The benefits of going to therapy cannot be overstated, though it may feel intimidating to dive in and make it part of your routine at first.
While therapists take many different approaches to meeting frequency and length, the norm for individual therapy (i.e., therapy with one client) tends to be weekly 45- or 50-minute sessions. But when did this time become the standard “therapy hour” or “therapeutic hour”?
“There are various theories on the origins of the 50-minute therapy session and some reports that trace back to Freud,” Becky Stuempfig, a licensed marriage and family therapist in Encinitas, California, told HuffPost. “There does not seem to be a consensus on exactly when the ‘therapeutic hour’ was established, but it has remained the industry standard.”
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Beyond the history, however, there are many reasons ― practical, psychological and insurance-related ― to stick to this time frame. HuffPost spoke to Stuempfig and other therapists to find out why the 45- or 50-minute session has persisted.
It Helps With Logistics
There are many logistical factors keeping session lengths around this time frame, rather than a full hour.
For clients, this timing may make it easier to see a therapist during a lunch hour or just before work. For therapists with back-to-back sessions, the 10 or 15-minute break offers the opportunity to write progress notes about the client they just saw, return calls and emails, handle billing, take a bathroom break, get a glass of water or even just breathe.
“There are therapists who work extensively with clients dealing with very heavy, traumatic experiences, so the break gives them the chance to decompress a little bit,” said Tammer Malaty, a licensed professional counselor at Malaty Therapy in Houston, Texas.
“Logistically speaking, therapists typically rely on the time between sessions to reset themselves for their next client,” noted Stuempfig, adding that this can involve “taking deep breaths to prepare themselves mentally for their next client so they can feel present and alert.”
Many therapists utilize 45 minutes, rather than 50, to extend the break between sessions, or to schedule back-to-back sessions on the hour and half-hour marks.
“This is a newer practice,” said Nicole M. Ward, a licensed marriage and family therapist in Los Angeles. She noted that 45-minute sessions also allow therapists to see more clients in one day.
It Feels More Contained
There are also psychological reasons why these session times remain the norm. First of all, the length of time feels more contained, so it lessens the risk of over-exposure to painful emotions.
“It could feel traumatic to a client to sit with their pain for an extended period of time, risking emotional harm and causing the client to not return due to fear of retraumatization,” Stuempfig said.
“Given the unique personal and emotional natures of therapy, many people would find an hour or more to be overwhelming to their nervous system and moving on with their day after that,” added Denver-based licensed psychotherapist Brittany Bouffard. “It allows the client to visit important processes, feel feelings, derive their insights and get the sense that there will be a reprieve from the intensity so that they can then go back to work or to their family.”
The therapeutic hour also sets psychological boundaries for the therapist and client. Stuempfig noted that 45- or 50-minute sessions allow therapists to offer a fresh perspective and remain objective without getting too immersed in a client’s life.
“At the core of the therapeutic relationship is confidentiality,” she explained. “The client enters the relationship being guaranteed that their revelations will not leave that space, unless of course there are safety risks. This creates a unique dynamic that is not meant to go on for long periods of time. It would not be sustainable to have this type of conversation for many hours at a time.”
Having a clear endpoint after less than an hour can help create a safe space for the client to feel, process and contain intense emotions, rather than go into it with the sense that there’s no end in sight.
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It Encourages Good Use Of Time
Keeping therapy sessions under an hour may also motivate both parties to make the best of the time allotted.
“It can encourage both therapist and client to get to the heart of the problem rather quickly,” Stuempfig noted. “They know that if they engage in typical small talk, it will be a waste of valuable time.”
When the client knows a big issue won’t be fully resolved in one session, they may feel more comfortable presenting it, discussing goals to counter the problem, exploring different aspects of it and learning coping skills to implement in everyday life.
“When people have longer, they don’t get to the meat of the material very quickly,” Lori Gottlieb, a Los Angeles-based psychotherapist and author of “Maybe You Should Talk To Someone,” told HuffPost. “When people know they have 50 minutes, they feel aware that they need to take advantage of that time. It’s about striking a balance so that work is getting done.”
