In the standard "therapeutic hour," which typically lasts only 45 to 50 minutes, a frustrating phenomenon often occurs: the "doorknob phenomenon." Just as the patient touches the doorknob to leave, they finally drop their guard and share the most vital piece of information. By shifting the paradigm toward extended sessions—ranging from 90 to 120 minutes—we can bypass these systemic delays and move toward more timely, profound healing.

While shorter sessions are often a byproduct of administrative convenience, longer blocks align more naturally with human biology and the mechanics of deep psychological change.

Harmonizing with Biological Rhythms

The human brain does not operate on a 50-minute clock. We function on Ultradian Rhythms, biological cycles that last approximately 90 to 120 minutes. These cycles govern our levels of arousal and focus.

In a 50-minute session, the patient often spends the first 20 minutes "warming up" and shedding the stress of the outside world. This leaves only a narrow 20-minute window for deep work before the "cool down" begins. A 90-minute session allows the patient to settle into a state of flow, where the prefrontal cortex can relax its grip, allowing for more authentic exploration.

Opening the Window of Memory Reconsolidation

Neuroscience has shown that for a core belief or traumatic memory to change, it must be "unlocked" and then rewritten—a process known as Memory Reconsolidation.

Ecker et al. (2012) suggest that this process requires a specific sequence: the memory must be vividly reactivated, and then a "mismatch" or "disconfirmation" must be experienced.

This sequence is delicate and time-consuming. In a brief session, the therapist may successfully reactivate a difficult memory but run out of time before the "mismatch" can be fully integrated. This leaves the patient in a state of raw vulnerability without the resolution needed to actually change the neural pathway.

Unlocking the Unconscious

Intensive Short-Term Dynamic Psychotherapy (ISTDP) has long utilized extended sessions—often called "trial therapies"—to achieve results in months that would normally take years.

By staying with the patient’s resistance for a longer duration, the therapist can help the patient move past the "defensive" layer to reach the "unconscious therapeutic alliance." As documented by Abbass (2015), this "unlocking of the unconscious" frequently requires more than an hour of sustained focus to overcome the patient's ingrained anxiety and defense mechanisms.

The Efficiency Paradox

It may seem counterintuitive to suggest that longer sessions lead to faster treatment, but it is a matter of efficiency. Three 50-minute sessions often contain 60 minutes of "warm-up" and "wrap-up" time. One 120-minute session provides nearly 100 minutes of pure, deep-level work.

By investing in "Deep Work" sessions, we respect the complexity of the human psyche and the biological requirements for lasting change.

Supporting References

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation.

Abbass, A. (2015). Reaching Through Resistance: Advanced Psychotherapy Techniques.

Rossi, E. L. (1991). The 20-Minute Break: Using the New Science of Ultradian Rhythms.