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Most counselors and therapists offer a standard session length to everyone. Typically, it’s either 45 minutes or 50 minutes. For some people that’s a perfect length of time.

But I’m not most therapists.

After 11+ years in private practice, I have found that certain lengths of time work best for certain types of situations. Here’s my guide to what the best session lengths are for certain situations.

So just how long do you need for a session? I say- that depends on a few things:

Questions to Consider When Choosing Session Length

Answer the questions below in the decision tree. When you get to a yellow box, click on the pink circle to find out more info about that session length.

Laser Focused: 30 Minute Sessions

I have heard other therapists say that they couldn’t get anything done during a 30 minute session. But I say otherwise! These babies pack a punch and have a multitude of uses! They are perfect in the office, over the phone, or online for:

• Seeing adolescents! They have short attention spans and it helps them to focus and feel good about what they do in session.
• College students who are trying to fit in therapy sessions between group projects, club meetings, studying, work, and hanging out with friends.
• Check-in sessions for individuals to stay on an upward trajectory with towards goals. They are especially helpful when you are starting to move away from meeting weekly or every other week, but maybe you’re nervous about “what if” something happens before your next session? Then…book a 30 minute session in between the longer sessions as a safeguard.
• Focusing on a specific issue. This is especially good if you’re doing great in life, but you need to process through a random situation that pops up.
• Maintaining where you’re at right now. These work best every 2-4 weeks when we’re in this phase of our work together. Often, we know we’ve made improvements, and we feel so much better, but we’re testing the waters to see if there are any areas we need to make stronger, or anything we may have not realized.

I will say that 30 minute sessions work best for individuals. Couples should not schedule a 30 minute session unless they are in the final stages of therapy, or unless they are in agreement to focus on one specific topic.

Interactive: 45 Minute Sessions

This is the length of time that most people are familiar with in terms of therapy, whether it’s a traditional 45 minute session, or the “50 minute hour” that many therapists provide.

While anyone can benefit from a 45 minute session, I’ve found they are best for:

• Family sessions with a parent and a child.
• Parents who want to come in either at the beginning or the end of their child’s session to check-in and know what the focus is on for the next week.
• The individual assessment sessions I do with couples in Session #2 and #3. For a first session, I see the couple together. But then I see each of them individually before we come back together again for Session #4. This lets me get to know each of them individually and to assess where each one is at in life and the relationship.
• Couple sessions can be done in 45 minutes, and that length works well for many couples.
• Individual clients also benefit from 45 minute sessions. After we have been working together for a while, and you have begun to see progress and change, we can shorten down to a 30 minute session.

In-Depth: 60 Minute Sessions

This is the length I do the most in my practice, as most people find it allows them to go in-deep and to cover more ground in fewer sessions. It also means they are able to make a “full circle” during our time together, with the deepest work in the middle of our session, allowing us time to process and pull things back together so no one has to leave in tears.

These sessions are my favorite for:

• First sessions with couples. This allows me to get a great background on your relationship without rushing or making one person feel unheard.
• In-depth work at the beginning of our time together. We can move faster at the beginning when I have enough to get background info, build a relationship so I know the things that help you succeed, and then time to process through some new strategies to try.
• Handling a crisis situation. There are lots of details to share, and I don’t want to run out of time and make you feel like I don’t care about the rest of the story.
• Updating me when it’s been more than 6 months since our last session.
• Sessions where you are bringing a guest for that session. Those appointments always go by quickly and we run out of time.
• Individual, couple, and family sessions can all be done as 60 minute sessions.

If you are a person of few words, or if you are nervous about coming, thoughts of a 60 minute session may feel like torture! Ain’t nobody got time for more anxiety. Grab a shorter session and we’ll ease in slowly!

WARNING: If the emotion gets too much, I have been known to tell bad dad jokes to lighten the mood.

