Clients soon discover that when therapy starts to get at their emotional issues, it’s no walk in the park. When it reaches this level of intensity, therapy becomes an even more powerful opportunity to make decisions and changes that can transform your life. I encourage you to make your best efforts to help your therapy succeed, including following through on your therapist’s recommendations even if this takes substantial effort.
One of the most difficult tasks for any client is facing the truth about addictions, self-destructive habits or impulsive actions that shut down uncomfortable feelings. Ask your therapist for help in overcoming such issues. The solution may include referrals to a medical doctor, specialist or clinic. If you don’t address these very difficult issues, they’ll continue to block your path to happiness and success — or worse.
Understanding the Psychotherapy Framework
“For psychotherapy to be effective, a close rapport is needed …. The rapport consists … in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found.” Carl Jung. 
The following discussion of the psychotherapy framework is intended to help you understand some of the “rules of the game,” why they’ve been established, and their role in making therapy effective. Although there are many approaches to psychotherapy, some elements are found in most approaches. These elements include:
- A standard session length
- Frequent sessions held at the same time(s) each week
- Typical roles and tasks of therapist and client(s)
- Disruptions of the framework that can lead to breakthroughs
- Activation of childlike responses
- Stages of therapy
- Types of questions and comments presented by the therapist
- Adherence to legal and ethical standards
People often wonder why the typical “therapy hour” is 45 to 50 minutes. Group therapy sessions usually last longer and brief therapy interventions may take much less time. One answer that’s funny and probably true is that psychotherapy pioneer Sigmund Freud couldn’t last more than 50 minutes before visiting the bathroom!  There are other useful reasons for this session length:
- Therapy can be emotionally intense and someone may learn many things in session. More time in session can be difficult to absorb mentally and emotionally.
- Psychotherapists spend time outside of session thinking about the client(s), completing required notes and doing treatment planning. The minimum needed is 5-10 minutes, so the standard session time allows for scheduling of sessions on the hour. In some situations a therapist may offer longer sessions. For instance, a couple in therapy may find themselves just getting into a long-needed conversation. Added time may help them maintain the momentum.
- A standard session time helps the therapist pace the session for the client, for instance, giving them time to pull themselves together before going back to work. This predictable session length helps establish an expected emotional rhythm to even intense sessions. It instills a sense of emotional safety and teaches the client that he or she can choose to open up difficult feelings and then contain them.
- Standard starting and stopping times and session length provide a way for client and therapist to notice if emotional reactions or issues are expressed in lateness or attempts to stay beyond the end of the session. Exploring such attempts to go “outside the therapy frame” often gives the client powerful and unexpected insights.
- Often clients bring up significant issues at the very end of the session. This can occur for many reasons. Sometimes it’s because the issue is uncomfortable to talk about, but as the end of the session approaches, the client realizes it’s something she or he really wants to bring up. This happens so often, there’s even a name for it — “doorknob therapy”! 
Seeman, G. (2009). Getting the Most Out of Psychotherapy. Psych Central. Retrieved on May 19, 2013, from http://psychcentral.com/lib/2009/getting-the-most-out-of-psychotherapy/
Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
Published on PsychCentral.com. All rights reserved.