90 minute therapy sessions

Do any of you do 90 minute therapy sessions with your therapist?

If the standard "therapy hour" is 45 minutes, is doing one 90 minute therapy session with a therapist counted as doing therapy once a week or twice a week?

I do two 90 minute sessions with the therapist. I think that equates to meeting twice a week, but the therapist insists that we are meeting four times a week.

Mine were always 45 minutes. Now with this new one it’s an hour. 45 minutes was never enough and I was always running out of time and 90 minutes seems too long for me. But an hour is just about right.

I never understood if it was the insurance saying how long a session is or if it’s the therapist making that decision.

I think your therapist is off base here. Yes, the therapy hour is usually anywhere between 45-60 minutes, but just because you meet longer than that doesn’t mean that you’re magically seeing her 4 times a week. You see her twice, just for extended sessions.

I see my therapist for 90mins every two weeks. That is one session each time I see her.

I think your therapist may be referring to how she bills. There are different billing codes for different lengths/types of sessions that they base their fee on. Yours may essentially equate to the cost of 4 sessions. (just guessing here)

You have two sessions, in my opninion.

I doubt the therapist is calculating it as per how insurance handles it because the therapist actually doesn't accept insurance at all. It's self-pay. The therapist is psychoanalytically trained. I suspect that she calculates it the way she does because in psychoanalytic training, 45 minutes is considered one session while a double – that is 90 minutes – is counted as two sessions.

When the former therapist was in psychoanalytic training and we were exploring the possibility of adding a 45 minute session to our weekly schedule of one 45 minute session and one 90 minute session, she said she that needed to get approval from her supervisor in order to meet with a patient four times a week. I said we aren't meeting four times a week. The former therapist explained that as per the psychoanalytic handbook that 45 minutes equals one session, two 45 minute sessions and one 90 minute sessions equate to meeting four times a week and is considered doing psychoanalysis proper.

If my suspicion is accurate, then the psychoanalytic community has an interesting way of calculating that I disagree with just like how I disagree with insurance dictating the length, frequency, et cetera of therapy sessions. I think that it should be dependent on what feels right to the patient – whether it's shorter 30 minute sessions or longer 75 or 90 minute sessions. Whatever duration feels most therapeutically effective to the patient should be counted as one session or meeting once a week. Then the therapist is free to prorate or not.

But here's what hurts...

The therapist says that she never meets with any patients as many times a week as she meets with me – that is four times a week per her calculation that two 90 minute sessions equate to meeting four times a week. I insisted that we are only meeting two times a week. I explained to the therapist that 45 minutes is too short for me; it always feels rushed, I can't think and sit with my feelings, and that doing 90 minutes feels like when I'm actually doing therapy. The therapist says that she has never heard of anyone calculating it the way I do.

It always hurts when she says that. It makes me feel like I'm "the odd one out." It also leaves me feeling invalidated because the number of times we meet a week is held to some external standard rather than the duration of session that feels therapeutically effective to me. Based your guys' response, I'm clearly not the only one who counts it the way I do. At least I can feel more confident and rest assured that I'm not "an odd one out." One of my former therapists offered to increase our 50 minute sessions to 75 minutes because she noticed that I was needing more time. That therapist also calculated as just one session rather than meeting one and a half times a week.

I don't know how else to explain this to the therapist in a way that I can feel heard and understood, and not made to feel like I'm thinking in an odd or strange way? I'm glad that she's at least able to do a double with me, though.

My T is currently in a psychoanalytic training program. When she first entered the program she let me know about it and I looked up the program. She has to have so many supervised hours of psychoanalytic type therapy to meet the requirements of the program which means seeing someone 4+ times a week. They cannot move to that stage of the program until they reach a certain stage in their education and self analysis unless they get approval from their supervisor. Since I see my T for the full 60 mins; I wondered when I was seeing her 3x a week, if I qualified because of the total weekly time = the same as 4 x 45mins. So it is possible her perspective came from something taught in her program on how to determine which approach in therapy to take (if she has actually fully completed her program). If she hasn't completed it; she might need to define the sessions as 4x week for them to count towards her program. Or it might be how she decides her case load - how many clients to take on at x level.

Technically, you want to count sessions by therapy mins you are meeting the weekly minutes that average a 4x a week client. That being said, I agree with you that I would consider myself seeing my therapist 2x a week for extended sessions.

So I guess I see both perspectives here. One question here - other than you left feeling like 'the odd one out' what does it matter? What would it mean to you if you imagined you were seeing a therapist 4x a week? What would it be like for you if you really were seeing her on 4 different days for closer to 45 mins (for the moment, ignoring the struggles you have about feeling rushed or needing the transition). That is one thing I found when I moved to 4 x a week was things slowed way down for me - I didn't feel so rushed to try to get it all in because I would see her the next day. I'm not saying that it would work that way for you. And I do still get to see her a full hour; so based on your T's definition - I'm seeing my T 5x a week. And really, we have daily email on the days I don't see her.

Have you brought up her lack of acknowledging how or why you have your perspective impacts you? This seems to be a very common thing between you and your T - the different perspectives and her seeming to not support or really acknowledge how your perspective exists or be curious as to why you have that perspective. It seems to cause a fair amount of distress for you and issues in your therapeutic relationship with her.

eta - as someone that increased number of sessions per week basically each year, there is a big difference in seeing someone 2 days a week verse 4 days a week in terms of how it feels. I don't think it would have matter if I was seeing her for more time when I was seeing her 2 days a week. It is just different when you see someone that many times a week.

Elio brought up the point that I had been thinking about. Sure, the classification of therapy minutes may matter to your therapist for some reason, but why does it matter to you? The reality that you live is that you see her for 90 minutes twice a week. It seems that the minutiae matters quite a bit to you. The thing that sticks out most for me is when you said that she had ended the call two minutes early. Again, I don’t agree with the way that she handled that situation, but I remember you focusing on the time a disproportionate amount compared to what actually happened. This may be something for you to explore more deeply. I would encourage you to try to put the details aside and focus on the content and experience of therapy. I know that may be easier said than done. Just something to consider.

I did two 90 minutes sessions per week with my past Therapist, M. He also counted it as 4 sessions when he was grumpy. He did a bit of insurance fraud in which he charged them for 2 sessions, and me his full fee out of pocket for two . I didnt know at the time that in my state are required to use insurance if they elect to be enpanneled.

50min is standard in my country, and that is all my T can bill so far as I know. That being said, our last session was close to 90min.