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, their guard drops, and something important comes to the surface, but without the time to process it!

Shorter sessions are most often a byproduct of administrative demands (e.g. back-to-back appointments and paperwork), longer blocks align more naturally with human biology and the mechanics of deeper psychological change.

Harmonizing with Biological Rhythms

The human brain does not operate on a 50-minute clock.

In a typical 50-minute therapy session, the client often spends the first 10 minutes "warming up" and circumnavigating the important emotional issues inside. That leaves only 30 minutes for deep work before wrapping up (10 minutes). By adding a mere 10 minutes to the session duration, we are adding 30% more time for deeper work to occur before the session is over.

Opening the Window of Memory Reconsolidation

Neuroscience has shown that for a core belief or problematic emotional reflex 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 can be elusive and time-consuming.

That's why it pays to hone in on the important stuff early, and reserve as much time as possible to deepen and process through it.

Unlocking the Unconscious

Intensive Short-Term Dynamic Psychotherapy (ISTDP) has long utilized extended sessions and more focused pressure in the therapy room to achieve results more quickly.

By identifying the client’s resistance early, and then staying with it throughout the extended session, the therapist can help the patient move past the "defensive" layer to reach the "unconscious therapeutic alliance."

By investing in longer, more intensive sessions, we can increase the likelihood of catalyzing neuronal requirements for lasting psychological 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.