The Hokey-Pokey Clinic

Several years ago, a friend gave me a plaque for my newly opened psychotherapy practice.  The gift was her witty affirmation of my work.  Over the years, I’ve displayed it in various locations, and it never fails to elicit a chuckle. 

I love this plaque.  Those of us of a certain age probably will probably recall the song and even doing the motions as children.  It was a catchy tune and a simple dance—perfect for children.  However aside from eliciting childhood memories, my friend’s gift also humorously reflects simple but deep wisdom about psychotherapy and the healing/change process.

You do the hokey-pokey

And you turn yourself around—

That’s what it’s all about.

People usually enter psychotherapy to “turn [their lives] around.”  Crises, situational discomfort, chronic dissatisfactions and unhappiness, emotional pain in the form of depression or grief, anxiety, relationship issues—all these cause people to seek help.  Further, people seek therapy because the stories they tell themselves about themselves have grown stale and leave little room for meaningful growth.  Old coping strategies don’t work anymore. 

And so they seek help which manifests in the form of a therapist whose job it is to help clients see and understand the origins of the problem(s), perceive their lives in new ways, and develop new strategies for moving forward in the world.

An important point here:  while many clients want and need to solve problems (and therapy facilitate problem-solving), real healing goes well beyond problem-solving.  Meaningful healing requires that you reorient yourself—you look in new directions to turn your life around.

Meaningful change and healing is often slow in coming.  It takes time to exercise the courage and deeply look at yourself.  It takes time to understand of how you got to where you are.  It takes time to discern that you can genuinely make other choices for yourself.  It takes time to actually implement those choices.  And it takes time to feel confident about the choices you’ve made.  It bears repeating:  meaningful change rarely, if ever, happens overnight.  Changing your perceptions, your ways of thinking, old behaviors require mindful practice before they are fully integrated. 

Therapy can be pokey, at times. 

Most clients, upon seeing the plaque, are amused but don’t stop to reflect upon the fact that the plaque signals the path of healing:  a slow, deliberate, careful reorientation and reconciliation with your life that can be helped with a small dose of humor and a wise, compassionate and experienced guide. Healing is both that simple and that complicated.

Indeed, “that’s what it’s all about.”

The 50-Minute Hour: Psychotherapy and Time

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.