The 45-minute therapy session is a standard practice in psychotherapy, but have you ever wondered why this specific duration has become the norm? This seemingly arbitrary time frame is rooted in a combination of historical models, practical necessities, and psychological principles. Understanding the rationale behind the 45-minute session can provide valuable insights into the therapeutic process, benefiting both therapists and clients.

This blog explores the origins of the 45-minute session, the cognitive and emotional reasons for its effectiveness, and the potential challenges of extending beyond this time frame. By examining evidence-based theories and research, we will understand why this duration is optimal for fostering meaningful therapeutic progress.

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Historical Background and Cognitive and Emotional Basis

1. The Historical Origins of the 45-Minute Session

The origin of 45-minute therapy sessions can be traced back to the early days of psychoanalysis. Sigmund Freud, a pioneering figure in psychotherapy, initially established a standard session length of approximately 45 to 50 minutes. Over time, this practice has been adjusted, leading to the current norm of 45 minutes per session (Wolberg, 1977).

2. Practical Considerations: Balancing Client and Therapist Needs

As psychotherapy became more widespread, therapists needed to accommodate multiple clients within a working day. The 45-minute session allows therapists to schedule sessions on the hour, leaving them with a 15-minute buffer. This extra time is perfect for jotting down notes, reflecting on what happened during the session, catching up on paperwork, and even taking a quick breather before the next client.

3. The Importance of Breaks: Preventing Therapist Burnout

This buffer period helps therapists uphold a high level of care while avoiding burnout (Freedheim, 1992; Felix & Sage Psychology, 2024). Research backs this adjustment, showing that the 15-minute break is crucial for sustaining both therapist well-being and quality client care. By reducing the strain of continuous work, this brief pause is essential in managing the emotional demands of therapy (Norcross & Guy, 2007).

4. Cognitive and Emotional Rationale: Attention Spans and Mental Fatigue

The 45-minute duration is not only practical but also aligns with our understanding of human attention spans and cognitive functioning. Research suggests that the average adult’s attention span ranges from a few seconds to 20 minutes, after which focus begins to reduce (Wilson & Korn, 2007). A 45-minute session creates a good balance, allowing enough time to explore the client’s issues and concerns, without creating a mental or emotional exhaustion for both the client as well as the therapist.

This also aligns with the cognitive load theory, which suggests that frequent shorter breaks can enhance productivity and prevent mental fatigue (Sweller et al., 2011).

How should clients and therapists utilize the 45 min session most optimally?

To make the most of a 45-minute therapy session, both clients and therapists can follow the 20/20/5 rule

1. First 20 Minutes: Checking In and Setting the Agenda

Start by catching up on any updates since the last session, checking in with how the client is feeling, and setting the agenda for the current session. This time helps establish the context for the issues that will be discussed.

2. Next 20 Minutes: Collaborative Problem Solving

Use the middle portion of the session for focused, collaborative problem-solving. This is where the therapist and client can work together to address the key issues, explore emotions, and develop strategies for coping or change.

3. Final 5 Minutes: Winding Down and Summarizing

The last few minutes are crucial for winding down. This time can be used to discuss any to-do’s, review key takeaways, and summarize what was covered in the session. This ensures that both the therapist and client leave the session with a clear understanding of what was accomplished and what comes next.

By following this structure, both clients and therapists can maximize the effectiveness of each session, ensuring that the time is used efficiently and meaningfully.

45mins vs 60 mins?

According to Muran & Barber, 2010, shorter and more frequent therapy sessions can often be more beneficial than longer, widespread ones. Maintaining a consistent schedule, along with short (i.e. 45-minute sessions) helps build a stronger therapeutic relationship and fosters better engagement, which leads to more effective overall therapy.

Additionally, emotional processing requires balancing depth and avoiding overburdening the client. A 45-minute session offers a structured period where clients can delve into their feelings, get feedback, and work on therapeutic tasks without feeling rushed. This helps avoid emotional fatigue, which is possible if sessions drag on for too long (Duncan, et al., 2010).

Practical Challenges of Extending Sessions

“But a longer session ‘feels’ like it would hold more space for emotional disturbances and crises!”

On the surface, it might seem beneficial and even tempting to extend therapy sessions beyond 45 minutes. However, as mentioned earlier, this can lead to several challenges.

