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  1. #1

    45 minutes not long enough

    So, as I mentioned before in another post that was accidentally deleted (whoever responded I didn't get a chance to read it...sorry, I wish I had), I liked the therapist I went to (yea!). However, today was my second session and I was a bit underwhelmed by what happened (nothing happened). It feels like the 45 minutes goes by so fast that nothing gets accomplished. I started thinking that I don't see what can possibly happen in 45 minutes once a week that is going to be so important. I mean...45 minutes? I just don't know if this is worthwhile. On the other hand, I can see why people like medication now, because it is there all the time, where as the therapist is far more elusive.

    It's like, I feel slightly more down now than before (when I did not feel down at all) with no insights. It seems like if this is just a normal 45 minute conversation I could just have it with some person that is actually talking to me because they want to, not because I'm paying them.

    I don't know what to think about this. I thought it was going to be so good and interesting but now I just feel weird and let down.


    PS-I couldn't spell check this, it says "PSPELL couldn't open the dictionary. reason: No word lists can be found for the language "en". "

  2. #2

    Re: 45 minutes not long enough

    Toeless,

    It may seem like nothing was accomplished but rapport is developed during the sessions. It helps to develop a therapeutic alliance between you and your therapist. I have some clients that wished that they had more than 45 mins per session; however, you will find as time goes by that those 45 minutes will be full of therapy. 45 minutes can be the most worthwhile time you ever spend. One thing to consider is how medication provides a therapeutic window for you and your therapist to be to work through your experiences, thoughts and ect. I would bring your feelings up to your therapist so you can work through your feelings. Take care and best wishes,

  3. #3

    Re: 45 minutes not long enough

    I have noticed that 45 minutes seems to be the 'going rate' for therapy now. I just think that an hour would be a more appropriate chunk of time. I doubt I'll bring this up though since, as it is, I don't have enough time to bring up the actual things that are actually going on.

    I think perhaps that my expectations were too high and the more that I think about it, I think that it did have some value. I am very surprised though, that you say that some of your clients wish the sessiosn were longer. I would have thought that it is pretty universal to think that the sessions go by too fast.

    One thing I will say for that odd hypnotist social worker I saw, was that he was willing to spend a seemingly open ended amount of time with me. By the way, that social worker just sent me an insurance form to sign and mail directly to the insurance company and it had my diagnostic code on it! I looked it up in the DSM IV and he had me down as "adjustment disorder with mixed anxiety and depressed mood. I think that diagnosis is a bit off, I wonder, are LCSWs qualified to diagnose psychiatric conditions?

  4. #4

    Re: 45 minutes not long enough

    I have noticed that 45 minutes seems to be the 'going rate' for therapy now. I just think that an hour would be a more appropriate chunk of time.
    Up in this area, 45 minutes has become standard for psychiatrists, while most psychologists use a standard 1 hour session time.

    that social worker just sent me an insurance form to sign and mail directly to the insurance company and it had my diagnostic code on it! I looked it up in the DSM IV and he had me down as "adjustment disorder with mixed anxiety and depressed mood. I think that diagnosis is a bit off, I wonder, are LCSWs qualified to diagnose psychiatric conditions?
    Depends on the laws of your area. Up here they wouldn't be legally authorized to do that. On the other hand, it isn't unusual, depending on the circumstances and the nature of the insurance coverage, for professionals to be a little cautious in a diagnosis conveyed to an insurance company. The "adjustment disorder" one sounds milder on paper and covers a lot of ground, especially as a "working" or "provisional" diagnosis, since one can always upgrade it to say major depression or panic disorder or whatever later on should it become relevant.

  5. #5

    Re: 45 minutes not long enough

    Hi Toeless,

    Yes, LCSWs are qualified to diagnose in the US. They have a strong lobby in the US.

    Private pay clients can have longer sessions if they are wiling to pay for the longer period of time; however, those who have insurance or Medicaid are limited to the number of sessions. In the US we are hopeful that the Pariety Law passes as this will stop some of the practices of the insurance companies in being extremely limiting in the mental health services being provided. A few of my clients do not get more than 8 sessions per issue while others get up 25 per year. Medicaid offers only 45 hours per year. So the therapist has to make sure about the time.

    I think the sessions tend to go by fast. But then my weeks go by fast too...so it feels like I have just seen a client and then I am seeing them again. I do the progress notes in the 10 or 15 mins left between my sessions. I tend to have 8 to 10 sessions per day on Mondays thru Wednesdays while my Thursdays and Fridays are not as hefty.

    Please keep us posted Toeless. Look forward to hearing about your progress.

  6. #6

    Re: 45 minutes not long enough

    Hi Toeless,,

    In England we get 1 hour with NHS psychologists, and its limited now to 6-8 sessions, which in my view is not enough to work through problems, you can get it extented to 12 sessions but thats normally it, in the days before the system changed you could see a NHS psychologist for up to 2 hours every week or two, for up to a year!

