Ryan Howes has an interesting post this week on scheduling. And this seemingly prosaic issue is a lot more interesting than meets the eye. Howes talks about the necessity of that 10 minute gap between patients --
I believe those ten minutes between sessions are essential for client care and my own mental health. Sometimes clients wonder if they can go overtime a few minutes to finish their thought, or they might want to know if I care enough to bend the rules. What they might not understand is by keeping that ten minutes sacred I am caring for them. I'm modeling good boundaries and self-care, reflecting on their session and making time for the tasks that keep my practice rolling.
I once saw a therapist who was really sloppy about scheduling. He would run over time sometimes, stop short of the 50 minutes others and routinely the next patient would arrive and knock on the door as we were still speaking. There was something random about it all, boundaries too loose to find the security of knowing that time and space was for me for that period.
Then an analyst who by scheduling on the quarter hour so that there was an hour and fifteen minutes between patients. I never ran into a patient leaving or the next one coming. There was the sense always that it was just me in that time and that I could imagine, if I wanted, that there were no other patients at all.
And a supervisor who had extraordinarily tight boundaries around time and space. He never ran over the 50 minutes and had a separate entrance and exit so patients could never run into each other.
We don't really even have a standard session length -- most run 50 minutes, many are 45, some 60 minutes. It is possible with many therapists to schedule 90 minute or even double sessions routinely. And if I am not mistaken, Lacan never had a fixed session length.
So the whole issue is mostly predicated on how the therapist finds her own comfort level.
After considerable experimenting over the years, I have settled on scheduling sessions on the quarter hour. That leaves a small cushion for the occasions when the needs of the moment don't fit neatly into 50 minutes. We can run over a bit without worrying about the next person arriving. And I have 15-25 minutes to get a cup of tea, go to the bathroom, check my messages, walk around a bit and clear my mind.
This means I can't see as many people in a week as some therapists I know do. But I also know my limits there. I know that my limit is 15-18 patient hours in a week. More than that and it becomes difficult for me to keep them in mind. I learned this the hard way by once having tried to work 25 patient hours per week -- I was tired, I found it hard to keep people straight and by the end of the week I felt fried. Doing depth work requires a level of focus and attention that for me limits my capacity.
That interval between patients is vital, yes.