Therapy has become almost commonplace in the modern era, at least throughout the developed world. As therapy has become run-of-the-mill, the one-hour-per-week therapy session has become standard along with it. Given the dominance of the one-hour weekly session, it is somewhat surprising that there is so little in the way of actual scientific basis for this standard. Money is inevitably a factor, and in a country like the United States where payment usually comes through insurance companies, it is important that services provided are easily billable. The vast majority of insurance companies will only cover therapy sessions lasting 30, 45 or 60 minutes; as a result, most psychotherapists will limit their sessions to one of these times so that they do not run the risk of going unpaid for their services.
A Lack of Research Leaves Therapists in the Dark
This may seem self-serving on the part of both insurance companies and psychotherapists, but the truth is that they are operating without much hard data. There is little evidence that one hour per week is the ideal unit of therapy for most people, but there is equally little evidence that it is not. Unfortunately, psychotherapy does not attract nearly the same amount of scientific research as chemical treatment for mental health issues. While clinical trials do their best to establish exactly the right dose of a drug over a certain amount of time in order to achieve optimal results, psychotherapy does not garner the same kind of attention or anywhere close to the same amount of money for research.
Too Little Time, or Too Much?
The optimal length of individual therapy sessions is not the only mystery when it comes to the time that patients and psychotherapists allot for treatment. There are also many questions about how long patients can expect to be in therapy before achieving results. For many people, therapy becomes a process of months or even years, and some people seem willing to commit such time (and money) even when they have little to show for it. A 2001 study in the Journal of Counseling Psychology showed that patients in psychotherapy made the most progress between their 7th and 10th sessions. Despite this, most people remain in therapy for much longer—often well beyond the point at which they stopped making forward progress. And when people fail to make any progress through psychotherapy, they often wait much more than 7 to 10 weeks before deciding that the process is not right or that their therapist is not a good fit.
The Myth of the Passive Therapist
In a 2012 opinion piece for the New York Times, psychotherapist Jonathon Alpert rejects the classic image of the passive therapist who does little more than listen while the patients work out their problems for themselves. He cites a study from the National Institute for Health and Welfare in Finland, which found that extroverted and active therapists achieved better results than therapists who mostly stayed quiet and did not offer active solutions. Alpert goes on to say that the highly-engaged approach will not be ideal for everyone, but that research and his own personal experience suggests that it, rather than passive therapy, should be the default approach. He argues that part of the reason many people remain in therapy for such extended periods without achieving major results is that they have established a relationship with their therapist in which their sessions are little more than loosely guided self-therapy.
Making Therapy Work for You
Psychotherapy has been and will continue to be a helpful tool for many people. But existing research—and a lack of certain research—suggests that more people will benefit from it if they question some of the accepted standards of the industry. Recognizing that open-ended therapy with a counselor who sits silently taking notes for one hour per week is not the only method that may help more people get their money’s worth out of psychotherapy.