How is one hour a week ever enough? How do your sessions break down for time?

Probably longer sessions would be beneficial for many if not most people. Not sure why the 50 minutes; it seems completely arbitrary. Some therapies such as family or child or couple and some techniques such as prolonged exposure routinely require longer sessions like 90-120 minutes. Once when hospitalized in a good place the doctors did 75 minutes a day. That seemed ideal. Just a little be extra to finish up and be more complete.

I go twice a week because I really don't feel satisfied with 50 minutes. It's not possible for many people. I do try to plan my sessions so I don't waste his or my time, but sometimes it is hard to make sure that the session is always focussed. He has gotten pretty good at returning the attention to how I'm really doing when things drift somewhat. And I try to make myself bring up things earlier and not wait till the end when there isn't enough time to really deal with it.

Girl, I wonder how you decide what to talk about? Is it your intentions go awry, or that you really can't distinguish what's important to you and what's not?

I rarely talked about "things " once the supportive phase of therapy was past. While I was actively depressed, probably half or more of the 1 hr a week was spent on what I did and how it felt. But once we were into the depth work of therapy, it was rare that talking about an event of the week co-opted a session. Most time was spent in the moment: what thoughts were in my mind, what was I feeling in the moment. During the early days of trauma work a lot of session focused on memories that I had written about. Those events were revisited as much as necessary over the years, often while making new connections, recognizing insight, etc. My T never started sessions by asking , "What happened this week?" or "What did you do this week?" But rather "So, how are you feeling?" or if I appeared upset or sad or whatever, he'd say, "You seem upset; what's upsetting you?" The focus was always in the present moment with him. There were often periods of silence, but they never felt unproductive. Of course, my therapy was psychodynamic in orientation, rather than discrete CBT or something more behaviorally oriented. But I rarely, if ever, felt like time was wasted. Each session was an experience; what it meant or how it would fit into the overall process wasn't always immediately apparent, but collectively they did feed a process.

I guess I'm not clear on what the process is that your T is working within?

I think the feeling of 'not enough' has less to do with the therapeutic hour and more to do with the past.