[sunrise]

It seems like the most common schedule for therapy is one hour (50 minutes) once a week. Why is that?

Are there studies that have shown that is the most effective length of time for a psychotherapy session? And that once a week gives optimal results? Or is it just historical? When people are studying to be therapists, do they tell them to stick to this plan? Is it due to what insurance will reimburse for (not the issue for my T, since insurance does not reimburse for his services)? Is it to keep therapists from taking financial advantage of their vulnerable clients?

It seems like so many of us here angst about increasing our therapy time each week. I would love to see my T twice a week. I have so much territory to cover and I want to make really fast progress. Only 50 minutes a week slows me down. Each session I have a huge amount of stuff I would like to fit in, and it is impossible. Two hours once a week would be great. Or one hour sessions twice a week would be good too. I could make so much progress. Why is that not acceptable if one is willing to pay? Have studies shown you need a full week between sessions to process what was discussed? Or that T needs a full week between the same client to recover from him/her, lol?

Other professions that have clients are not like this. I saw my lawyer yesterday for 3 hours straight. It was a great session. I had a long list of questions and we just kept talking until I had all my answers. Why is that so bad? It made me long for that with my T.

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sunrise said:
Or that T needs a full week between the same client to recover from him/her, lol?

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Have you been discussing this with my T? lol....

As much as I wish I could spend a 2 hr. session with my T, I have to look at it from the T point-of-view. Sessions aren't just emotionally draining for clients-- they can be for Ts, as well. 2 hrs. per person would be a lot-- The T would have to see less clients, and he would probably burn-out a lot quicker. I think 50 min. sessions probably keep our Ts at their best, you know? My T consistently keeps me for a full, 60 min. hour. As with you, my T works on a sliding scale, not insurance-- so I think it really has to do with the level of emotionality that one can handle, as well as boundaries. I'm sure that if I were my own therapist, I'd kick myself out after an hour, too.

I think it really has to do with the level of emotionality that one can handle, as well as boundaries

That's what I was thinking.

Just like little kids (at some point) have to learn how to handle stuff on their own and not run to their mothers, T's want us to learn how to handle a crisis in-between sessions so we aren't dependent on them? I don't know, just thinking out loud.

I also think it depends on the T and the issues that are being worked on. At the beginning of T I was an absolute mess. She would schedule my appointment so there would be no one scheduled after me in case we went over the time.

And if we were working on difficult stuff she would always ask, as I was crawling out the door, to call if I needed to come in again or needed to talk. And a lot of times I did.

She often told me to "check in" and leave a message just to let her know how I was doing. Especially after leaving a session to make sure I got home safely.

This went on for the first year until I was able to stand back up on my own. Now I see her twice a month...after 10 long years.

BUT--it always seems just as I stand on my own two feet and brush myself off, "something wicked this way comes" and knocks me down.

[(JD)]

Unfortunately this is driven by the insurance companies. The typical insurance company only pays by the "session" ..the same amount whether that session is one, two, or three hours. You can see how having extended sessions is not financially feasible for a therapist. (And, no, they can't submit it like you saw them twice instead.)

However, the one hour (50 moinute) session really is a good standard. Covering too much material.. well opening up too much material at once can be detrimental.

An hour gives a brief amount of time for IRL events that happened (my sister had her baby..blah blah blah) and the real reason you're in therapy (I hate myself and everything I do is wrong), homework results, and then summation and homework giving. Once a patient is "stablized" or at least on the road of healing... most of the therapy work is done outside of the session anyway. What patients do the other 6 days, with what they are learning about themselves and their world while in that session, is most important.

Any good T will try and give some fudge time to your session, if you really do need a few more minutes... but you can see how that might ruin the whole day... especially for the next patient who takes their lunch time and can only stay 35 minutes!

Just my POV TC!