Let’s be real: most people really don’t want to go see a counselor. I joke with my clients that it can be less nerve wracking to see a dentist or a gynecologist than it is to come see me. 🙂 While I work hard to make this process as easy as it can be, I get that most people are nervous when they first walk in the door.

To help you get the most from therapy, I’m going to share the list of tips that I give to my friends when they call me up and ask me how to choose a counselor.

 

Personality and Interaction Style

When I invite my clients back to my office, I often tell them, “Let’s go have some fun!” Usually the first time they hear me say that, they scrunch up their eyebrows. But once they see me put my feet in my chair and see how casual it feels, they get what I mean.

Research has shown us over and over again that your connection to your chosen therapist is essential to your outcomes. It’s even more important than the type of approach they take with you. If you feel like you can’t be yourself around your counselor, then it can prevent you from sharing the necessary details they need to be helpful to you. Personality fit is important to your progress.

Some clinicians are more formal and others are more laid back. Both are fine. But you may have a preference. So think about which you are more comfortable with and look for that part of them to be apparent on their websites or in their online profiles.

Things to consider include:

• Language: Do you want to be able to freely use all kinds of words? Is this someone with whom you can share freely? Do you want to be able to let out an occasional four-letter word?
• Faith: Do you want your sessions to have a strong faith focus? Should your counseling sessions compliment your faith, while letting your minister focus on what he does best?
• Age: Do you want someone close to your age? Would you feel more comfortable with someone who is older than you?
• Culture: Would it be easier on you to share with someone else who can relate to military life? Do you need someone who’s familiar with Indian families? Is it important to have someone who has a focus on divorced families?

Appearance

Appearance encompasses a lot, so we’re going to break it down bit by bit. First up is fashion style. In my office, I tell everyone up front that I don’t like to wear shoes. You will find my flip flops beside my chair, and I often greet my clients in the waiting room with bare feet (even if I’m wearing a dress). That’s just how I feel comfortable. I believe if I’m at ease, then my clients will be at ease, too.

You may prefer someone who wears a suit and tie or who dresses more formally. There’s nothing wrong with that. As silly as it may sound, the appearance of your therapist will help you to feel more confident in your work with them. So try to visit their websites or other online profiles in places like Psychology Today or Good Therapy, to see what info you can glean from their photo.

Another aspect of appearance is the office. Do you prefer something that looks homey, with lamps and soft lighting? Are you looking for a small office, with only one or two clinicians sharing the space- giving you more privacy and a greater sense of calm? Or do you want a large office setting with a full-time receptionist to greet you?

Therapy Style

From the letters behind your counselor’s name to the techniques they pull from to help you, each therapist has their own style. Formally, we call this the “theory of change” that we operate from. In graduate school, all aspiring mental health practitioners learn the theories that relate to their disciplines. There are some theories that most all mental health fields learn, and others that relate specifically to each one. Marriage and family therapists learn things that are different from social workers and professional counselors.

Many online therapy directories will allow clinicians to list their preferences. You may see things like cognitive-behavioral (CBT), dialectical behavioral (DBT), emotionally focused (EFT), or family systems.

You can always ask your counselor to explain their approach to you. Or, if you see their approach listed on their website or online profiles, you can Google it to learn more.

Availability

Some offices schedule during normal business hours, like Monday-Friday 9-5. Others offer evening or weekend hours. Making sure up front that your counselor’s office hours match your needs will help ensure that you are able to continue together. It’s really hard when you find a clinician that you connect with, only to learn one or two sessions in that they don’t typically schedule during those times.

Save yourself a headache and check up front to make sure their availability matches you.

Cost and Insurance

Often the first thing interested clients ask me if what insurance I take. I get that cost can be an important factor when seeking this kind of support. We’re seeing a growing trend in mental health practitioners who are not on insurance panels for a variety of reasons. I happen to be one of them.

It used to be that clients would come in, and several weeks into therapy, they would receive a big bill from their insurance providers. Mental health was covered differently then, and I never wanted my clients to be taken back later by their insurance failing to come through. Now with the changes set out by the Affordable Care Act, deductibles are higher for many people. So even with health insurance, most clients have to pay out of pocket for many expenses. So I decided to stay off of the panels.