Longer sessions may also lead to a sense of fatigue or burnout for both the therapist and the client. For children, that timing sweet spot can be shorter with 30-minute sessions, as 45 or 50 is sometimes too long for a kid’s attention span.
It Helps You Process What You Learn
Saniyyah Mayo, a licensed marriage and family therapist in Los Angeles, compared therapy sessions to high school classes. Each class presents a set amount of time that students spend learning about a specific section of the curriculum. Afterward, they can process the information and even explore it in a different setting through homework.
“A person can have a 4-hour session but they are not going to reflect and digest everything that was discussed during the session,” Mayo explained. “The client may think it was a good session, but too much information would be covered for them to completely digest it and benefit from it. Giving people increments of information and allowing them to process it in sections is good for the best possible outcome for treatment.”
This is why therapists often suggest meeting more frequently, rather than extending sessions, when clients express a desire for more time.
“I think more work gets done in two separate sessions than in one longer one when you feel like you have all the time in the world,” said Gottlieb, who compared therapy to a big, filling meal.
“You can’t have this whole huge meal at once and expect it be digested or processed in the same way as if you’d just eaten a little bit and let it digest and then eaten more later,” she explained. ”You need that time in between. You can’t take too much in and have it stick.”
It Allows You To Incorporate Your Findings
The important thing to keep in mind is that therapy is an ongoing conversation, and the real change happens when the clients practice what they learn in their lives outside the therapist’s office. The focus should be on the skills and insights they gain during sessions and how they’ll implement them ― not the length of the sessions.
“There’s a great deal going on in the span of the therapeutic hour,” Stuempfig said. “It is intended to be limited and therefore, powerful in its impact. This also leaves time between sessions for the client to reflect on their therapeutic insights and hopefully adjust their perspective or relationships. Our brains and bodies need time and space to incorporate lessons learned in therapy.”
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Insurance Pushes it
Insurance companies also feed into the 45- or 50-minute session standard, as they base reimbursement on the type and length of therapy. A common billing code is 90834, which denotes 45 minutes of individual psychotherapy but can be used for sessions ranging from 38 to 52 minutes.
“If the clinician stays with a client for more than 52 minutes, then technically a different code should be used ― a code that defines ‘one unit’ of therapy as 60 minutes,” said Zainab Delawalla, a clinical psychologist in Decatur, Georgia.
“However, there is a lot of pushback from insurance companies about actually paying clinicians for the ‘60-minute’ code. Many companies require preauthorizations and have very strict criteria of when and for whom the 60-minute therapy hour is appropriate. If the insurance provider decides that the criteria were not met, they will not pay the clinician.”
Thus, to avoid not being paid or breaking the law (by billing a code that doesn’t accurately convey the length and nature of the service provided), clinicians tend to stick with the industry standard of 45 or 50 minutes.
Of course, therapists can and do offer different session lengths based on individual client needs and make it work with providers. And even if your therapist doesn’t take your insurance, your provider may offer out-of-network reimbursement options.
Beyond The 45- Or 50-Minute Session
Although 45- or 50-minute sessions are the industry standard, it’s not a hard rule across every case. For couples or families, therapists offer longer sessions, usually 90 minutes.
“These are spaces where there are multiple perspectives at play and you want everyone to be able to have space,” Ward said, noting that these sessions involve more information and relationship dynamics to address.
In individual therapy, there’s sometimes a clinical need for longer sessions, whether that’s a more complex issue to work through or even a time of crisis. In these cases, session timing may shift.
Many therapists also offer longer sessions for intake appointments with new clients to ensure that they have enough time to gather information and ask questions for diagnostic clarification.
Ultimately, therapists assess clients and determine meeting times on a case-by-case basis.
“The therapeutic hour … may be common but there are other lengths of time out there. It is important to communicate with the specific therapist if you feel like longer sessions are needed,” Ward said. “I think it’s really important to demystify therapy and what happens in sessions because we can form stories about why things are a certain way. Being able to have information helps to remove some of the stigma from therapy.”
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