[IndestructibleGirl]

This seems to be the most common frequency for folks to go to therapy, in general. But how is it ever enough to get stuff done?? An hour is over in the blink of an eye. I already don't want to go to my session tomorrow because it feels fruitless.

Five minutes of pleasantries. Twenty minutes about something that probably has importance and needs a bit of discussion, but isn't not crucial, like the email errors. Random spin off (by her or me) into something else that pops up, as conversations do, another fifteen minutes. Ten really intense minutes at the end where I start to get upset and go to pieces inwardly and say a string of words that do not remotely help. Five or ten mins to wrap up/pay/ blah blah.

Am I missing something? Am I structuring it all wrong? But how do you make yourself talk about the most important stuff straight off?

How do you even know what to prioritize? Focus on smaller issues that are more fixable (so therefore give the reward of succeeding) or chip away at bigger problems?

What do you do?

[InRealLife45]

bigger problems- the ones that impede your daily function.

[TheWell]

I write them down and walk in with them on my phone so I can bring them up right away. If I don't I tend to make the entire time without bringing up the big issues.

[Leah123]

I think all that really needs to be said re the email is: "Please don't email me anymore. It's unsettling."

She should apologize and acquiesce!

Then, on to what is troubling you most I hope.

It's very hard with an hour.

I help myself a good deal when I can by writing a lengthy essay about what is going on with me prior, and letting my T read that as we get started. The reading goes much faster than speaking and catches her up on me while it gives me a few minutes to settle in.

As far as what to focus on: I tackle the most disturbing, high import issues. If they're destabilizing me, i.e. I'm feeling close to a nervous breakdown, severely dissociated or suicidal, then instead I have a calming session where I talk lightly about day to day things maybe, but focus on deescalating and do visualizations or share poetry or let her read to me, make a plan to destress my week a bit, or whatever seems most calming on that day.

[kororain]

I don't really typically care how sessions go... not because I "don't care", just that they never go how I think, so why bother trying to fit a square peg in a round hole, kwim?

BUT the one time I had like 3 super important topics to discuss, I just told her, I have 1 hour and 3 topics, how are we going to get through this? She said I was in charge and I could watch the clock this time and I got to pick when to switch topics.

It totally worked great for that session, and I like I said, other than that, I dont typically care.

[Sometimes psychotic]

My T and I would set a specific agreed upon and prioritized agenda in the first 5 minutes----she made sure we followed through on the most important things that I wanted to address in that session.

[sailorboy]

I plan my agenda all week long. I even play out various different ways it can go. I'm a planner. We don't do small talk. I'm like ready, set, go when I sit down. It wasn't always that way but we're very intimate now.

[sweepy62]

If you really think about it, yes 50 to 60 min is quite ridiculous . Even if you are going weekly . Imagine going every 2 weeks, it gets absurd!!!!!!

The only possible way, Is just jumping right into it, walking right in there, wasting no time, with a list in hand, no small talk or chit chat and fire away.

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Diving right in is what I do. Now that I do 25 min sessions due to my budget (or lack thereof) it is critical to just ready-set-go it. Plus I do a lot of work between sessions and mostly we discuss said work. And with dream work, we decide up front to break my dreams up into parts for working on, she'll give me her thoughts, we toss stuff around, I take notes and then work more with the dreams on my own.

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[Partless]

IndestructibleGirl, I agree, and in some approaches, people do it more often, like several times a week. Then there are certain kinds of CBT that are not only once a week but also limited to, say, 16 sessions only!

I think in reality there is no rule that says exactly once a week is the magical number. A lot of it has to do with practicalities of seeing someone for longer or more regularly, what the insurance is willing to pay, and so on. I personally think some problems require more frequent visits while others probably don't.

[JaneTennison1]

I pay cash so usually I go into the office and just set my payment down, I\ll settle in for a minute or two and sometimes she offers to get me a drink. Then it can go multiple ways. Sometimes I just jump right in, sometimes I have something I want to work on or to read out to her/

Recently some of the topics have becpme difficult and I have started talking about anything BUT the main issues. Last week I asked her to help me find focus becaise I really do want to work on things and just don't know how to start.

Afterwards, last 5 minutes I just decompress. get my shoes on and chit chat about non sensical things to kinda of bring me down so I can face the world again.

[The_little_didgee]

At the end of every appointment we make a list of goals that I need to accomplish or at least attempt to before my next appointment. Usually I add notes to my list about my tasks. Sometimes I will include other topics or issues that I need to discuss. When I arrive I immediately take my list out and talk.

My list helps keep the discussion going. Before I would often sit in silence and look out the window.

I have also been wondering how it is really helpful to have just one hour a week. My thought this week about it is to consider that we are paying them one hour a week for us to practice things within the supposedly safe (if you are lucky) relationship, like being assertive, talking about your feelings, experiencing being accepted (as opposed to being rejected as I was as a child), and that this practice helps you in the real world?

[iheartjacques]

I see t every two weeks. He says slow and steady. It takes time to talk about stuff and it takes time to change how I think or feel about something. Doesn't seem like much, but when I look back on 18 months, there's been some big changes.

Once a week isn't really enough. I did once a week for a year for stabilisation, then we went to twice a week. Been twice weekly for last 10yrs
But at first, there are so many emotions that had beenleft unattended for so many years, therapy feels like a bucket with holes. There's a constant feeling of emergency resulting in hysteria often times.
That changes.

