The 45-minute hour

When scheduling a new patient, I am often asked how long my sessions run.  I welcome this question as it potentially indicates that this prospective patient values her time and mine.  My response is that when I provide psychotherapy, I schedule “45-minute hours.”  There was an interesting Op-Ed in the New York Times about the “shrinking hour” – – an interesting pun on the shortened duration of the hour and calling ourselves “shrinks.”

So why do I allot just 45 minutes per patient?  There are many reasons… It makes it easy to start on the hour and wrap up with time to do my clinical documentation, run to the restroom, refill my carraf of water, pop a few M&Ms and return some emails.  If for some reason I start a few minutes late (which I very rarely do), I can always extend the session a few minutes beyond x:45.  Occasionally an emergency arises and that 15 minute buffer gives me the flexibility to devote additional time to the emergencies.  …but these are all practical reasons.

There are also therapeutic reasons to maintain a 45 minute hour.  Patients are often anxious when they come to therapy; if they know the “ground rules” such as when our session starts, when it ends, etc, that typically reduces some unnecessary anxiety.  A certain degree of predictability from your therapist is essential; even those patients who do not explicitly ask quickly learn that I am pretty diligent about time management and they know what to expect from me.  I empower my patients to use the therapy session in the way they believe is most useful for them.  Now this doesn’t mean I do not interpret and feedback to my patient their recurring “doorknob disclosures” (when an emotional “bomb” is dropped at the end of the session, as the patient is walking out the door), but my consistent structure affords my patients the opportunity to do this so that we can then interpret this behavior.

I am also a strong proponent of therapists caring for themselves.  In fact I chair the Colleague Assistance Program for the Maryland Psychological Association.  The 15 minute break between patients allows me to wrap up the previous session (typically done by writing my progress note for the previous patient), clear my head and prepare for my next session (typically done by reviewing previous progress notes from the next patient’s chart).  This is good for me, but it is also good for my patients; instead of having to keep details of the last session in my head until the end of the day when some therapists do their clinical documentation, I write my notes immediately after session, producing better notes and essentially “freeing up RAM” in my head for the rest of the day.

By setting clear time limit boundaries for my patients, I empower them, model time management, make myself more present for them during session, care for myself, produce better clinical documentation and respond to emails, phone calls and clinical emergencies in a more timely manner.






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