Monday, August 22, 2011

Why won't my therapist give me longer appointments?

One of the things I do when I come into work in the morning is pick up the messages from people who have called during the hours we're closed. This morning, there was just one - a plaintive request from a client of one of my colleagues, asking for longer sessions. The client said that she felt she could do more with more time.

This is not an uncommon request. My clients will ask from time to time if we can meet for two hours instead of one, or go 15 minutes over, or any stretch of extra time, because they feel that we're ending while they still have something to say. I understand that, and I think there's all kinds of merit to the desire to do more work in therapy.

Here's the problem, though, from your therapist's perspective. If I do that for a client, should I do that for all my clients? If one of my clients finds out what another one is doing (and, in my job in a college counseling center, many of my clients know each other) how will they feel? Of course, I can't talk to any of my clients about what any of my other clients are doing - but they'll know. And they'll wonder why someone is getting special treatment when they're not. And this will color our work together, at least for a while, and maybe distract from the other good stuff that we're getting done in session.

Incidentally, one of the hallmarks of therapists that are sliding towards an ethical violation is doing special favors for one client above all others. Keeping later hours when they'd usually be headed home. Coming in on a weekend. Allowing that client privileges that no one else is getting.

I'm very sensitive to this, and I work hard to keep the "therapeutic frame," that container that helps our work together feel safe and consistent. If I find myself favoring someone, or feel like I'm NOT doing something for someone that I'd do for someone else, it's time for me to sit with that and figure out what's going on.

For your therapist, the work continues after the clients are gone. We need to make sure that we're centered, available, and doing everything we can to clear out those hidden prejudices and acts of favoritism. From the outside, it might just look like 15 extra minutes. From my perspective, it feels like a lot more than that.

Not all therapists are with me on this one, and I know of some folks I very much respect who give extra time to some folks. I've done it myself, when the clinical need was strong, once or twice. Those instances have been few and far between, and I've had a good conversation with myself, and then my client, about the reasons behind the shift. As will all things involved in being authentic and human, sometimes the little things mean a lot more than we think.


  1. This actually makes a lot of sense spelled out this way. It's easy to think "Why won't they give me a few more minutes," but if you figure out how many patients your therapist sees and then multiply "a few extra minutes" times that number and I suspect you'd tack on a couple of extra hours at the end of the day. So while the few minutes doesn't seem -that- long to the individual, it adds up fairly quickly for the therapist in question.

    Is it difficult to find a balance with people who want/feel they need to stay longer and the reality of needing to move on to the next client?

  2. I recognize this from some people in my 12-step meetings. The charitable interpretation you make above is no doubt sometimes true. From people in my meetings I've also sensed other motivations, e.g. scapegoating oneself, testing boundaries, controlling the situation by acting out, finding something to be upset about so they can avoid going next week etc.

    In my experience being firm but gentle tends to work best regardless of the motivations of people who try to push the envelope. They may not like that I'm enforcing the meeting boundaries when I do it, but in the long run they usually feel safer if the boundaries are upheld.

    Particularly when they see me gently but firmly set boundaries with the next person who is trying to create chaos so they won't have to feel their own pain. This stuff is hard. Somebody's got to hold the space.

  3. apel - holding the space is what it's all about. I think that this work has changed things in my day to day life regarding how my boundaries work, and how firm I am with them. I understand now why that's so important.

  4. Brekke - You ask about whether it's difficult to find the balance with people wanting to stay longer. I think one of the hardest parts of my job is finding that balance with everything I do with clients. I'm guessing that most therapists are like me - we wish we could do so much more for our clients, but we realize that we have to preserve our boundaries and ourselves lest we just fry out trying to be everything to everybody.

  5. In my legal practice, where clients were victims and not quite survivors yet, if I didn't keep strict boundaries, they'd walk all over me. Not intentionally, not cruelly, but it's just the way it is. There seems to be an unwritten rule that the clients you bend the rules for will be the clients who file bar complaints and/or never pay on time.

    Anyway, lawyers get next to zero training on how to interact with clients (other than the ethical guidelines about not having sex with one's clients), but clearly they should.

    As a therapy patient, I always feel bummed when my time is up. I never actually thought about getting more time (or asking for it), but just figure that as long as I want to come back again, it's working!

  6. Atty-

    I keep thinking that I should quit the therapy gig and just spend time training other professionals who get just as much mental health content in their work as other stuff. Like attorneys, bartenders, and massage therapists, for starters. :)

  7. Seriously! I wouldn't quit therapy, but definitely the training is needed! The absolute best CLE I ever did was titled something like "Representing Clients with Personality Disorders." It was *awesome*. I wish there were more like that out there!

  8. I enjoy your blog. I am in therapy again after a not so good therapist ended therapy with me. it took me several months to decide to go back. Boundaries are not easy but I think of the times my therapist has gone above and beyond, and it reminds me that it is still ok. I think clients should help train therapists. But this is a great blog, please keep it up. The reminder that I exist beyond the therapy room, helped.