every therapist adhere to this notion?

Psychiatry professor Richard A. Friedman, MD, New York Times, reports that whereas once upon a time sessions were actually an hour (otherwise known as 60 minutes), eventually they were whittled down to 50 minutes, and more recently to 45, though aiming for somewhere between 45 and 50 minutes is also generally viewed as reasonable.

“Aiming for” being the key phrase, unless like Stockard Channing‘s therapist character in A Girl Thing (2001), an alarm clock signals your client’s exact ending, mid-word or mid-sentence or not.

On his website psychologist Gary Seeman offers several reasons the less-than-an-hour therapy hour has persisted. A couple of them: “More time in session can be difficult to absorb mentally and emotionally,” and therapists need time for progress notes, calls, and treatment planning. Also, says Seeman, “One answer that’s funny and probably true is that psychotherapy pioneer Sigmund Freud couldn’t last more than 50 minutes before visiting the bathroom!

Ryan Howes, PhD, Psychology Today, details how he uses his time between sessions and why he sticks to a full 10-minute interim:

I know some colleagues who see clients back-to-back, no break. They must know something I don’t, because that would never work for me. I believe those ten minutes between sessions are essential for client care and my own mental health. Sometimes clients wonder if they can go overtime a few minutes to finish their thought, or they might want to know if I care enough to bend the rules. What they might not understand is by keeping that ten minutes sacred I am caring for them. I’m modeling good boundaries and self-care, reflecting on their session and making time for the tasks that keep my practice rolling…

Another determiner of session length involves health insurance guidelines. Until a few years ago, the standard billing code allotted “45 to 50” minutes. The comparable new code, however, is now 45 minutes, period. And although there’s an additional code for a 60-minute option, a real therapy hour, this seems mainly for show—either insurance companies don’t actually honor this code, or special difficult-to-get permission is needed, or it’s there for the using but boosts your rate only by pennies. Thus, extensions of session length, while possible, are usually not covered adequately by your health plan—at least for the therapist, that is.

And who knows for sure if any particular period is more effective than another? “Are two 30-minute sessions as effective as a one-hour appointment?,” Friedman asks. “Would a therapy marathon, say, two or three hours at once be two or three times as effective for a particular patient?”

French psychoanalyst Jacques Lacan (1901-1981), Friedman states, was fond of “the variable-length therapy session,” his own invention, which could be quite brief depending on his whims. “One of Lacan’s former patients, Stuart Schneiderman, recounts in his book ‘Jacques Lacan: The Death of an Intellectual Hero,’ that Lacan once arose abruptly from his chair shortly after Mr. Schneiderman started talking and announced, without explanation, that the session was over.”

Too bad for Lacan that he couldn’t convince the International Psychoanalytic Association of the worthiness of his method—they ousted him.

Interestingly, the therapy non-hour we’ve all come to know seems readily and widely acceptable among  therapists and clients. Some things, whether through years of custom or a commonly understood rationale, have a way of seeming so natural they’re unquestioned. Business as usual. Just regular. Like clockwork, you might say.

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