I’ve never seen a psychiatrist or a therapist, so I don’t know if this is accurate or Hollywood. I’ve seen in a lot of TV shows and movies: a character is in a session with a therapist or psyciatrist or psychologist, after a set amount of time (often an hour) the therapist ends the session until next week. A lot of times the patient insists that the session keep going, that they just had a breakthrough, they need to tell the therapist something else important, they need to talk about their dreams, etc. But the therapist always says that the hour is up and they’ll continue next week. Why is that?
Is there some psychological reason that therapy can only last a specific amount of time each week? Is there a reason that the session can’t continue even a little bit longer for the patient to describe one dream? Why does it have to end right then and go no longer?
You cannot make exceptions to a rule like that when dealing with potentially emotionally damaged or unstable people. Otherwise a single patient will drain your entire schedule.
Like everyone else, the psychiatrist has a schedule to keep. If the patient has a crisis or is making an especially important breakthrough, the therapist may ask him or her to come back later in the day; this happened at least once in The Sopranos, I recall.
It is therapeutically useful to have a termination time. Often clients will resist talking about important matters until they know there is little time left. The last ten or fifteen minutes of a therapeutic hour (50 minutes) are often the most useful, emotional and revealing.
I know a psychiatrist who used to work as a private therapist. She once had a client who’d show up for his weekly appointment, on time, week after week, and not tell her why he wanted to see her at all. He wouldn’t say anything, and she’d try asking questions, talk about something else to try and segue into why he felt he needed therapy, and so forth, to no avail. He just wouldn’t talk about it.
Sometimes, when she said “OK, time’s up”, he’d seem to be on the verge to start talking. Finally, she kept the time slot after his appointment empty, said “OK, time’s up” at the end of the appointment but didn’t rise from her seat. Two minutes later he started talking and didn’t stop for half an hour.
I saw a therapist recently (not to worry, nothing serious) and she kept a fairly close discrete eye on the clock. She began to wrap things up with 5 minutes or so to go and then when time was up, time was up.
The industry standard around here seems to be a 1 hr. session. (45min/15 min). I discussed this with a psychiatrist I worked with years ago and he explained it like this.
If there is significant progress being made, 45 minutes is a long time for both the patient and the therapist. It can be quite a gruelling process at times.
If the session is not progressing well, if the patient is reluctant to talk, etc… again 45 min. is a long time. As well, it is sometimes very difficult to maintain the intensity that certain topics bring with them and he didn’t want his clients leaving, feeling completely burnt out.
The 15 minutes was spent writing notes on the session while they were fresh in his mind (most therapists don’t sit and continually scribble notes during a session, only perhaps during an initial assesment ). Also he used this time to read his previous notes on his next patient.
All this was 15 or so years ago but I think it still holds true today.