[sunrise]

OK, so I've seen some good reasons here why sessions are not longer than 1 hour. But why not one hour sessions more than once a week? I know a few of us have them, but why is this not more common if the client could benefit and pay? I am so motivated to make progress. And I am willing to pay. I wish I could see my T twice a week. I'm not wanting the two sessions out of obsessive attachment--I'm past that. I just need to get my goal done. I have my session tomorrow and once again I have this huge amount of stuff to cover, and I just feel it's hopeless. I guess we'll go over the legal stuff. Sigh. Forget the really disturbing SI fantasy (see that other thread I started). Forget my feelings. Forget my fear. That stuff has to take back seat. Just stuff it all inside of me again. Where does it go? Who knows. I hate this. It was so satisfying to have my lawyer willing to spend the time with me to get through what I needed to get through. (Seeing my lawyer was almost more therapeutic than seeing my T.)

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As with you, my T works on a sliding scale, not insurance-

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Just an aside, pinksoil, but no, my T does not work on sliding scale. That's great yours does this.

sky, homework results and homework giving? Wow, I think my therapy is different from yours! I do agree with you that much of therapy is done outside of the session. I guess I just need my T's expertise more than I have access to right now, and that's frustrating. I have tried to maximize my productive time with T. I don't spend time on superfluous stuff like IRL events (sister and baby etc.). I get right to the heart so we waste no time. I just don't think I can eliminate any more extraneous stuff from session--I've done that.

Sorry to whine on and on. Just frustrated with this, and it never changes.

(( sunny )) I'm sorry you're frustrated. Understandably frustrated!

i agree with Sky that the time is mostly set by the insurance companies. there may be standards within the profession too, but I don't know. if so, I wonder what the criteria is

i wonder if the fast pace of today's world (and our lives) makes once a week sessions too far apart and should be reconsidered.... could be an outdated practice.

in analysis a person can go twice a week or even more than that. I would love to go at least twice a week but could not afford it. i pay my T myself like you do. the session isn't long enough for me and the time between session is just too long... excrutiating... lonely...fearful...panicky...frustrating...

have you asked about having twice weekly sessions sunny? if so, what does he say about that?

i think you really HAVE to make time to talk about your SI fantasy with him. you NEED time for your stuff!! ask him to help you with getting to all the things you want to get to.

i'm glad you and your daughter had a nice trip!

ECHOES

[pegasus]

Hello sunrise,

T sessions last approx 45 minutes here in the UK.

Insurance does not come into the equation at all.

I am thinking that probably much research has been done on how long a person needs and can take on board.

Saying that though it may also be due to how many patients/clients a T can fit in, and still be useful!

I have had sessions in the past that have only lasted half an hour and other times the session was an hour and a half. My T must have judged what I needed on those particular days.

I have also had two sessions a week at times, I think it really depends on what you need and are capable of taking on board.

Also I think (after 5+ yrs of therapy) much of the work is now done at home ie. processing the stuff after the therapy session.

[majella]

<font color="purple">When I first started to see my t and she sent me a letter outlining all of the 'housekeeping' stuff, like how to get to her office, how much she charged each session, her phone numbers etc etc, she had originally written that we would have one hour long sessions (the full 60 minutes) once a week.

But from the very first session, my t has always extended this 'one hour' to 90 minutes ... and I really dont know how I'd cope without a session of that length. It takes me so long to articulate the thoughts and feelings that I'm experiencing ... not to mention that I have dissociation problems that tend to cause disruption to my sessions and move things off track during therapy.

I dont know whether my t routinely has 90 minute sessions with other clients, but this is the way its always been with me.

(Although 'always' isnt exactly true - there have been a couple of sessions where my t has had to finish up on the hour, coz she had other commitments directly after our session. Personally, I found it very intriguing how badly I reacted to this news! I had become accustomed to my t spending extra time with me, and was upset when she was unable to do so ... but I also felt extreme guilt that I was upset, coz my t did me a favour by regularly going overtime - it wasnt something she HAD to do!)

The way my t explains to me about her going overtime, is that she doesnt want to spend our sessions 'watching the clock'.

I think though that the situation with me and my t is a little different than most therapy set ups though, as my t only has 2 or 3 clients that she sees for regular therapy sessions, because her major source of income is through lecturing and supervising psychology PhD and masters students (she works at a university).

I have no idea what the rationale is behind one hour sessions ... I would have assumed that it originated from the days of Freud, where people were seeing doctors and therapists, for analysis ... and maybe those 50 minute hours are best for that sort of thing.

