One of the questions clients occasionally ask about therapy centers on the 50-minute therapy hour. Why 50 minutes? Why not an hour? Why not 90 minutes? Why not less?
Every therapist approaches time differently. For some, 50 minutes is the ideal amount of time in which a reasonable amount of work can be accomplished. A client’s (and therapist’s) ability to focus and concentrate attention begins to fade at 45-50 minutes into the session; the ability to be productive diminishes after 50 minutes. Time-limited sessions hold both the therapist and client accountable for addressing priorities. The 50-minute session also allows 10 minutes following the session for the therapist to write notes, attend to administrative tasks, breathe, reset, and freshen in order to be ready for the next client.
However, I think there is another equally important purpose to the time-limited sessions: they create a structure that in turn creates safety, especially for clients new to the therapeutic process. Knowing that the session has an end creates a sense of safety, which in turn helps both therapist and client focus on the issues at hand; a time-limited session encourages the you to be vulnerable. Indeed, it’s important that you know that there will be an ending; the vulnerability that is exposed and addressed during the session will not endure forever. You are likely to become willing to allow yourself to feel vulnerable when you know that you will have to tolerate those feelings only for the period of time that constitutes the session.
The therapeutic relationship is a uniquely intimate one where you are likely to experience a wide array of feelings. Difficult feelings—anger, sadness and grief, anxiety, shame—can and will arise in therapy. These feelings can be challenging to tolerate in relationship.
Despite the reality that all feelings are welcome in therapy, many clients have spent their lives fleeing them: they deny or minimize their feelings, leave relationships that trigger vulnerable feelings, or escape into a variety of addictive behaviors. Tolerating strong feelings in the context of a relationship can be very difficult, and the impulse to flee can indeed be powerful. The intimacy that constitutes a good therapeutic relationship will, over time, support and even enhance your ability to tolerate the discomfort that attends vulnerability. Trust in the therapeutic relationship builds over time—in small increments of time. It takes time for you to integrate the experience of having strong feelings in relationship and knowing that you will survive your feelings, your vulnerability. Discomfort and vulnerability do not last forever; there will be an end—just as there is always an end to everything else in life. In the therapeutic relationship, it becomes safe to explore the discomfort of vulnerability here, now—precisely because there will be an ending.
Indeed, psychotherapy’s effectiveness is predicated on the ability to have and express all one’s feelings in relationship—a relationship that is structured and facilitated by the 50-minute hour.