Psycho-Babble Psychology Thread 781695

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Re: the 50-minute hour... twinleaf

Posted by RealMe on September 8, 2007, at 23:12:15

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

50 minutes used to be the standard, and my last T saw me for 45 minutes as does my current T. I am not sure why that is as the insurance company says they will pay X for sessions that are 45-50 minutes. My T never goes over. Very strict boundaries. I don't know what he would do if I refused to leave. I think he would stand there with the door open. That would be embarrassing, but no one else is there at that time of the morning except the next person way down the hall and around the corner and down that hall. So, HUM. Maybe I should test it out some time to just see what would happen.

RealMe
(OzLand)

 

Re: the 50-minute hour... annierose

Posted by RealMe on September 8, 2007, at 23:19:33

In reply to Re: the 50-minute hour..., posted by annierose on September 8, 2007, at 23:09:31

Could it be in the big city areas that they have gone to 45 minutes. I don't know. I am in the Chicago area and both persons I have seen have 45 minutes appointments.

On the other hand, the ECT doc I saw, when I went back to see him to talk about what was happening with me since the ECT, I was scheduled for a 50-60 hour appointment (per the University scheduling), and we ended up one time chatting away for two hours. This was not therapy, though. I had actually thought of going to him for therapy when I decided to leave my last therapist. But he said no to me. He said he views me as a colleague too much to be able to work with me in therapy. But, I am better off with who I have anyway even if I only get 45 minutes.

At Menninger's sessions were 50 minutes, but since I had not seen anyone for 10 years when I went back to see my last T, I had no idea that things had changed to 45 minutes. I don't like it, though.

RealMe
(OzLand)

 

Re: the 50-minute hour...

Posted by annierose on September 8, 2007, at 23:23:03

In reply to Re: the 50-minute hour... twinleaf, posted by RealMe on September 8, 2007, at 23:12:15

I can usually feel when the 45 minutes are up and I always freeze internally when 40 minutes near (as I can't see a clock but gage it internally). She'll usually say, "Our time is up for today" or "that's all we have time for today". If it's Friday or before a holiday or a vacation, or knows about a special event occuring, she always will wish me well, etc.

She keeps pretty strict time limits. I appreciate them since it keeps her on-time for me as well. But I do LOVE it when we run over even a minute or two or even three. It's not often though.

 

Re: the 50-minute hour...

Posted by Honore on September 8, 2007, at 23:41:29

In reply to Re: the 50-minute hour... annierose, posted by RealMe on September 8, 2007, at 23:19:33

My appointments are 45 minutes, which is standard. My T is exact about time, but tells me when there are about 15 and about 5 minutes left, and then sort of ends things slowly, and walks me to the door, where we usually talk for a second. He would freak if the appointments didn't end at exactly the right time. I can't imagine what he would do if I wouldn't go-- I mean now he would just get mad-- but earlier, if I really didn't want to go.

But he always makes the point that the person waiting has the right to their whole time-- which isn't related to what he feels, but to being fair. I kind of like that, because I'd have felt guilty if it weren't fair-- and worried about what he did with others--even when it was much harder. It's much better that he does it since I couldn't-- nor would I feel in control, even if I stayed a few minutes more, so at least I don't have to try to force myself to do something that's too hard. Probably it would be better if I could, but I can't.

It's so interesting how we feel about the end, though.

Honore

 

Re: the 50-minute hour...

Posted by RealMe on September 8, 2007, at 23:51:31

In reply to Re: the 50-minute hour..., posted by Honore on September 8, 2007, at 23:41:29

What is weird is that my T does not say anything typically. I can tell our time is almost up by the way he sort of doesn't encourage me to go deeper into something. And when our time is up, he sits forward and then slowly gets up. He doesn't say anything except as we walk to the door, he will often say, "Take care; see you on Wednesday." And off I go.

RealMe
(Ozland)

 

Re: How long are your sessions? 90-120 mins. (nm)

Posted by zenhussy on September 8, 2007, at 23:54:13

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

 

Re: How long are your sessions? 90-120 mins. zenhussy

Posted by twinleaf on September 8, 2007, at 23:59:06

In reply to Re: How long are your sessions? 90-120 mins. (nm), posted by zenhussy on September 8, 2007, at 23:54:13

Gosh! One and a half to two hours every time? Is that standard for your T.? Does it work well?

 

Re: the 50-minute hour...

Posted by Dinah on September 9, 2007, at 0:08:55

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

We're supposed to be fifty minutes. But as I've long complained, he often starts later than he finishes.