But speaking as a trauma survivor, 50 - 60 minutes per week is nowhere near enough time to be of benefit. During alot of my sessions, I end up getting sucked into a flashback which can last quite a long time ... and then I need time with my t to be able to talk about what happened and settle myself so I'm okay to go home. I reckon if my t was strict with our sessions ending after 60 minutes, then I'd either be too reluctant to get into any specific trauma memories, for fear of being cut short right in the middle of something that is really horrible and disgusting ... OR .... I'd end up starting work on some difficult memories, but then running out of time and having to finish up while I am stuck in the deep end of the pool, feeling extreme panic, struggling to breathe and keep my head out of the water, and findnig a way to survive for a whole week until my next session.

I would have hoped that most ts nowadays realise that some flexibility is needed with regards to session time, depending on what problems the client may have, how easy or difficult they find it to self-disclose to their t, and what sorts of things they have to cope with outside of the session. Of course, there is the flipside of this issue, and there are a number of different practical issues that need considering, and the t may not be able to give more time to a client ... or the client may be unable to afford longer sessions etc etc.

Definitely an interesting issue to ponder, Sunrise! Thanks for posting about this. </font>

[MissCharlotte]

Sunrise,

I echo Echoes You must make time for your SI fantasy. It feels so important. Of course I don't know what else you have on your list. I do make time for the mundane stuff of daily life because it is in the context of our current relationships and current life tht our unconscious stuff plays out. Like you, I always wanted to get right to the heart of the matter and talk about the hard core issues but my T guides me away from that approach. Maybe that's what your T is doing by limiting you to once per week. I think you should tell him about all you are feeling about the SI and needing more time and see what he says. Maybe they are connected somehow. Take care & good luck.

PS I also don't get homework, so my T has a different approach as well. Good thing too because I have enough of my own and my son's to contend with

[SecretGarden]

I do not know that I have formally been given homework though there might be a mention to think about something..but really all in all I think that, after being in therapy for some time I find myself during the session assigning myself homework. I might say that out loud or just to myself. It could be something that the pdoc has said that I wish to mull over or I do not know what else... perhaps observation or something.

I now see mine every two weeks. I am having a difficult time (it will pass) that has led me to ask for an extra visit to work some things through.

I have been a weekly person and even a 2x a week person for a time in my life that I needed it. I have also been a monthly person for 6-8 months.

I think that you need to ask YOUR therapist if you could be seen more frequently and if not, ask why. Their practice may be full or they may have a reason to limit your time or times per week. I think that my pdoc thought I needed to be able to figure out things for myself more and maybe I was too connected...and needed to work in other people for support and I have.

I also would concur that the therapist may have a limit of energy and ability to take it all in. Also, it is alot for you to take in too if you wish for extended sessions.

Your therapist will have their own reason for their limiting your time. If you are not using insurance, then that should not be the concern though that might be a model your therapist has chosen to follow,,,,for a possible multitude of reasons.

Also, when I was early in my therapy I told my pdoc that I would like to have double or triple sessions... or could I book a whole day. LOL. DId not wash... but ....I know how you feel.

[sunrise]

My therapist has a schedule that is very full (usually no free sessions each week), and a waiting list of potential clients to see him. I would feel very, very guilty asking him for 2 sessions a week, when so many can't even get in to see him 1 time a week. I don't ask him because it is obvious there is no room in his schedule for it, and asking for something with the obvious end result of rejection would be hard for me. I have told him more than once, at the beginnning of sessions, how hard it is for me to fit everything in, which seems a pretty blatant hint to me. He just says "let's get started, what's on your mind?" or "I'm all ears." Last week I had to change the time of this week's session, and I saw his crowded schedule. He was nice enough to squeeze me in during a blank time he had not planned to see a client (early morning), and I appreciate that, but it was clear it was not a regular slot and everything else was filled to the gills. I guess if you want to see a therapist twice a week, you should be seeing someone who is not so popular.

Anyway, that's my story. I don't think I can't see him twice a week because of some specific therapeutic contraindication. I think a first barrier is simply his schedule. Quick, my T needs some good competitors in my city to take away some of his clients and clear his schedule!

Thanks, everyone, who has posted here. It's turned into an interesting conversation!

It was largely driven by the insurance companies.

