Psychotherapy is a pretty well-understood treatment method used to help people with serious concerns like depression and bipolar disorder, to life adjustment issues like the loss of a significant relationship or one’s job. Therapists and psychologists spend years in classes and training, and generally see patients in modern psychotherapy for one 50-minute session per week.
You know from the outset that a therapist relationship is a professional relationship, and the therapist is running a business. Most therapists, to one degree or another, try to distance themselves from the business aspect of their practice as much as possible. More well-to-do therapists and those who work in a clinic or group practice may even hand off billing and paperwork issues over to a receptionist or secretary. The purpose for this distancing is two-fold — most therapists make horrible business people (and many have trouble even asking for payment due) and many therapists have an uneasy discomfort with the business side of their profession. Business is not the reason most therapists go into the profession and although they want to make a living, they often have a difficult time acknowledging the business component of the professional relationship.
The professional nature of the relationship is set immediately when you get your first orientation with your new therapist. You don’t get an hour with the therapist or psychologist, as you may have been led to believe. Instead you get 50 minutes — what therapists refer to as the “50 minute hour.” Why 50 minutes? Because, the party line goes, the extra 10 minutes gives the therapist time to write up a progress note, deal with any billing issues, take a short bathroom break, and get ready for their next client.
But this whole arrangement is based upon a false assumption — that therapists need every precious minute of their 480 minute work day, because they see (or expect to see) 8 patients every day (or 40 a week). I don’t know of a therapist who sees 40 patients a week, which would be a heavy burden for most therapists. Therapy is an emotionally draining experience not only for the client, but also for the psychotherapist.
Therapists and psychologists could just as well see patients for 60 minutes (you know, an actual full hour), but then they put themselves at greater financial risk. If you schedule 35 patients a week, that means 3 or 4 of them will be no-shows or cancellations every week (for one reason or another). Therapists, therefore, tend to over-schedule a little bit, to try and take into account this rate. This arrangement ensures the professional sees a full weeks’ worth of patients without too much down-time (time for which they’re not getting paid). It’s smart time management, and it’s a careful balancing act that most therapists have learned to juggle fairly well.
I think all of this is well and fine. This is just the way modern psychotherapy works in the U.S., where most therapy is reimbursed by insurance companies and our government Medicaid program, all of which dictate pricing and time standards. But a professional can take this need to manage their time a little too far…
The other day I learned of a practice that made my stomach turn.
A therapist uses an actual kitchen timer to denote their “50 minute hour.” You know, the kind that goes “tick tick tick” and then dings when the time you’ve set is up. Set it and forget it! Fifty minutes later, Ding! Time’s up!
The person could be in mid-sentence, relating a horribly traumatic experience of not being heard or listened to by their parents while growing up.
Ding!
Sorry, you’re not going to be heard here either.
The person could be sharing a tender moment of insight of why they feel so reluctant to put themselves out there in a new relationship, for fear of rejection, and…
Ding!
Sorry, your therapist is rejecting your right to some basic dignity.
The person might be wrapping things up and saying, “Hey, I really appreciate your time and not cutting me off like my ex-husband used to–”
Ding!
Sorry, the therapist can cut you off just like anyone else.
I get the need to keep on schedule and help clients keep to the therapist’s schedule (because, after all, it is the therapist’s business), but this is just plain obnoxious.
Worse yet, this sort of behavior reinforces the power differential in the relationship and basically says to the client, “While the time you spend here is valuable, your human dignity is not.”
Most ordinary therapists and psychologists deal with scheduling by simply being aware of the time. Not by clock watching, mind you, but simply sensing when the time is coming to a close. Sure, it may help to glance at a clock every now and again, but most therapists learn this skill as second-nature over time. Some therapists may set their phone or PDA to vibrate to remind them. Others put clocks in strategic places in their office so both client and professional is aware of the time. But such mechanisms are subtle, tactful, and perhaps most importantly, respectful. They don’t denigrate the patient’s experience and humanity with a “Ding! Time’s up!”
Because people are human beings, meant to be treated with dignity and respect. Especially by their therapist.
We’re not turkeys. Well, not most of us anyway.