As I mentioned in the my last post, to facilitate good work together, it is important to work within a consistent framework. At the most basic level, this starts with the decision to work together and the setting of a weekly appointment time, but I’d like get into some of the nuts and bolts of what this generally looks like.
We will meet for 45-50 minutes each session. This means that 45 minutes from the start of our appointment time, I will let you know it is time to wrap up. We may stop there or spend a few more minutes wrapping up within the 50 minutes. This also allows for natural fluctuations of a minute or two. You may have heard of the “50 minute hour”, which allows therapists to maintain an hourly schedule, with time for notes, a stretch, a bathroom break, and, most importantly, to make their next cup of tea before the next appointment. The principle that is most important, however, is that we have a predictable and consistent beginning and end to sessions. Sometimes this will be an immense comfort, sometimes it will be really frustrating - but no matter what, it will be consistent. I encourage you to bring up how you feel about the time boundaries of the session, we never know when that might open up new opportunities for understanding.
Scheduled sessions are assumed to be in-person, unless otherwise prearranged due to travel or some other extenuating circumstance*. I believe that in-depth, exploratory therapy is more effective when taking place in-person, or when we are “co-present.” So, if you are running behind or slept too late, for example, will will either meet for the portion you can be present for or it will be considered a missed appointment. I know that sometimes life happens, and if the schedule permits, may allow us to reschedule an infrequent late cancellation. However, consistent with my therapeutic approach, we may explore the meanings of missed appointments, especially if there are potential patterns developing. This ties to a bigger idea that the changes in the framework of the therapy can carry important information about your ways of living, relating, and feeling. If I do not hold these boundaries or fail to be curious about alterations to them, I believe I can do a disservice to the work we are engaged in together.
This all goes both ways, of course. It is my job to be at my office for our appointments and to be on time. If I am running late for any reason that does not allow us 45 minutes together, I will provide you the missed time. And if I ever “no-show” on you, I will not charge you for that time (and I am sure we will explore the meanings of that experience for you in our next time together). Thankfully, while “life happens” for therapists too, these occurrences are few and far between, if at all.
*I wrote the original draft of this article before COVID-19 hit us. I’ve kept the wording the same above, because in “normal” times, I stand by this value. However, during the COVID-19 emergency, we have been required at times to continue to work from a technologically mediated therapy, through either phone or video. For some, this has been minimally disruptive to our work, and even opened up new possibilities. For others, it has felt very limiting and changes the nature of our work together. For my policies and recommendations regarding remote therapy during the pandemic, see my COVID updates.