The notion was that in the beginning their was Freudian psychoanalysis. We are talking 4-7 days a week and I'm not sure how long the sessions used to be for.

Then there was this big push for 'therapist accountability'. It was a great deal cheaper to offer sessions once per week and it was possible to see a great deal more clients (important when people are on wait lists) if they had only one session per week.

I'm not sure that studies have been done on the 'effectiveness' of different numbers of times per week / different lengths of sessions. I'm fairly wary of the 'effectiveness' studies anyrate because oftentimes whatever it is that they are measuring was not at all what the patient wanted help with.

I'm fairly sure that the following has been found, however.

- People with anxiety, depression, OCD (and the like) can benefit quite well (and quite quickly) with cognitive behaviour therapies. Therapies that are too indepth lead to deterioration, however. The analytic theorists would say that you need to get worse in order to get better... But the person presents for treatment for their anxiety and ends up being treated for their failure to develop secure attachment in early childhood - whats going on here??? Accountability (was the argument)

- Increasing the frequency of sessions tends to result in increased transference. All well and good for theorists who think transference neurosis is required for a successful working through but undesirable and complicating for people who aren't trained in dealing with (and understanding) transference responses / feelings.

- Some people do require more time to 'warm up' at the start and 'cool off' at the end. For those people it might be profitable to have longer session lengths. Sometimes therapists will increase session lengths while people work through trauma. The majority of my clinicians have spent 90 minutes with me because I find things hard. My present therapist is very rigerous with keeping to the hour. The notion behind 50 minute sessions is a 10 minute bathroom, stretch, coffee break (maybe to write some brief notes) before the next session. Its about the number of clients you can fit into your day.

Those are the origins anyway. There is a lot that goes on that is largely due to contingent matters of history rather than any clear rationale.

If you want more sessions with your t...

COuld you ask... And list some of the benefits you think you will get out of it?

[sunrise]

alex, your post was really informative. THanks.

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If you want more sessions with your t...

COuld you ask...

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I just hesitate to ask for another session when his schedule is totally full, because I know the answer would be no. I find it hard to take that risk when rejection is all but certain. But maybe I will try... After all, it is in my own best interest. Maybe he would be able to call me each week if he had any cancellations for a second session if I could be flexible on the timing. But my guess is he already has people on a waiting list for cancellations each week. Yeah, he's that much in demand...

In my trauma sessions, usually the EMDR ones, we did tend to go longer. It is hard to get through the full EMDR protocol in only 50 minutes. It seems like 80 minutes is about right.

Do you know his schedule is totally full?

My therapist fit me in from 8-9am because he was all full up during normal working hours. He was happy to do that, however. People leave all the time... It could be the case that something will free up. I was terrified of asking my t for another session so I agonised for a while and put it this way:

'I know you are really busy and stuff, but I wish I could see you more'.

He managed to find for an extra session every two weeks. So kind of half way between weekly and twice weekly. I really didn't think he was going to be able to do that but turns out he could do that. And... He seemed fairly pleased that I'd asked...

[sunrise]

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Do you know his schedule is totally full?

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Yes. I checked last week for this week because I had to change appointments. And I know he has a waiting list. But maybe if he has cancellations it might work. If spots open up in his schedule, he gives them to people on his would be client waiting list. That's how I got on with him at first. Alex, I think your line: "I know you are really busy and stuff, but I wish I could see you more" is a good one. Can I steal it, please?

I think you are right, I will never really know until I ask outright. You've convinced me.

of course you can use it (thats why i gave it to you). sometimes it can be hard to know what to say... it can help a bit if we have some examples and then can tweak them into something we might possibly be able to say...

yeah, you never know what might come up... i'm fairly sure my t was all full up. he works a couple days a week in the community doing DBT and the rest in private practice. he had no idea why i was referred to him, but he saw me in the community so i guess he thought it might have been because of his involvement with the dbt program. maybe... he would have put me on the wait list to see a clinician to do dbt or something like that... but after talking to him he found a slot for me 8am friday. thats why i worry a bit that if i'm not DID then he would have only agreed to see me under false pretenses. i've asked him whether he would still work with me if i was borderline and not DID and he was like 'of course, i agreed to work with YOU' but i guess i was still thinking that he might change his mind if he only agreed because of a false conception of who i was... i dunno.

so he really was full... i don't know how he has managed to give me that extra time slot every two weeks. i guess your t will weigh the pros and cons with respect to how much he thinks you will benefit from more sessions (if more become available) vs picking up another client. dunno. but if you don't register an interest then i guess its unlikely that he will offer more...

