Why a 50-Minute Hour?

“I’m afraid our time is up.”   ~ Said at one time or other by most therapists

Why not a 15-minute hour, like a physician? Why not a 60-minute hour, like on most people’s watches? Why an hour in the first place? Good questions all. And the answers do not involve any evidence-based reasons that I know of. It’s all about the convenience of the therapist. Or it’s because that’s what insurance companies pay for. Same thing?

Why do physicians only spend at most 15 minutes with you? Because that’s what insurance companies pay for. Therefore, doctors can pack four people into an hour and charge various insurance companies for the 15-minute chunks of time.

Why such little time? First, doctors get trained in a pressure-cooker environment where time is of the essence, as if it were life and death. Wait a minute, quite often it is life and death! So, I guess that’s a good way to train doctors, at least those who work in emergency rooms. Also, doctors typically know what to look for and can most often find it within 15 minutes. Or so say the insurance companies. Those doctors with a “good bedside manner” seem like they take longer than 15 minutes or give the appearance of actually listening to you. Yay for them!

Why is 15 minutes enough for a physician but not a therapist? Well, modern medicine comes out way ahead of psychology or even psychiatry as a so-called “science.” Doctors have it down to a science, so to speak, and have virtually only one way of doing their job. We might call this a paradigm, or model, for doing this work. Therapists, on the other hand, have many hundreds of models from which to choose, not just one. Therefore, therapists operate in a “pre-paradigmatic” manner. Whoa! Try that out at a fancy cocktail party.

Further, we (meaning the human race) don’t really know that much about the mind, or the brain from which the mind is said to emanate, for that matter. In fact, we don’t even know whether the mind actually does emanate from the brain. We just assume so because, so far, it’s very difficult to measure the energy of any consciousness outside the brain. Sorry for getting a little “woo-woo” on you.

In any case, compared to physicians, we therapists really don’t know what we’re talking about. Sorry guys, the jig is up! So, it takes us a while longer to figure things out, or to help our clients figure things out. But, we’re working on it!

Now, back to why not a 60-minute hour? Actually, I used to do 60-minute hours because lately insurance companies will pay for them (honest truth) and I preferred to give clients more time, if possible. But, that meant I did not get a potty break in between sessions or have time to write notes, etc., until later. Well, I switched back to 50 minutes for my own sanity and urinary tract health. But, now you know why most therapists do a 45- or 50-minute hour, instead of 60-minute hours. It all boils down to bladder capacity. And what insurance companies will pay for. Ka-ching!

Lastly, why an hour in the first place? OK, I’ll bet that you can answer this one by now. Yes, you’re right! It’s what insurance companies will pay for. Plus, it’s a tradition. And we can’t do away with tradition. If it was good enough for Freud’s day, then it’s good enough for 100 years later. That’s what I say!

Well, not really. It may be that insurance companies (for whatever reason) bill out in hourly increments and that also makes it convenient for therapists to schedule appointments on the hour. But, is that the best timeframe for a therapy session? Who knows! I don’t, I’m sorry to say. I am unaware of any evidence that proves this, one way or the other. If anyone reading this does know of such evidence, please contact me at your earliest convenience. I would really like to know.

And, while we’re on the topic, what about this weekly thing? Why not daily or twice a week or whatever the client needs? Again, tradition, therapist convenience, and (did I fail to mention) insurance policies. Yes, I know that some therapists will say something about boundaries, structure, and all that good stuff. I take your point, even if I don’t necessarily agree with it.

I suspect that if anyone were ever to do research on this topic, they might find that Alcoholics Anonymous (or any other program based on the 12 Steps) might have it right with their “sponsor” concept. When does the typical client really need their therapist? Whenever they need them, that’s when! Not once a week at 3 pm on Wednesdays. They need to talk to someone now! Hence they have the sponsor concept, where a self-identified alcoholic, drug addict, co-dependent, over-eater, sex addict, or whatever can get in touch with their designated “therapist” who will make themselves available for conversation, advice, or whatever the “client” might need. What’s better than that?

OK, now I need to talk to my therapist. No, wait. When’s my next appointment?

As always, let me know what you think of this article. Thanks!

 

Copyright 2014 Daniel J. Metevier

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