  7. #7

    Re: 45 minutes not long enough

    Hi Toeless,

    Have you ever met someone and only had just a brief chat with them, and walked away with either good feelings about that person, think that maybe it would be someone whom you would like to know better? Or maybe not like to know better?

    I think, though not experienced in it, the 45 minutes would be good enough. They are trained not only to listen to you speak, but to your body language as well, I believe.

    I know that I personally can get a good deal about a person when they talk to me for just a few minutes, 45 would be a bouns to me when I want to know more about that person.

    You would be so surprsied at what they can pick up in even the first 5-10 minutes of chatting with you.

    All I can say, is give it a chance. Let it work.

    Look at Doc Baxter, he doesnt' even get to meet the person face to face, however, just through reading what people write he is an excellent person to chat with, and he always, at least for me, has give me good answers to things that I would not even have thought about.

    Good luck, and I wish you much progress, just be open and honest, that is the most important part of any process of talking out what is bothering you.

  8. #8

    Re: 45 minutes not long enough

    At Kaiser I was allowed 45 minutes for therapy sessions, and only 30 minutes for the meeting with the psychiatrist. I often felt as though things were just starting to "happen" in the last 5 minutes of the 45 minute session, so it was a little bit unfulfilling. On the other hand, it gave me something to think about before next time.

    I didn't mind the briefer meetings with the psychiatrist, though. And it will be interesting to see if sessions for either are longer now that I'm in a more rural area, where things are much less rushed. I think Kaiser in particular may have been under-staffed. The workers there always seemed terribly hurried, which might have accounted for the shorter sessions.

  9. #9

    Re: 45 minutes not long enough

    First, thanks to all for responding. I found every single post extremely interesting. I was under the impression (from books and things) that therapy used to be a standard hour here too. Now after reading all of this I'm thinking that insurance and rising medical costs are most likely what is responsible for this. It basically sounds to me like, in the US, that insurance usually pays for x amount of "hours". To be a "preferred provider" the therapist has to give the insurance a discounted rate. The therapist has to make a living and satisfy operating expenses (like malpractice insurance?), so then the actual therapy to the patient is whittled down to 45 minutes so there is time for paperwork (and maybe to offset the discounted rate?) and to fit more patients into the schedule.
    Maybe that is what happened(????)...just like the other aspects of the medcal system, where patient centered care is declining, you could see where therapy, a field that is totally client centered, would perhaps suffer greatly under this system.

    Stargazer, I have heard that exact same thing about Kaiser. It seems like highly managed care...aren't the insurance company and the medical care one in the same company? That seems like trouble in and of itself. There must be an extra lot of pressure on those doctors to be efficient and to not promote pricey treatments.

    I have Regence Blue Cross and it's really good in general, but I only get 36 visiits every two years. That is one of the reasons that I think I feel rushed in therapy. I already used three of them before I even found this one that I like. I can't believe in England you only get 6-8 sessions!! Then you would really be expecting something big to be happening right away. That must be a lot of pressure for the therapists.

    Look at Doc Baxter, he doesnt' even get to meet the person face to face, however, just through reading what people write he is an excellent person to chat with, and he always, at least for me, has give me good answers to things that I would not even have thought about.
    That is an excellent point. I agree. But it seems more natural here because he's here because he wants to be.
    They are trained not only to listen to you speak, but to your body language as well, I believe.
    I couldn't agree more the observation aspect is really important. I don't think that everyone has it. That's why I a little impressed when the doctor started asking if I had an eating disorder, and even though I assured him that I didn't, he noticed that I was thin, which meant that he was actually looking at me and making observations, which in turn meant, that maybe I wouldn't have to spell other things out for him. I don't mind spelling things out but there is no time to go over every little thing. I think good intuition is really important.

    OK, sorry this was so long. Probably everyone stopped reading this a long time ago. I wanted to respond to so many things because the posts were so interesting. I also like hearing how therapy works in different areas.


    Oh, and I wanted to say re:the diagnosis that I do agree that he was probably being nice. I remember now one of my teachers saying that you diagnose someone with adjustment disorder if they don't really have anything. I just disagreed with the "depression" specifier.

  10. #10

    Re: 45 minutes not long enough

    Toeless, I believe I was only allowed 10 visits (with a therapist) per year under my Kaiser plan, so I think what you have with Regency Blue Cross is better for you. In fact, my therapist eventually stopped doing one-to-one visits, only groups. At that point, all my visits devolved into psychiatry only. When my Mom died, he made an exception and saw me individually three times. Yes, I would think that the combination of Kaiser's being both the insurance provider and the medical care provider was a contributing factor in the dilemma.

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