In order to bill insurance, you have to receive a mental health diagnosis. There’s nothing wrong with a diagnosis. That helps us know where to focus our efforts. You receive a diagnosis every time you go to the doctor’s office, too. However, with strep throat and the flu and many other diagnoses, they represent a certain time in your life. With mental health, it seems that if you are working to feel less depressed in 2016, they will assume that you are still depressed in 2020. I don’t operate from that belief system. And I feel it harms my clients.

Ask about cost and insurance up front. Those of us who aren’t on insurance panels often price our services lower as a way to compensate and show our appreciation to you. Most of us also offer what we call a “Superbill.” My clients can print those off in the secure client portal. It will have the necessary codes for your insurance provider and they can reimburse you according to your plan.

One thing I can say about not being on the insurance panels: instead of the insurance company being my client, YOU are my client. I work to make you happy, not a stranger on the other end of a phone line who tells me what you and I have to do and talk about. Many clients who work with counselors who are not on insurance panels report a better experience and higher results.

These are just a few things to keep in mind. You may have other traits that are important to you. Taking the time to find a good fit when you are starting out can save you a lot of time, money, and give you better success!

It’s often confusing to others what the differences are between the various mental health disciplines. From psychologists to psychiatrists to counselors and therapists, we’re all different from each other. Here’s your guide to the types of mental health professionals and how they can help you. (And yes, it’s perfectly fine to have more than one of us on your team at a time.)

Psychiatrists Prescribe Medications

Degree Needed for Independent Practice: Doctorate

Licensure/Letters Behind their Name: MD

Psychiatrists are the only members of the mental health professions who can prescribe medication. They have completed medical school and a residency in psychiatry. While most psychiatrists receive training in various types of therapy while completing their training rotations, as the field evolves and more medications come on the market, psychiatrists are the gurus on medications in mental health.

While some pediatricians, family doctors, and OB/GYNs will prescribe some small doses of medications to treat mental health conditions, many have begun to refer their patients to psychiatrists so they can receive the best care in terms of those medications. Most psychiatrists treat either children or adults. Currently, due to the number of people on medications, there can be a long wait to get in to see a psychiatrist for your first appointment (particularly in eastern North Carolina where I live). If your primary doctor gives you a temporary prescription, ask them if they are willing to continue to writing your prescription, or if they would like for you to see a psychiatrist. That way, you can move quickly to get an appointment scheduled, as it can sometimes take three months to get in for an appointment.

Some psychiatrists engage in more therapeutic interventions than medications and spend time asking questions. Those appointments will go longer than the typical 15 minute sessions where they review how your medications are working for you.

One Important Word of Caution: if you have been prescribed medications, always consult with your doctor before just going off of them. Some of the mental health medications can have a negative impact on you if you suddenly stop them for any reason (including just forgetting to get your prescription filled). Always use your medications as directed and be sure to ask your pharmacist or doctor if you have any questions about them. This will help to keep you safe and healthy.

Psychologists Connect the Mind to the Individual

Degree Needed for Independent Practice: Doctorate (Ph.D. or Psy.D.)

Licensure/Letters Behind their Name: LP (Licensed Psychologist); LPA (Associate practicing under the supervision of a doctoral level psychologist- all master’s level psychologists remain under this level of supervision)

Psychologists consider themselves part of the “hard sciences” as opposed to the “soft sciences.” Psychologists love to zero in on the brain. They work hard to understand the individual’s inner world, and are fabulous at treating conditions such as schizophrenia, dissociative identity disorder, personality disorders, and other psychological conditions that are complex in nature.

Psychologists are the mental health professionals who do all of the testing. So when clients are looking for official tests for work or school, psychologists are the people to call. While the rest of us can do some assessments, they are simple questionnaires that help us, as opposed to in-depth measures that look at personality.