[IndestructibleGirl]

Sometimes I make a list. For some reason, I don't feel it helps. It feels like I recite problems and she acknowledges and it doesn't address anything.

It works best when there's time and plenty of it. Thinking for this reason of quitting my weekly hour and doing a two hour session every fortnight - was going to do this but with the weekly hour as well, for in between weeks. But really, I think (for me) the hour is wasted time and money because it doesn't get off the ground.

She prefers not to work in one hour slots either, so I wonder if that has an impact too.

More time doesn't equal more work getting done in a single sitting.
The therapy hour is for solid work. A therapist would find it hard to concentrate and reflect for longer than an hour.
A therapist has to really tune into herself and asking anyone to do that over a sustained period is a big ask, their attention would wander.

[Leah123]

Originally Posted by _Mouse

More time doesn't equal more work getting done in a single sitting.
The therapy hour is for solid work. A therapist would find it hard to concentrate and reflect for longer than an hour.
A therapist has to really tune into herself and asking anyone to do that over a sustained period is a big ask, their attention would wander.

In my case, more work definitely gets done in longer sessions. I had 15 months of them and saw a significant difference. Most of my sessions averaged two hours, and there were several days where I did more than that, up to six or so hours in a day on at least two occasions. I did find it tiring but very rewarding.

My therapist typically did extremely well with longer sessions and did not have issues staying attuned and focused 95% of the time.

Many therapists offer double length sessions. Though that's not the norm, it's common enough. I think the hour is more useful in terms of billing, scheduling and filling up a practice than because it contains the perfect number of minutes for a session.

No, it's not for easier billing. Nor practice filling.
II actually had this conversation with my T. There's a French psychoanalyst who would have open ended sessions. He noted the majority of the excavation happened in the early stages of the sessions.
Change needs to be long lasting. What we achieve can be measured eventually, as to what worked and what only offered light relief.

[Leah123]

Just because one French psychoanalyst had an opinion doesn't mean every client is always best served by a 50 minute session. Neither is your T a particular specialist on evaluating the effectiveness of 50 minutes versus a different number.

If you would like to provide scientific research on a sufficient sample size corroborating your opinion, your case might hold weight, otherwise, all we have is our personal experience and your T's anecdote.

It may take you several years to determine your therapy is helping you, but that's again your experience. Let's try and speak for ourselves please. We're each on different paths.

Since I'm stuck with once a month/ once every 6 weeks for the moment I find that I tend to think of a million things I need to talk about and then when I get there I kinda just blurt it out. Then it all ends up jumbled I get none of what I wanted to across and then I just end up rambling with the occasional suggestion/ comment from the T.

Totally ineffective in my case. Am wondering now why I even bother lol

[Soccer mom]

I wish I could go 90 minutes each week - sometimes I just need a little bit more but not an entire extra hour (or 50 minutes). I just go once a week. Sometimes it's fine. But, if I'm upset about something or mad at T (which I am currently) then the week seems to last forever.
I have a list in mind of what I want to talk about. We used to chit chat when I got there but now I cut to the chase and start. And, we never get to everything on my list. I told her I want to come weekly until my list gets shorter.

[IndestructibleGirl]

Originally Posted by BeteNoire

Since I'm stuck with once a month/ once every 6 weeks for the moment I find that I tend to think of a million things I need to talk about and then when I get there I kinda just blurt it out. Then it all ends up jumbled I get none of what I wanted to across and then I just end up rambling with the occasional suggestion/ comment from the T.

Totally ineffective in my case. Am wondering now why I even bother lol

Totally get this.

This happens me even on one hour a week. I can't cut to the chase, I can't prioritize, I ramble and it feels important to get it out, like it's the lead into the something critical, but it takes up time and the hour has vanished.

I can only go veeeerrrry slowly into really hard things without shutting down like Fort Knox.

I agree with Leah, that it must be because we are all on different paths that things work or are less effective. So unfortunately different things are useful and useless depending on the individual.

[Leah123]

You probably already mentioned this, so I'm sorry if I overlooked it, but I remember you talking about trying maybe alternating one week at one hour, the next week at two hours: did you consider, or would it be an option to try for 90 minutes weekly? I've seen many posters write that made a big difference, it really did for me too.

[HazelGirl]

Things are a little different for me. We have 60 minute appointments, but if I am the last one for the day, we often go over.

On 60 minute days, it's something like this:
10 minutes - random stuff, maybe my T will mention something about her life (I love that she does this), if something small came up I will bring it up, etc...
15-20 minutes - pressing matters, things that I need to deal with in my day-to-day life
20-25 minutes - trauma talk, where has it come up, how is it impacting my life this week, what ways am I dealing with it, any specific memories that have come up, how am I feeling about it, etc...
10- 15 minutes - wind down, small talk, preparing me to go back out into the world, etc... Really, this step takes as long as it needs to. My T will make another client wait for a few minutes while I come around to being able to leave again.

If we go over time, it's normally because the trauma aspect is digging into some deep and difficult things, and my T doesn't want to shut me down if I need to talk. Sometimes, if there's no one after us and we don't have anywhere pressing to be, we can end up going up to an hour over. I really appreciate that time because I feel like I get much further in that extra time than I would without it.