I generally try to control the ending (big surprise). I used to watch the clock, but now I can generally sense where we are timewise in a session. I have my own internal map of where we should be. Ten minutes left? Winding down, calming down. Twenty minutes in? Good time to start an important topic.

And of course the pretherapy warmup. I either focus on my favorite dog's face imprinted on the inside of my eyelids, since she was obligingly black and white with a distinct face marking, or listen to my therapy playlist on my iPod. I relax, open myself up.

As I walk into the room, I try to sense his mood. Once he told me I looked like a puppy when I did that. He was probably right. Head tilt, practically scenting the air.

So twenty minutes catching up on the time since the last session, settling in, winding my way through afterthoughts from last session, etc., then twenty minutes of the meat of the session, then a ten minute cooldown.

I ought to set it to music.

If I don't, for whatever reason, bend down to my purse to take out his check and hand it to him, he picks up his sheet and signs his name. Like a well trained puppy that will usually prompt me to hand him my check. If he's shorting me on time and I care, I cross my arms and glare at him, he gets back to listening mode, sometimes with a statement that he wasn't indicating that the session was over, and we sit mostly in silence till I hand him the check.

If I try to hand him the check while I'm upset or angry, and he thinks I'm trying to control the outcome of the session rather than just the timing of the end, he'll just continue talking and ignore my outstretched hand. I'll wave the check a few times and he'll either taking it, admitting defeat, or refuse to notice it, at which point I generally admit defeat after having my hand hang there for a minute or so, and lower my check holding hand to my lap. Sometimes I'll beg him to end the session. In any case, he'll finish what he considers needs to be finished before I leave.

He does it well, and I don't think we've run over more than a handful of times in the thousand? or so times I've seen him.

We set the times for the next week as I hand him the check on Tuesday. I ask him if there's anything he needs to tell me at the beginning of each session (about future absences, etc.), and if I forget and he does have something to tell me, I guess he's well enough trained now that he tells me as I hand him the check. I often share a followup thought or small joke at this time. He rarely responds, and if he does, then briefly. My way of holding on? Sometimes I ask him if everything will be ok at the end of a session, and he says with great conviction that it will. He always tells me as he opens the door to call him if I need him. Sometimes he holds the door shut to make sure I know he really means it, if he thinks I'm in a fragile state of mind. If he forgets, I'll turn around and knock on his door or stop him as he goes down the hall and smile expectantly. He'll laugh and say it.

Have I ever said I think I tend to get into a rut?

 

been almost 5 yrs-it's huge reason it *is* working twinleaf

Posted by zenhussy on September 9, 2007, at 0:09:40

In reply to Re: How long are your sessions? 90-120 mins. zenhussy, posted by twinleaf on September 8, 2007, at 23:59:06

dunno about other clients. for us this is workable schedule 2x/wk. it took us (therapist and self) a while to find workable times, lengths of time and days. much trial and error...much error!
thank goodness therapist hung in there/is hanging in there...tenacious bugger!

 

Re: been almost 5 yrs-it's huge reason it *is* working zenhussy

Posted by twinleaf on September 9, 2007, at 0:35:23

In reply to been almost 5 yrs-it's huge reason it *is* working twinleaf, posted by zenhussy on September 9, 2007, at 0:09:40

That's just wonderful. I can believe it, as you've got so much time to really work together, without thinking about beginnings and endings.

 

it's all about beginnings and endings! ack!! ; ) twinleaf

Posted by zenhussy on September 9, 2007, at 0:59:09

In reply to Re: been almost 5 yrs-it's huge reason it *is* working zenhussy, posted by twinleaf on September 9, 2007, at 0:35:23

there have been large gaps of no therapy due to circumstances. some therapy related posts by this poster on this site discussing some gaps.

for the really broken, the severly damaged and the super fscked up it has taken this long for that to sink in. there is no comparison in trauma depsite obvious differences.

recent (and oft repeated) dialogue from sessions--
zh-like are you sure? like really sure?
T-yes. you endured huge losses and major trauma enough to create the survival functioning you've been living until now.
zh-but what about____? (insert most horrible traumas you can think of here)
T-yes, other endure awful things. doesn't make what you experienced any less awful, any less damaging.
zh-are you sure?

can you see why it has taken a long time to even get here? the fifty minute hour or fifty five minute hour was only scratching the surface for our particular needs.

making the time and fully using that time is full time work. ups and down. lots of doubts. lots.

it was scary going to longer sessions despite knowing it was going to make the difference.