Many psychologists work in the schools, helping students with their Individual Education Plans (IEPs) and overseeing specific testing that helps the schools to better serve their students.

Psychologists often rely heavily on the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. This goes hand in hand with their focus on pathology.

 

Counselors Advise Individuals on Actions to Meet Goals

Degree Needed for Independent Practice: Masters Degree (M.A. or M.S.)

Licensure/Letters Behind Their Name: LPC (Licensed Professional Counselor); LPCA (Associate practicing under the supervision of a more experienced clinician)

Counselors typically train in colleges of education. There, they are able to choose between two tracks of learning that prepare them to either work in schools or in private practice. Because of this, professional counselors have extensive training in career, vocational, and lifestyle development.

You have probably worked with these counselors in grade school or while in college. Counselors in private practice will help their clients to take a closer look at how their current life situation fits in with their goals and reality, and to assess what areas need to change to make them feel better about things.

Social Workers

Degree Needed for Independent Practice: Masters Degree (M.S.W.); Doctoral Degrees optional (mostly for teaching and research at the university level)

Licensure/Letters Behind Their Name: LCSW (Licensed Clinical Social Worker); LCSWA (Associate practicing under the supervision of a more experienced clinician)

Social workers at every level have a great deal of training that focuses on connecting their clients to resources. With course work that prepares social workers for school settings, along with substance abuse and gerontology work, social workers are passionate about helping their clients to overcome the obstacles to resources that hold them behind.

Some master’s level social workers go on to achieve training that allows them to combine their knowledge of resources with mental health treatment. They focus on treatment theories that help them to better understand how society impacts and influences individuals. Some examples of their focus areas include social justice, feminist theory, and community partnerships.

Marriage & Family Therapists Look at the Whole Picture

Degree Required for Independent Practice: Masters Degree (M.A. or M.S.); Doctoral Degrees are optional

Licensure/Letters Behind Their Name: LMFT (Licensed Marriage & Family Therapist); LMFTA (Associate practicing under the supervision of a more experienced clinician)

Clearly, this is my favorite group, since I am a Marriage and Family Therapist (MFT). 🙂 Unlike every other mental health discipline, we look at the bigger picture while working with whoever is in the room with us. This is “family systems theory.” Even if one person is in the room, we are assessing and looking at how all of the relationships in your life impact you. Those relationships can be with the people who raised you, the people you live with, the people you work with, your faith, your physical health, your goals and dreams, everything.

From day one of our graduate training, marriage and family therapists are the only mental health professionals who are trained how to treat relationships, romantic or familial or friendships or co-workers or whomever.

Some of the other mental health professionals may have been trained at a time before there was distinct licensure for marriage and family therapists available in all 50 states. Others, may have sought out additional training specifically on how to work with relationships. So if you work with one of those professionals on a relationship issue, be sure to ask about their training and the focus of their practice.

Which One Should I Choose?

With so many disciplines, it can seem overwhelming trying to choose which one is the best for you. Depending on what issues you want to focus on, there can be room for a team of various backgrounds to help you.

For example, if you are going through a challenging time in your relationship, you may be working with a marriage and family therapist. As a result of the extra time you are devoting to saving your marriage, your child may experience some troubles at school. So you are brought in to meet with the school counselor, who recommends some additional testing done through a psychologist.

Some of the things you should look for when choosing a therapist include:

• personality
• interaction style
• appearance
• therapy style
• availability
• cost and insurance
• complete privacy and confidentiality

It breaks my heart when I hear that someone had a bad experience in therapy. I know that people aren’t excited to call a therapist in the first place. People would rather go to the dentist or the gynecologist than to come see us. It’s not like anyone calls us when they are happy or having a fabulous day.

I know that by the time someone contacts a therapist, they have done everything they know to do. They’ve probably done it five times, thinking that this time, things will be different.

People contact me when they are almost out of hope. They are scared. They are clinging to a tiny ray of possibility. They fear being told that they are the problem. But they are willing to brave things anyway because something has to change.

