How long is your therapy “hour?”

July 3rd, 2008 • Related • Filed Under

As I travel across the country I meet such interesting people. I get to see unique differences among therapists and how they practice the art and science of therapy.

While therapeutic techniques come and go, the therapy “hour” has been somewhat of a guiding structure and is very common among most therapists.

But why? Why is the 45 or 50-minute session length so important? I know that I use that time to “pace” the session. But what if the person needs more time or even less time?

For some years now, we have seen some exceptions to the 45 or 50-minute therapy hour. Many of you do 90 minute sessions or “double-sessions.” But what about people who want a quick session - to get their ‘thinking straight’ - or to help with a particular situation - that may not need (or want) a “full” session?

I believe that as we move into the next phase of providing psychotherapy, we will see even more variations on how therapy is provided. For example, we will see more e-therapy and phone sessions.

To be flexible to the changing cultural norms will be very important as the Gen-Y’ers enter our practices. These young people are used to information delivered quickly and in short segments. If possible, they’d like it online. They order pizza and movie tickets online. Information is quickly disseminated on cell phones via text messaging.

This will also lead to interesting questions about how to book our schedules effectively. Will we have “online” timeframes booked in our schedule where we are available for internet communications such as a chat session? Will we offer quick 15 minutes phone sessions? Will shorter sessions help those therapists who want to stay at home - for example, moms, be able to make more money because they can do work from home?

I do think the 45 or 50-minute therapy “hour” is here to stay. In many cases it is the most clinically appropriate thing to do. And, first, of course, we must do what is clinically appropriate.

But I also think that it might be in our best interests to begin thinking of ways we could serve our clients even better.

As your e-coach, I invite you to ponder the following questions:

1) What is my therapeutic reasoning for my current session lengths?

2) What is my business reasoning for my current session lengths?

3) Is it possible that I could add more to my menu of services that might serve both my clients and my business?

Feel free to share your comments below.

Happy practice-building!
Casey

There Are 5 Responses So Far. »

  1. Comment by Sylvia Lane on 3 July 2008:

    I retired from doing therapy in 2003 but now am resuming a part-time practice. My sessions were 60 minutes. I have worked with a coaching company for the past year and have done telephone sessions from 15 to 90 minutes. I plan to be more flexible as I re-enter the field. Your book has been very helpful.

  2. Comment by Lani Stoner, LMFT on 4 July 2008:

    I have an internal clock that seems to be keeping me at around a 50 minute hour–when I begin setting the next appointment, take payment and start my note. I don’t stick religiously to a 50 minute hour, though, especially when the client is in severe distress, when working with a couple or a family in the first session or when there is high conflict going on in a family or couple session that makes it hard to terminate right at the hour point. I put 1/2 hour between sessions to give me time to take a snack and restroom break, write my note, take a breath, and when there are longer sessions, know that I have some time to work with before the next person comes in. I know that this means less money coming in, but also less wear and tear on me as their therapist. When the client is private pay, I will bill them extra by the quarter or half hour, but this tends to happen rarely for me.
    An interesting question has come up about clients coming in late–Some therapists are rigid about not seing people beyond their contracted hour mark if they come late, or they choose to reschedule with the client if they come in late. With the 1/2 hour between sessions, it means that I can give clients a little slack if they’re late and still give them their full hour-long as they are no more than 1/2 hour late.
    So far, I’ve not been doing phone therapy except sometimes when I am having the first phone call from the client and they want to talk to me about their history or problems that led them to want to come to therapy. When I worked with the local County as a therapist, I could bill MediCal for this kind of work (at least for phone contact). I think that with one MediCal source of referrals that I’m in the process of contracting with, I can bill for phone contacts. I could, but haven’t billed for private pay clients this way–so far, not much call for it. I’m usually almost immediately accessible because I have my office phone direct forwarded to my cell phone, but people don’t seem to have much need for that once I start working with them. (Now watch that’ll change cause I said it…).

  3. Comment by Vondie on 7 July 2008:

    Hey Casey,

    Thanks for your newsletter.

    I have recently chosen to become more flexible with my time slots for counseling sessions.
    With gas prices being what they are, and some of my clients driving a long way, I have tried doing longer sessions at times.
    I also offer shorter sessions, for people in crisis, who need to touch base more frequently, like 2x week. This way, we get the contact, without a full-fee for each session.
    I’m not sure about internet services, just yet. But, I know I eventually end up doing most of the things you recommend, so I “never say never.”
    Take Care and Keep the Good Ideas Coming!
    Vondie :)

  4. Comment by Jeannie on 7 July 2008:

    Session length is a very interesting topic. I meet with clients for 45 minutes pretty regularly, so my clients develop an “internal clock” (as Loni put it) regarding our sessions. It’s always interesting to me to see what emerges for a client in the last few minutes of a session.

    Is there something sacred about 45 mintues? Possibly. Casey, you’ve inspired me to research more about the topic.

  5. Comment by Edie Olaughlin on 8 July 2008:

    I had a couple in crisis and we just kept going until the problem was resolved. It took 2 1/2 hours, but was well worth it to them and to me. Edie Olaughlin MFT, LEP
    Priority Parenting

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