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Ninety-Minute Therapy Sessions

When it comes to therapy sessions, bigger is better.

There is a longstanding mystique about the therapeutic “hour.” I put the word hour in quotes because the therapy session traditionally consists of 50 minutes, never a full 60. The practical reason for this shortened hour is so a therapist with a full day’s schedule of one client after another has a few minutes in between to write notes, go to the bathroom, and/or catch her breath.

While this shortened 50-minute hour is what insurance reporting forms acknowledge as standard, 30- or 45-minute therapy sessions, if that’s what the therapist decides upon, are also issued a reporting code. What does not seem to be a possibility on insurance forms or the bureaucrats who design them is a 90-minute session, a full hour and a half. It is precisely this time frame that I decided would be optimal way back in the early 1980s when I began my therapy practice and one of the many reasons I have never agreed to work with insurance companies beyond the barest minimum of issuing a receipt for my client to present to them when requested.

There is a great advantage to both therapist and client to running a practice I design myself rather than working in the format of someone else. First of all, I can see a client for what I believe to be the optimum amount of time for concentrated focus. There’s no “time’s up” just when things are getting interesting. Most people deeply appreciate this. I also schedule a half-hour between clients so that I am sufficiently refreshed and present when the next session begins.

The disadvantage for the client is that since the session is almost twice as long, my fee per session is necessarily going to be more money than most others. If a client is making preliminary inquiries in locating a therapist, Dr. A or B is going to appear much more economical than I am. The disadvantage for me in scheduling as I do is that I will see fewer people and net less money. It has always seemed worth it to me.

Since I see both individuals and couples, on several occasions a couple has asked to split the session with one of them taking 45 minutes and then the other. The few times that happened they seemed satisfied with the arrangement but it felt “skimpy” to me. I felt I barely got started in that amount of time. Particularly since my approach is problem-solving, I don’t intend to see anyone for very long, nor do I. So a few 90-minute sessions accomplish what some therapists do over a period of months or years. We don’t have to cover old ground.

I see, after rereading what I have written, that while the points I present make sense, this post might sound like a defense of my practices, an apologia. Let us end with the suggestion that if you have consulted a counselor or therapist ever, or are thinking of it, compare what you get done in a few shorter vs. longer sessions. Counselors, you do too. I rest my case.

To find a therapist, please visit the Psychology Today Therapy Directory.