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Thursday, May 27, 2010 incslave, Community Member, asks

Q: Therapist Etiquette - what to expect, length of session

Hello All. I have a question that involves expectations from therapists. I had never seen a therapist before until two years ago when I suffered my first major depressive episode. She would meet with me for an hour on a weekly basis. I really liked her, but unfortunately she moved to a practice that does not take insurance (only Medicare). I recently scheduled with someone new from a different office. I've had 5 sessions with her, but was disappointed from the start when I discovered her sessions were only 40 minutes.

Yesterday I arrived for my session and she told me I was only scheduled for 20 minutes. I asked why and she said she didn't know. This upset me. We spent 15 minutes catching up, and then 5 minutes into the main topic it was time to leave. I told her I didn't want to reschedule as I was frustrated with these short sessions. She seemed rather indifferent. No one ever offered an explanation, an apology nor offered to make up the time in a later session.

Are 40 minute sessions common (as opposed to an hour)? Was I wrong to be so upset? It seemed hardly worth my time to take off work, drive down there and make my usual co-pay. Thanks for any advice.

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Answers (4)
John Folk-Williams, Health Guide
5/27/10 3:46pm

Hi -


I would just add a couple of points to Judy's excellent answer. There are many forms of one-to-one therapy these days, and insurance usually pushes you to a limited set of providers with quite varied backgrounds. I think it's important to discuss the approach to therapy each one takes at an initial session - some rely on techniques that are less dependent on the therapeutic relationship. Or at least they're handled that way, and you clearly don't want that. The key thing is to see if you really trust the person and feel completely comfortable discussing the most difficult and personal feelings that come up. Many forms of talk therapy absolutely depend on the relationship between client and therapist in order to have the full effect. That's another reason to keep searching and using the initial meeting to get a sense of whether or not you have the right chemistry with him or her.


Good luck in finding a better therapist.



incslave, Community Member
5/27/10 3:58pm

I am beginning to understand just how important the right chemistry is. I must have about a hundred options from my provider's website, all with various acronyms behind their names. I have read up on what these all stand for, but now I feel the emphasis should well be on the relationship. I will continue my search. Thanks John.

Judy, Community Member
5/27/10 2:56pm

Hi, Incslave - you have every right to be disgusted with this.  Usually, a therapy "hour" is 50 minutes and the fact that she didn't seem to care that much about it, plus to tell you you only had 20 minutes - like, why bother?  I think you should look again, unfortunately, for somebody else.  It's just not worth it to waste your time with people like that.  You know how you liked working with the first one, so you have something to go by in terms of what you'd want from a therapist.  In fact, if an hour doesn't seem long enough, you might be able to get 90 minute sessions - I've been working that way for years and it's perfect for me because I tend to waste a little initial time chit-chatting until I can work my way into it.  You should feel like your therapist has your concerns at heart - she should have at least talked to you about what you would like, how long the sessions should be, etc.  I never heard of a 20-minute session.  That just blows my mind.


Good luck finding someone better, maybe you can get some names from other doctors or people you know.  I know it's frustrating, but it's worth the time in the long-run.  Take care.

incslave, Community Member
5/27/10 3:51pm

Thanks Judy. I appreciate the reassurance. I actually called the clinic initially and asked them how long their sessions were and the office worker said they were an hour. Go figure? I will be looking for another therapist.

tornadomom11, Community Member
5/27/10 3:59pm

I see my therapist once a week for 1 hour.  We review how the week went and I write down any notes from the week where I had any low or overwhelming moments.  We review those issues and she gives me great information on how to handle the issues.  This has help as far as not having panic attacks, anxiety attacks, or chest pain and I have not had any suicidal thoughts either. 

Donna-1, Community Member
5/27/10 8:16pm

I have been in and out of therapy since 1995 and have seen a total of about 6 therapists.  One lasted for about 5 years, the others lasted anywhere from 1 appointment to 7 months.  And none of them were exactly what I would want -- an experienced professional who has no agenda other than encouraging me to talk, listening, and offering some sort of insight and/or guidance.


The therapy relationship that I had for 5 years was with a woman who was trained in many different types of therapy and tailored her approach to the individual client.  I was very, very sick with mental illness for four of those years and often unable to stay on the subject or even comprehend what she was talking about.  The fifth year things finally started coming together.  I was able to share about years of marital sexual abuse and an unhappy childhood.  But she had an annoying habit of occasional sarcasm that drove me away.  Nevertheless, I did come a long way with her.


Two other therapists practiced CBT (Cognitive Behavioral Therapy) where the main thrust is "thoughts lead to feelings which lead to actions."  And if you learn how to "think right" you will eventually "act right."  Not exactly my cup of tea.  Insurance companies like it because it is fast paced and involves a very limited number of sessions.  Supposedly you share your problem and overcome your problem.  To me it is a little over-simplified.  I wanted someone who would be like a mentor...and maybe that's not what therapy is supposed to be.


You would do well to investigate different types of psychotherapy online and see what the major tenets are of each.  See what appeals to you.  Most of all, know that the first "evaluation session" is for you to evaluate the therapist as much as it is for the therapist to evaluate you.  Never stay with a therapist who doesn't feel "right."  Or one who gives you any less than the "50-minute hour."  All of my therapists gave me about 59 minutes of therapy, leaving one minute to usher me out and the next client in.


Best wishes for your success.  There is little as satisfying as finding a good therapist -- and you usually recognize one quickly.  To me, no matter what their particular type of therapy, what matters is the therapeutic relationship.  The give-and-take of ideas and ideals.

incslave, Community Member
5/28/10 4:31pm

Thank-you so much for the details of your experience. This helps immensely and will allow me to gauge my future experiences with some intelligence.

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By incslave, Community Member— Last Modified: 12/26/10, First Published: 05/27/10