November 04, 2013 at 1:40 PM
Why is therapy for an hour per week? Probably because:
- You can fit it into a weekly routine.
- Each session’s work can interact with the client’s life for incremental benefit.
- This is what the insurance companies will pay for.
The fact that a convention exists for good reasons does not mean that it’s still the best way to do it today. The custom of the weekly therapy hour should be reconsidered in light of recent developments in the field, namely (a) the growing recognition that trauma, broadly defined, is a primary contributor to most presenting problems (Fairbank, Putnam, & Harris, 2007; van der Kolk, 2007); and (b) the development of ever more efficient, effective, and well tolerated trauma resolution methods such as EMDR and PC.
For the first time in history, a trauma-savvy therapist can realistically expect to do transformational healing work with most of his or her clients, within a far smaller number of treatment hours than would be expected either with traditional talk therapy or a symptom management approach. The transformation/healing occurs due to memory reconsolidation via trauma resolution, which does not require spreading therapy out over months or years.
In other fields we would not put up with the provider declining to achieve the results as promptly as practicable. For example, can you imagine a tailor telling you, “I know this is your only suit and you need to wear it every day to work. I’ll make one adjustment to the suit each week, and in a couple of months it should fit pretty well.” Or how about an auto mechanic saying, “Your tires are so worn they’re unsafe. So I’ll change one of them per week until you have a new set of tires.” Crazy, right?
As an example of an alternative to the weekly therapy hour, we offer a Private Intensive Therapy Retreat service. In a Therapy Retreat, you typically travel to the therapist’s location, stay for several days, and get a big chunk of work done. Whether in a therapy retreat or some other format, doing a lot of therapy within a brief period offers these benefits:
- Achieving resolution of a given memory in the same session as the memory was initially activated reduces the destabilization risk associated with “opening up” a trauma memory.
- Getting through treatment quickly reduces the risk of the treatment being disrupted by crises or other life events.
- Intensive treatment is more efficient because of time not spent on session beginnings and endings. So with longer sessions, you get more progress per treatment hour.
- Doing it all at once gets it done, instead of dragging on and on with the problem. Why lose more months or years before getting better?
I’ve been providing these retreats for several years and it has become my preferred treatment format, because so much gets done so quickly. Even with local clients, I tend to work in multi-hour sessions, for the same reasons.
Despite the value of the intensive treatment approach, there is still a role for the weekly therapy hour. With certain clients – though fewer than you might imagine – it can take some time to build the stability, coping skills, and trust to allow for the trauma work to be productive. And when the client is working on developing coping skills for specific challenging situations, it may be preferable to spend a traditional-hour session focusing on a single skill, having the client practice that for a few days, come back and talk about it, and then take the next small step. Similarly, working on parenting strategies or relationship issues is often best done incrementally. So the therapy hour cannot be totally discarded – it just shouldn’t be the only option. And it probably should not be the default treatment format.
I understand that change is disruptive. Adopting this intensive treatment approach would wreak havoc on many therapist’s schedules as currently arranged. And it may take some time for the insurance companies to catch up. But psychotherapy practice should reflect what is best for the client. And admit it: doesn’t this make sense? Why not get better faster, and more efficiently?
Fairbank, J. A., Putnam, J. A., & Harris, W. W. (2007). The prevalence and impact of child traumatic stress. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice, pp. 229-251. New York: Guilford Press.
van der Kolk, B. (2007). The developmental impact of childhood trauma. In L. J. Kirmayer, R. Lemelson, & M. Barad (Eds.), Understanding trauma: Integrating biological, clinical, and cultural perspectives, pp. 224-241. New York: Cambridge University Press.