Clinical Tips: Eight Strategies to Finish Your Sessions on Time and Care for Yourself

How to Finish Your Sessions on Time

The ‘therapeutic hour’ is somewhere between 45-53 minutes. In Australia, Medicare rebates sessions over 50 minutes higher than shorter sessions. While you may schedule longer sessions because it’s your personal preference, for intake sessions, or because it’s needed for a specific protocol you use, whatever the length of time you have scheduled, that’s how long the session should be.

Unfortunately, many therapists struggle to stick to this schedule and regularly go over the time allocated for their sessions. It’s a constant battle that I hear in consultations and in conversation with my colleagues. If you are going over time, you are offering this extra time for free, and it is coming from your personal time.

There are many reasons why you might go over the scheduled time in your sessions. As therapists, we are motivated to help. If you choose to offer extra free time because you care about your clients, and don’t mind being paid a lower rate and giving up your personal time, this is your choice to make. This is charitable work, and it is wonderful if you want to offer this. Just make sure that this time does not come at your own expense.

Take a moment to consider how much this might be costing you emotionally and financially over the long term. Small sacrifices and minor compromises can really add up. If you often keep going longer the appointment time, you may spend your entire day running late. This can be stressful and exhausting. You may also end up working many more hours than you need to across the year, with work spilling in your personal time, and it is all unpaid. If you are doing this, it’s a problem that can contribute to chronic stress and burnout. And there is no guarantee that the extra ten minute will make any difference to your therapeutic outcomes.

To change this habit, start by thinking about why this is happening. If you are routinely going over the allocated time with clients, is it because you are:

• Getting lost in the content of the session?
• Chasing a perfect understanding of your client’s situation?
• Having difficulty developing a clear formulation or diagnosis of your client?
• Having difficulty managing overly talkative clients?
• Trying to demonstrate greater value by doing just one more activity?
• Lacking clear therapeutic goals?
• Trying to finish each session with a meaningful summary to demonstrate your value?
• Trying to deliver perfect therapy, and this takes a lot of time?

If these are problems that you struggle with, take heart: we all have clinical skills we can work on. The good news is that there are many things you can do to address these problems. Here are eight strategies to help you stay on time in your sessions.

1. Learn to interrupt and redirect your clients politely

You can manage verbose clients by interrupting in a kind and gentle manner and taking greater control of the agenda. It is helpful to practice this skill with someone else so you can get feedback. You may worry that interrupting or redirecting your client is rude, but if done appropriately, you will find that most people don’t mind and even welcome the direction. Many clients don’t know what to talk about in therapy. In the absence of knowing they just keep talking, hoping that more is better. In my experience, these clients appreciate getting guidance and direction – both of you want to make the most of the time.

2. Build your skills in case formulation

Being able to put together a cohesive formulation of your client’s problems and the processes that maintain them is one of the most important and difficult therapeutic skills. Your treatment should be built upon this. If you lack confidence in this area, seek additional training and guidance through individual supervision/consultation. It will help you make the most of your sessions and avoid wasting time and therapeutic dead-ends.

3. Set clear goals in therapy

The goals for therapy should be explicitly negotiated with your client built upon your case formulation. If your goals are unclear, you will know because you will feel lost, and your sessions will be wandering all over the place. This is the time to pause and review your goals. What are you hoping to achieve? Once you know this, you can agree on the agenda for your session.

4. Apply mindfulness to your practice

Mindfulness has an important role to play in the therapist as well as the client (Wilson & DuFrene, 2008). You may believe that you must give 100% of your attention to what the client is saying, however, this is not the case. Alongside this, you watch what the client is doing, and must pay close attention to the time in the session, track your progress, and be intentional about what you do, and what will need to wait for the next session.

5. Structure your sessions

Being mindful will help you implement better structure. This structure starts from the opening moments of your session. Make a more conscious agenda for each session rather than letting your client move from one topic to the next. You should begin wrapping up well before the end, summarising what you’ve learned, and what steps the client might take to reinforce this learning. This process should start 10-15 minutes before you finish – which means you have only 30-40 minutes to set an agenda and explore the client’s issues.

6. Stop trying to solve every problem

To stay on time and make the best use of the appointment, stop trying to solve all the problems your client presents. Instead, agree on one focus area with the client and only do this. By having a narrower agenda, you can go deeper rather than skating across the top of many different issues. It is valuable to then extract the learning so your client can apply it to other problems.

7. Be willing to feel uncomfortable

Our work is uncertain, ambiguous, and uncomfortable (Wittenberg & Norcross, 2001). We fight this uncertainty by trying to make sense of complexity and give good advice. It is an enormous challenge to make room for the discomfort of loose ends, unresolved issues, and unknown solutions, yet you must if you are to finish each session on time.

8. Let go of unrealistic expectations

If you are a perfectionistic therapist, you are likely to believe that you must help every client in every session (Deutsch, 1984; Ellis, 2003; Kemp, 2021). If you believe that you must have every answer or solve all your clients’ problems, you can end up working extremely hard, and yet still feel like you are failing. Letting go of these expectations means doing what you can, in the time you have. It means being useful, not perfect, aiming to make this client’s life a bit better because of the time you’ve spent together. You simply cannot fix everything, all the time.

For a detailed guide on how to address unhelpful perfectionistic patterns and become more flexible in the expectations you have of yourself, check out my book: .

References

Deutsch, C. J. (1984). Self-Reported Sources of Stress among Psychotherapists. Professional Psychology: Research and Practice, 15(6):833-45.

Ellis, A. (2003). How to deal with your most difficult client – you. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 21(3-4):203-213.

Kemp, J. (2021). The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance and Commitment Therapy and Self-Compassion Skills. Oakland: New Harbinger Publications.

Wilson, K. G., & DuFrene, T. (2008). Mindfulness for Two: An Acceptance and Commitment Therapy approach to mindfulness in psychotherapy. Oakland, CA: New Harbinger Publications.

Wittenberg, K. J., & Norcross, J. C. (2001). Practitioner perfectionism: Relationship to ambiguity tolerance and work satisfaction. Journal of Clinical Psychology, 57(12):1543–1550.

About Jennifer Kemp MPsych(Clinical)

Jennifer is a Clinical Psychologist who works with clients who are struggling with perfectionism and the mental health problems perfectionism facilitates and maintains. Jennifer is the author of . She integrates Acceptance and Commitment Therapy (ACT), behavior analysis, exposure, and Compassion-Focused Therapy approaches in her therapeutic and consultation work. Jennifer presents internationally on the topic of perfectionism and is available for public speaking, conferences, and workshops.