So when they muster up the courage and go to see a counselor, and things just don’t go well, my heart just hurts for them. I imagine how scared they must feel. I ache that they may think this is as good as it gets. I worry that they may give up and just resign themselves to living life this way.

There are times when therapy isn’t a helpful experience.

In fact, I became a therapist because of a bad experience my family had when I was 15. I didn’t want others to come away feeling hurt, unheard, and not helped when they were ready for a change in their lives. That experience was profound for me, and it shaped how I designed my practice and every interaction I have with my clients.

So here are five tips that help you make sure that you have a good experience when you reach out for therapy.

1. Be Comfortable and Connected with Your Therapist.

Did you know that many studies show that it’s not so much about the technique used by the therapist, but the connection between the therapist and the clients? Building an alliance with you where you feel understood and supported is essential for therapy to be beneficial. Your therapist should understand what brought you in and what you want to make different.

They should listen to what’s important to you, instead of jumping in with their own agenda and quickly dismissing your views. Your therapist should know your experiences and beliefs. Even a counselor who may have different religious views than you do should still be able to support you and not attack or blame your religion. That should never happen.

You should feel comfortable that they “get” you. Our first session is a time for me to really understand more about you. I’ll ask you all kinds of questions about where you grew up and about the family you grew up in. I’ll ask you about who you live with now, and what things take up most of your time. We’ll start to outline the goals that you want for us to work on.

It is also important for you to feel as though you can be yourself around them. Often, clients say that some therapists are distant. Many sit quietly in their chair, constantly writing. Some clients even feel judged by them. In my office, I actually take my shoes off and put my feet in my chair. I usually have my Chapstick in my hand, so it’s impossible for me to write notes constantly. And if you say something and I want to remember how you said it, I’ll ask you if it’s OK if I jot it down.

Oh, and you can say anything. Whether it’s something you’re afraid others would judge you for sharing, or it’s a four-letter word, this is your time and your safe space to be yourself. No judgment from me.

Being able to be yourself allows you to feel relaxed and to share. This information can help your therapist to be even more helpful to you. So if you’re feeling stiff in your sessions, it may be time to find a new clinician who encourages you to be relaxed.

2. Be Active with Your At-home Assignments.

I know, homework is a bad word. It’s made up of two four-letter words, so why would you get warm fuzzies thinking about it?

But doing things outside of our sessions can help make a huge difference in how you feel.

I love when my clients share that they feel so much better after a session. It makes me feel so happy for them, and it lets me know what I’ve provided a safe place for them to open up. However, my goal is for my clients to send me a Christmas card to let me know how great life is. They may need to come back in for a “check-up” session. I want them to experience what they feel after a great session, all of the time.

That means for us to get there, they have to do some things between our sessions.

At-home assignments shouldn’t make your life harder. If you feel nervous about doing them, please share that! It usually means that the task is too big for where you are at right now, it doesn’t make sense, or it’s not something that fits with who you are.

Now, not all therapists will give at-home tasks. But if they ask you to try something, or to think about something, or to notice how you are feeling, give it a try. All of that information is helpful to them. It lets them point you in the right direction. Should your counselor not give you things to do at home, and you would like some, let them know. And if you don’t really want to do things outside of the session, talk about that, too. It will help both of you.

I like to call homework “personalized action steps.” In fact, at the bottom of my receipts, there’s a section for those things that we talk about trying, or making note of between our sessions. I use at-home assignments a lot when I’m working with individuals on anxiety and depression, or with families on parenting and problem behaviors from the kids. When I’m doing couple therapy, I don’t always give assignments to do at home. It depends on what’s happening.

Within the client portal system that I use, there’s a section for journaling. My clients can journal there anytime they want. They can decide if they want to share certain entries with me or not. Many will reflect on their personalized action steps here, or they will make note of topics they want us to discuss during our next session.