Here are the reasons why

Therapists often have multiple clients scheduled throughout the day. Extending sessions would disrupt this schedule, reducing the number of clients a therapist can see and potentially increasing wait times for appointments.
Therapists also typically charge by the session duration, and extending this duration would require adjustments in billing prices. Sometimes clients might not be willing or able to afford longer sessions, which could create financial barriers to accessing therapy (Norcross & Guy, 2007).
From a therapeutic point of view, longer sessions do not equate to better outcomes, but rather the opposite. The law of diminishing returns suggests that after a certain point, the benefits of additional time decrease (Muran & Barber, 2010).

It’s important to explore why there might be a perceived need to extend therapy sessions beyond the standard 45 minutes. Reflecting on this can help identify underlying issues that may be affecting the therapy process. Here are some key questions to consider:

1. Who Feels the Need for More Time?

Is it the client who feels they need more time, or is it the therapist? Understanding where the need is coming from can provide insight into what might be driving the request. Did this need arise suddenly, or has it been building over time?

2. How Is the Session Time Being Used?

Evaluate what the time in the session is spent doing. Are you noticing that the client is stuck on a particular issue or experiencing an impasse? Is the therapist doing most of the talking, leaving the client feeling unheard? This could indicate a need to rebalance the session dynamics.

3. Are the Goals and Agenda Clear?

If the session goals aren’t clearly defined, or there’s a lack of consensus on the session agenda, it might lead to inefficient use of time. This can create a sense that more time is needed when, in fact, the issue might be with how the time is structured.

4. Frequency of Sessions

Consider the frequency of sessions. If a significant portion of the session is spent catching up on events that occurred between sessions held two or three weeks apart, it could indicate that the irregularity of therapy sessions is contributing to an accumulation of issues. In such cases, it might be more beneficial to increase the frequency of sessions rather than extending their length.

By reflecting on these aspects, both the therapist and client can better understand whether extending the session time is truly necessary or if there are other adjustments that could be made to improve the effectiveness of the therapy within the standard 45-minute session.

Role of Multiple Sessions

The structure and process of therapy typically involves a series of sessions rather than relying on a single meeting. This ongoing approach is essential to the therapeutic process, allowing for gradual progress, reflection, and adaptation of strategies tailored to the client’s evolving needs (Lambert, 2013).

Research indicates that the cumulative effect of multiple sessions is key to achieving long-term therapeutic goals. Lambert (2013) highlights that the therapeutic alliance (ie. the trust and collaboration between a therapist and a client) grows stronger over time. As the client and therapist engage in multiple sessions, they develop deeper trust and understanding. This allows for a more thorough exploration of the client’s needs and also enhances the effectiveness of problem-solving.

Furthermore, having multiple sessions allows clients to gradually absorb and apply what they learn in therapy to their daily lives. Research suggests that regular therapy sessions also help therapists adjust their approach based on client feedback and progress. This helps the therapists understand what works and what doesn’t work for the client, and make changes accordingly (Duncan, et al., 2010).

To conclude, the 45-minute therapy session has become a standard practice for good reasons. Its historical roots in psychoanalysis, combined with practical scheduling needs and cognitive principles, make it an effective and efficient format. While longer sessions might seem more beneficial, they don’t necessarily predict better outcomes in therapy rather risk the opposite.

The structure of multiple 45-minute sessions allows for continuous involvement, and gradual progress, leading to the holistic benefit of the client.

References

Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (2010). The Heart and Soul of Change: Delivering What Works in Therapy. American Psychological Association.

Felix and Sage Psychology. (2024, May 28). The 50-Minute Therapy Hour Explained | Felix & Sage. Felix & Sage Psychology. https://www.felixandsage.com/2021/11/15/the-50-minute-hour/

Freedheim, D. K. (1992). History of Psychotherapy: A Century of Change. American Psychological Association.

Lambert, M. J. (2013). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. John Wiley & Sons.

Muran, J. C., & Barber, J. P. (Eds.). (2010). The Therapeutic Alliance: An Evidence-Based Guide to Practice. Guilford Press.

Norcross, J. C., & Guy, J. D. (2007). Leaving It at the Office: A Guide to Psychotherapist Self-Care. Guilford Press.

Sweller, J., Ayres, P., & Kalyuga, S. (2011). Cognitive Load Theory. Springer.

Wilson, K., & Korn, J. H. (2007). Attention during lectures: Beyond ten minutes. Teaching of Psychology, 34(2), 85-89.

Wolberg, L. R. (1977). The Technique of Psychotherapy (3rd ed.). Grune & Stratton.