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A standard therapy session is 50 minutes, but what if you need more time? Extending your session time may sound like the answer, but it can actually hinder your growth.
Ending therapy sessions on time can be difficult.
I hate ending therapy sessions on time.
But I do anyway.
I hate it because my clients matter to me and so do their lives. Both the unpleasant stuff that brings them to therapy and the nice stuff that has nothing to do with it. I always like hearing about those good parts that make them happy.
But with every single client, in every single session, I am aware of the clock. There are two clocks in my office. From any of the places I sit, I can see one of them. And no matter where my client chooses to sit, they can see the other one.
The importance of the therapy hour.
In a sense, my sessions end on time for logistical reasons. I believe in the therapy hour: fifty minutes of session, five minutes to write notes, and five minutes to prepare myself for the next client. My preparation often includes grounding myself to help mentally switch from one client to the next, quickly checking texts and emails, and perhaps a quick phone call. Sometimes in those ten minutes I check the notes from the week before because I remember there was something specific I wanted to begin with. Usually, I only need to do this for new clients. With the others, their stories are already embedded within me.
But logistically, if I have a full slate of clients, ending just one of the sessions late can cost me that period of reflection. I wouldn’t be able to take all of the notes that I wanted to. I would lose the chance to ground myself sufficiently. Or it could be as simple as me losing my one chance to eat in between sessions.
So yes, I usually begin each session on time. And I mostly end on time, fifty minutes from when the session started.
Transitioning out of sessions can be a struggle.
It’s still disappointing, every session, everyday, with every client, when we are engaged in therapy and I need to bring the session to a close just because these fifty minutes are over.
As a teacher, I entered my classroom on the dot, and ended each period exactly when the bell rang. I learned from a mentor that keeping the students past the bell steals time not only from them, but from their next teacher.
But hey, that was when I was a teacher, back when students counted down the seconds to the end of my class. But in therapy, it is exactly the opposite. Clients dread the countdown of each session. Sessions usually end up feeling too short, or unfinished, no matter how much effort I put in to making a smooth transition.
It feels disappointing because there is still so much more to say, explore, and think about. When the session time is up, I often wish I could turn back the clock, like a sand timer, and give us more time together.
This raises the obvious questions: Why are my sessions only fifty minutes? Why don’t I leave more of a buffer in between sessions so that if a client does need more time, I can always extend the session?
Why is the therapy “hour” only 50 minutes?
The fifty minutes is an arbitrary number that was fixed into place over the years. Nobody really knows how the therapy hour came to be, and nobody really knows why it’s called the therapy “hour” to begin with when it’s only fifty minutes. In fact, in many practices today, the therapy hour has shrunk to forty-five minutes. And in some agencies ruled by insurance, it is only thirty minutes. Fifty minutes is just an arbitrary amount that has become standard practice.
And for the most part, it works. At least for me. My clients may have something else to say about that.
When I say it works for me, I mean professionally, as a therapist. Each session has a beginning, middle, and an end. There is enough time to acclimate to the therapy room, do some work, and then wind down to an ending. I can’t say that each of my sessions are as neat as this, but those are my goals for each session.
A week in between sessions is also an arbitrary configuration that became the therapy norm. Although, personally, I feel that twice a week is optimal, time and money obviously factor into that being impractical for most people. Regardless, whatever the time in between sessions, it is important for there to be space in between to allow the session material to integrate into the client’s system because most of therapy happens in between sessions. For this reason, two sessions weekly is generally much better than a double session.
So yes, the fifty minute sessions is just an arbitrary design that works for me professionally, but it also appears to be sound and ethical practice, evident by the client progress effected by these weekly sessions. Now, let’s get to the second question.
Why not extend the therapy session time as needed?
Even if a client offers to pay for an extended session, it is not good therapy practice for a session to run over.
A therapist learns to be adept at managing how a client is affected by a session and then helping them regulate their emotions before leaving the office. For this reason, there should be no need to extend a session.
Sometimes, a client engages in what we call “doorknob confessions”. This is when a client decides to drop a bombshell just as a session is ending. This is surprisingly common. It sometimes takes the client all session to get the guts to reveal an important piece of information. Or the client may subconsciously wait until the end so that they won’t have to talk about it, but will still feel the relief of getting it off their chest. Or, perhaps a client does this in the hopes that the therapist will feel obligated to extend the session. Whatever the case, part of the therapy work is to help each client better handle boundaries of time, space, and relationships, issues that are probably concerns outside of the office as well. For this reason we try our best to abstain from extending sessions based on circumstance.
Adhering to the therapy session time can be empowering.
Not extending a session also gives the client a message that the therapist has faith in the client’s ability to manage their life. Extending the session gives the message that a client can’t handle the issue without the therapist. This could be disempowering.
The therapeutic relationship includes how session time is managed, especially for a client who has had unhealthy relationships with unhealthy boundaries and/or boundary violations. The artificial set up of the therapeutic session time is a tool that helps a client learn to navigate healthy boundaries with the therapist. The therapist’s role is sometimes to maintain these boundaries of session time at all costs, in order to contain and repair the client’s traumatic past of damaging relationships and ruptured boundaries.
All that said…sometimes exceptions are made.
Of course, there are times in which extending the session spontaneously or thoughtfully is part of the therapeutic relationship. It can happen when I lose track of the time because of how involved I am in the session content. It can happen when the client really does need an extra moment or two to compose him/herself. I know it happened this past week when a client brought up a relationship rupture we had a few years ago and I spent a few minutes over the time to apologize (because she was right!).
In theory, I could have waited for the following session, but I felt she deserved the apology then and there, and she was my last client of the day. There was no harm in it, and definitely benefit.
Clients also tend to find creative ways to extend the session time.
They may write out their check only after the session is over. They may ask to show me a picture they forgot to show all session long. Or they may spend time gathering up their belongings, pocketbook, or putting on their coat with excruciating slowness. I know why they’re doing it, and it’s okay. It’s all part of the therapy and it is my role to notice everything. My clients know that I do, and, as I tell them with everything: we can and will work it out.
Note: This was previously published in Ami Magazine
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