[sidony]

Wow! Wild that your therapist's schedule is so full!

When I first started therapy, my therapist said he wanted me to come once a week and said that was important for his memory as well as for therapy to be effective. If he'd left it up to me, I would have originally said I'd like to come every 2 weeks (I didn't really know that much about therapy then), but I found very quickly that I love going every week. I even sometimes wish I could go twice a week, though I think I do well enough without it. I hope you'll get a chance to get in some extra sessions (maybe if only periodically). Just talk to him about it.

I think my therapist's schedule is reasonably full but not to the degree as yours! If I need to reschedule there's usually a couple of different slots I can take (unpopular times of course but it works).

Sidony

[withit]

Sidony, given the fact that you have a need for more frequent sessions I would definitely advise you to ask for it straight out. That your t's schedule is filled to capacity is not of your concern. Really. You are not here to take care of your t, you are here to get your needs met. And you are paying for it. Your t needs to know that you want more sessions. The last I've heard, t's aren't trained to read minds....
I recall the time I called my t and said that I am finding it so helpful to be seeing her once a week and I feel I need to see her twice a week, and would she be able to work out something financially doable for me. She was so glad to accommodate me and I sure was glad I asked for what I needed.
We whose lives have been touched by trauma and want to heal and move on may not be able to do it on a 50-minute hour once a week.
If you are afraid of rejection you can say something like, ''I want to ask you for something yet I am so afraid of being rejected.....'' Somehow, I find it helpful to express my fear and then go ahead and ask for whatever it is I want to ask for.
Please report back to us, we want to know what happens...
Take care,

Now this thread has got me wondering how my T knew from the first meeting that we would eventually need twice weekly?? I have read that once a week is to stablise the client then twice a week is for the deep work. I was in once a week for a yr and now in twice weekly for the last 2.

[sidony]

Just to clarify -- I think the post below is actually directed to sunrise rather than to me.

Sidony


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withit said:
Sidony, given the fact that you have a need for more frequent sessions I would definitely advise you to ask for it straight out. That your t's schedule is filled to capacity is not of your concern. Really. You are not here to take care of your t, you are here to get your needs met. And you are paying for it. Your t needs to know that you want more sessions. The last I've heard, t's aren't trained to read minds....
I recall the time I called my t and said that I am finding it so helpful to be seeing her once a week and I feel I need to see her twice a week, and would she be able to work out something financially doable for me. She was so glad to accommodate me and I sure was glad I asked for what I needed.
We whose lives have been touched by trauma and want to heal and move on may not be able to do it on a 50-minute hour once a week.
If you are afraid of rejection you can say something like, ''I want to ask you for something yet I am so afraid of being rejected.....'' Somehow, I find it helpful to express my fear and then go ahead and ask for whatever it is I want to ask for.
Please report back to us, we want to know what happens...
Take care,

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I think that it really does depend on the therapists theoretical orientation and also on practical constraints.

Therapists who work in a public service usually have guidelines that they are expected to follow. People in private practice typically have a bit more leisure to do as they please.

Different therapists feel comfortable treating different things. Some believe that once per fortnight is optimal for the kind of work they do and so they wouldn't increase that whether they could or not. Others believe that once per week is optimal. Others believe that twice per week is optimal. My t said he thinks this would be optimal for me but he doesn't have the available slot... Others believe that three times per week is optimal. Sometimes they vary it depending on the kind of work they are doing as well. Or for different clients with different issues (e.g., more sessions for clients who have trouble feeling attached or for trauma work).

[withit]

You're right, Sidony, it was directed at Sunrise; seems my mental circuit was on overload....I apologize for any discomfort I may have caused.

[sidony]

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withit said:
You're right, Sidony, it was directed at Sunrise; seems my mental circuit was on overload....I apologize for any discomfort I may have caused.

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It's no problem! Just trying to keep everybody straight so it's no more confusing than all our threads usually get....

Sid