 

Re: the 50-minute hour...

Posted by Wittgenstein on September 9, 2007, at 5:28:03

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

I have 45 minute sessions although they sometimes go over to 50 minutes - only once to 55 minutes. It's interesting, sometimes that time flies by and before I know it he's saying "It's time. Until next time..." and wishes me a good week or weekend - times like that I wish the session were a little longer. Other times, time goes slow and then I'm glad the sessions aren't longer.

I hate it when I'm sort of in the middle of something when the session ends - you lose your flow and it's hard to 'hold on' until the next time. It's also weird when I leave as he opens the door from the therapy room to his hallway, shakes my hand and then mostly closes the door behind me, leaving me in his hallway (his practice is in his home), so I put on my coat and make my own way out. I kind of wish he would stay with me until I actually left his house - I know it's stupid but it makes me feel a bit like he doesn't want to see me for any longer than he has to. I never see his other patients/clients - he doesn't have clients back-to-back.

Zen, I think it's great how flexible your T has been. I know mine sees one client for 90 minute sessions but that is because she has a long way to travel and only comes once in two weeks.

 

Re: the 50-minute hour... Wittgenstein

Posted by twinleaf on September 9, 2007, at 9:12:49

In reply to Re: the 50-minute hour..., posted by Wittgenstein on September 9, 2007, at 5:28:03

I interviewed two T's who had offices in their homes before settling on the one I have now. They both did the same thing that you describe- ended the sesson at the door of their offices, Then I was on my own, going down hallways, opening and closing more doors, etc. But if they had come all the way to the door to the outside with me, there probably would have been a sort of dual relationship involving small talk,etc., so I think they all do the right thing. There are times when it feels lonely, but perhaps it would anyway, afterwards.

So now I get to go in an underground parking lot which is always perilously close to being full, take an elevator, and then have to deal with a complex lock system to my T's office, involving pressing one of 19 buttons, turning a lever just afterwards, and then opening the door with the door-handle. You have to do this exactly right, with the proper timing, When I first came, I was so anxious that I never did it right, and had to wait until someone came out in order to get in. But the T. I see inside makes it all worth it- and I HAVE learned to open the door!

 

Re: the 50-minute hour... twinleaf

Posted by Poet on September 9, 2007, at 12:10:21

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

Hi Twinleaf,

My sessions are usually an hour, sometimes a little more if she doesn't have another client waiting. I know she goes an hour with other client's, too, not just me.

Poet

 

Re: the 50-minute hour...

Posted by LadyBug on September 9, 2007, at 13:34:17

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

I'm lucky, my 45-50 min sessions go for an hour, longer if I'm ever in distress but that's rare that we go over an hour. She won't let me leave if I'm struggling with something. I can't quite figure out if she gives other people and hour or not because sometimes she calls and leaves me a message on my phone on the hour or shortly after. I'll have to ask her about it. I'm glad I get an hour, I always hate leaving no matter what.
LadyBug

 

Re: the 50-minute hour...

Posted by Dinah on September 9, 2007, at 13:50:47

In reply to Re: the 50-minute hour..., posted by Dinah on September 9, 2007, at 0:08:55

Nope. Only 869.

 

Re: the 50-minute hour...

Posted by Dinah on September 9, 2007, at 13:52:16

In reply to Re: the 50-minute hour..., posted by Dinah on September 9, 2007, at 13:50:47

I wonder if we should throw a party to watch $100,000 go by?

 

Re: it's all about - trigger zenhussy

Posted by DAisym on September 9, 2007, at 14:40:06

In reply to it's all about beginnings and endings! ack!! ; ) twinleaf, posted by zenhussy on September 9, 2007, at 0:59:09

Gosh Zen, I thought I was the only one who did this.

me: I'm not sure what happened to me was bad enough to feel this bad and have all this therapy.

him: What happened to you was bad. Very bad. The damage is very deep.

me: (wincing at being damaged) - but other people have had really, really horrible things happen. (I think list all the refugee, torture stuff I can think of.)

him: And you didn't suffer, think you were going to die, wish you were dead and are still suffering?

me: Ok - fine. Maybe. really? (but don't tell anyone)

 

