The 50 Minute Therapeutic Hour
Why Are Therapy Sessions One Hour Long?
I have been a part of internet culture for a few years now. During this time, I have come across many stupid ideas. The world is run by mole people. Your handwriting can change your fortunes and the latest edition: 5 minutes of free therapy!
But this is not a story about the horrid ideas that some “mental health” startups have. It is a question about one of the most basic assumptions of the therapeutic process.
A therapy session usually last 45-60 minutes.
It has been one of the cornerstones of therapy in my time both as a client and a practitioner. It is something so basic that until last week, I never even questioned it.
Why do therapy sessions need to be 45-60 minutes long? Who decided this? Why? On what basis?
A proposition of 5 minutes of free therapy made me feel a whirlwind of emotions. I laughed. I was perplexed. I was angry and then…I was curious. Why do we put a limit on therapy? Why must the sword of the ticking clock always swing over the head of the client and the professional?
I went down a rabbit hole. Here are the interesting things I found.
Of course, it’s Freud.
Run from it, hide from it, Freudian influence on psychotherapy arrives all the same. He is truly inevitable.
In the modern psychotherapeutic space, Freud might be looked at with ridicule but his influence on our practice is unquestionable. Scholars trace back the origin of the 50-minute therapeutic hour to Freud’s practice in Vienna.
For a long time, Freud used to visit his patients at their homes. There was no time limit on his visits. Some would last for 3-4 hours on end.
As Freud gained prominence, his demand grew as well. He was at a stature where he could invite his patients to a clinic instead of being a visiting doctor. This threw up more problems.
He struggled with scheduling sessions rationally. In such a situation an hour-long fixed session seemed like the best fit.
Why 50 minutes then?
Because Freud understood that he needed a few minutes to take notes and recover between sessions as well.
A 60-minute session with 10 minutes of break before the next one would make appointments have odd timings. Some sessions would start at 2 PM sharp, others at 6:40 PM, and some at 3:29 PM.
So, the 50-minute session was a product of convenience and efficiency instead of being a result of empirical data. (Something psychologists today are big fans of)
Variations of the 50-Minute Hour
Psychologists have largely stayed away from testing the need for a 45-50 minute therapy session. As I said, it is considered something so basic that we never even wonder why we do it.
But there have been those who strayed from the pack. Most notably, Jacques Lacan.
Lacan was a psychoanalyst known for taking extremely short sessions. These would sometimes last merely 3-4 minutes before he got up and left abruptly. Lacan was heavily criticized for this practice.
Despite criticism, Lacan continued his practice. We cannot know for sure if his practice bore fruit more or less efficiently than one would expect from a 50-minute session.
Previously, in 1922, when the idea of a 50-minute session was still young, psychoanalysts in Germany experimented with 30-minute sessions. This is what they observed.
It was originally our intention …. to reduce the length of the analytic sitting from one hour to half an hour, but we have had to give up this idea. It could be managed only in the case of a small class of persons who were still, in spite of their neuroses, amenable to discipline…
The Clock In Therapy
We don’t appreciate it much but during a session, it is not just the therapist and the client who participate. There is a third, omnipresent entity that guides us, drives us, and holds us during therapy. It is the clock.
The clock offers safety and security, it quantifies your space for you. When you are in therapy, for 50 minutes, you are the point of attention, no one and nothing else.
But the clock also limits.
It puts limits on how much we share, how much we open up, and how much we can put together again before the session ends.
Despite its omnipresence, I believe the therapy clock is one of the most overlooked aspects of therapy.
Therapy by the minute
The safety of the clock and the 50-minute hour is why I am certain that startups and companies offering “therapy” by the minute will not be doing their users much good.
The user, in this case, would always have an eye on the clock to ensure he isn’t being charged too much. Remember the days when call roaming used to be a thing?
Conversations used to be so short and superficial.
We knew that the more we talked, the more we expressed ourselves, and the more injury our wallets would face. Something similar happens when we offer therapy by the minute.
It can be useful for those who are desperate to talk to someone. Anyone, just any human soul would do. But it is not the long-term solution to anything.
50-Minute Hours Today
The world has come a long way since Freud first proposed the 50-minute hours in 1913. People are always in a rush and they need solutions and results as quickly as possible.
Does it make sense to reconsider the relevance of the 50 minute hours in such a world?Maybe they could be longer, may be they could be shorter. I don’t know what would be the right choice.
One thing I know for sure is that the 50-minute hour is not an unquestionable truth of psychotherapy. What are your thoughts on this?
You can let me know by replying to this email or in the comments! I look forward to your thoughts.
Until next time,
Arjun
Sometimes my therapist would end early because I had nothing new to say or the objectives previously mentioned are in progress. 50 minutes seems perfect. Almost self care for people who ignore themselves. The 50 minute could be relaxing for them.
This was really interesting to read. For me the only reason there was a time limit for therapy was to ensure you are not depleting yourself of your emotional resources and can manage your time with other clients, as you mentioned. But when it comes to therapy by minute, I think it leans closer towards counselling than it does towards therapy. There are brief counseling approaches like solution-focused counselling, narrative counseling and crisis counseling which are also proven to be effective although they have their own limitations. So according to me the timing and the therapeutic approach that the client needs can be decided best by the client and therapist in a collaborative alliance.