3. Be Committed to Your Growth.

You’re probably thinking, “I’m already committed to my spouse/child/family/etc. If not, I wouldn’t be here.” Usually, being committed to your significant other or children or to your marriage isn’t a problem. It’s often that you may feel guilty for being committed to your own happiness and growth. That can feel selfish.

There’s a phrase, “If mama ain’t happy, ain’t nobody happy.” Well, the reverse is true, too. If you’re happy, then the others around you are happier, too. You’re worth it. It’s OK to focus on improving yourself. Oh, and you don’t have to a mom, either. 🙂 We’re all in need of personal happiness.

One thing that often happens with growth is what I call the “see-saw effect.” Often the changes start out smoothly. Things go well for a day or so. Then, about three days to a week later, BAM! Things get wobbly again. It feels like you’re back where you started from, and you may start to wonder if things will ever be different- and if they can stay that way.

This back and forth can be part of the process. It doesn’t mean that you are doing anything wrong. As you change, others adjust, and there’s a ripple effect. Just because things get tense again, or feel like they have gone backward, it doesn’t mean that nothing is ever going to get better.

4. Modify Your Time Table.

While patience may be a virtue, it is definitely in short supply now that we can download information in seconds and have food ready in minutes. When things are tense and it feels like the bottom is going to drop at any minute, time can feel like an enemy. The therapist is “joining” your situation and it will take some time to not only bring them up to speed, but for each party to feel like they’ve had a chance to get out their side of the story. To you, this is old news and it can feel like a waste of time. However, if everyone involved doesn’t feel like they’ve had a fair chance to share and they don’t feel like the therapist understands them, it can hinder the process.

The therapist is “joining” your situation and it will take some time to not only bring them up to speed, but for each party to feel like they’ve had a chance to get out their side of the story. To you, this is old news and it can feel like a waste of time. However, if everyone involved doesn’t feel like they’ve had a fair chance to share and they don’t feel like the therapist understands them, it can hinder the process.

I often see clients come in expecting a “one-session miracle.” After doing what they knew to do, giving things time at home, and then mustering up the courage to come see me, they are geared up to come see me one or two times, and then things should be better.

But this isn’t like strep throat. In fourteen days things may still feel pretty lousy. It didn’t get tough overnight, or even over a month or two (especially when it involves a relationship). This doesn’t mean that therapy will take months or years.

Please try not to get discouraged if things are taking longer than you had hoped in your mind. Adjust your time expectations. The best things in life take time- and they are worth it.

If you are feeling deeply depressed or completely on edge, typically within 3-4 sessions, you have started to feel things shift around some, with better moments mixed in. For couples who come in at their low point, usually after 5-6 sessions you can start to feel some improvement. Again, there will be some good moments mixed in during that time.

Don’t stop after things start to feel better. Just like with strep throat, you still need to take all of the medicine, even if your hurt doesn’t hurt anymore. This keeps the infection from coming back. The same thing is true in therapy. When things start to feel less tense and happier, this is the time when we do our work to prevent things from going backward.

Share your time expectations and fears with your counselor. They will be able to give you some insight.

5. Ask Questions.

If you are not comfortable or don’t understand what’s happening in your therapy session, ask! To you, this can feel like a whole new way of looking at things. One of the big roadblocks in things changing is not understanding. So please don’t be shy!

I actually share with my clients that we are a team, and questions and concerns are welcomed. Many of my clients have a hard time speaking up at home or at work or with family members. When they are able to ask me a question, I celebrate! It means they feel safe. It means they are growing. It means their confidence is improving. If they can ask questions to me, then it’s going to be much easier for them to speak up and ask questions to others. It’s a big sign of growth!

If you’re ready to reach out to someone for therapy, please know that my thoughts are with you. I hope that you have a great experience and that you’re able to make the progress you are hoping to achieve. It is my hope, that these tips will help make your experience successful.

And if you have any other tips or ideas on what makes therapy helpful, please comment below! I’d love to hear your thoughts.