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 60 to 90 minutes—we can often move toward more timely positive change.

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 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 circumnavigating the important emotional issues inside. That leaves only 30 minutes for deep work. By adding a mere 10 minutes to the session, we are adding 33% 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 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 briefer 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 and more focused pressure in the therapy room to achieve results in months that would normally take years.

By identifying the patient’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." This "unlocking of the unconscious" frequently usually requires more than the standard 50-minute hour of conventional therapy in order to overcome the patient's ingrained anxiety and defense mechanisms.

By investing in longer, more intensive sessions, we can increase the likelihood of catalyzing biological 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.