Re: the 50-minute hour... twinleaf

Posted by sunnydays on September 10, 2007, at 8:43:20

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

My sessions are usually 50 minutes to an hour. My T gives me the full hour whenever he can, and rarely we go over an hour. I do what annierose was saying - I can usually gauge what time it is without looking at the clock and sometimes I get incredibly sad that it's time to leave. But my other T gave me anywhere from 35-50 minutes. It wasn't a question of starting late - I honestly think I bored him or something. He was very rigid about how he ended - he just picked up his appointment book and asked when we would schedule for next. Being his last appointment of the day probably didn't help that.

sunnydays

 

50-minute hour...and yuk 'leaving', and GUILT

Posted by muffled on September 10, 2007, at 11:59:28

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

Officially its 50 mins.
We have gone over sometimes.
Sometimes I just have had enuf, I just have no more to give, I am zombie, completely shut down. So then I leave. So sometimes its shorter, dunno how shorter, but time wasn't up i'm sure of that.
Yeah, the LEAVING feels SO awkward. I just kinda grab up my stuff pay and bolt, book next appt over phone later.
Sometime when I leave I feel like SUCH a mutant freak.
Sometimes its worse than that :-(
Sometimes I feel really good.
T TRIES to have me leave in 'right' frame of mind, but I just bolt, so what can she do?
No wonder she afraid to push me...:-(
And I think LOTS of us feel we shouldn't be in T, or STILL be in T, cuz we got no good enuf reason.That we should be spending money on kids or whatever....its hard. The guilt.
T is apparently a neccessary evil or something.
M

 

57 minutes!!!

Posted by LlurpsieNoodle on September 11, 2007, at 20:57:18

In reply to 50-minute hour...and yuk 'leaving', and GUILT, posted by muffled on September 10, 2007, at 11:59:28

I got a 57 minute hour yesterday. I kept on trying to "wrap things up" and he kept on asking me questions, so I kept on going. I think I was his last client of the day or something?

:)


:)


-Ll

 

Re: 57 minutes!!! LlurpsieNoodle

Posted by twinleaf on September 12, 2007, at 9:30:43

In reply to 57 minutes!!!, posted by LlurpsieNoodle on September 11, 2007, at 20:57:18

Well. ll, you are right at the top in the length sweepstakes, with senhussy's wonderful arrangement being in a class of its own. I think it's amazing how more time so strongly equals more caring to us all. I go first thing in the morning, and have begun to notice that my T. often brings me in to his office several minutes early, So, I.m running about 53-4 minutes a lot of the time All of this makes me feel that he really cares about his patients- me included. I have to aadmit that I haven't gotten into the most shameful or terrifying aspects of my childhood, yet, but I feel that I need to build up my trust and confidence in him, so that when I do discuss these things, they will not be recitationns of facts, but rather a real re-living of the feelings they evoked. I think that time is coming up soon. Yikes!

 

Re: the 50-minute hour... twinleaf

Posted by JoniS on September 12, 2007, at 15:56:38

In reply to the 50-minute hour..., posted by twinleaf on September 8, 2007, at 22:17:26

My sessions are typically 55-60 minutes. I think he's OK with them being anywhere from 45-60 minutes. He has gone over some with me when we were really in deep or I was upset.

This is interesting. As someone said above, I think, it is funny how so many of us relate the time of the session or if they go over the normal time, that is an indication of how much they care.

My T usually ends by picking up his appointment planner to set the next appointment. I am usually aware of the time. I check the clock a lot - because I have to prepare myself for the "rejection". which of course, I know it isn;t rejection.

My t is free to everyone he sees so we don'[t have that 'check' issue.

But I never have a set sechedule hour/day of the week, we just set it at the end of the sesson. He asks "do you want to come next week?" and lately my response is YES or of course. There have been times in the past when I was OK with waiting 2 weeks or so, but for some reason, it's harder now.

great post twinleaf!

 

Re: the 50-minute hour...or 40min half hour

Posted by cactus on September 16, 2007, at 0:25:24

In reply to Re: the 50-minute hour... twinleaf, posted by JoniS on September 12, 2007, at 15:56:38

I got a 40mins instead of 30 with my pdoc the other day. MOST not all, aussie pdoc are T's as well and don't write scripts and throw you out the door. They do loads of therapy and psychiatry together. I'm down to half hour sessions. That was a good bang for my buck. I think one of his patients had canceled so I went into extra time free of charge.
But I was getting the 50min hour just like everyone else before I went down to half hour sessions.

 

Re: I just got another one!!!!!! (nm)

Posted by cactus on September 19, 2007, at 21:33:05

In reply to Re: the 50-minute hour...or 40min half hour, posted by cactus on September 16, 2007, at 0:25:24


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