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How much time does your counselor provide?

January 24, 2013

FYI – My approach to counseling is different from my colleagues. Rather than the standard 50-minute hour where people must return week after week, my first meeting is a good three hours. That way we typically get somewhere before the time is through. In fact, I always provide a good three hours for my sessions even though I only bill for actual time used. That way our sessions end when it makes sense, instead of arbitrarily by the stroke of the clock. For more information about my approach to counseling, see: http://www.yoursocialworker.com/Counseling.htm

I never would have imagined how well liked this approach would be!

Gary Direnfeld, MSW, RSW

(905) 628-4847 

gary@yoursocialworker.com
http://www.yoursocialworker.com

http://www.facebook.com/GaryDirenfeldSocialWorker
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Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead, parenting columnist for the Hamilton Spectator and author of Marriage Rescue: Overcoming the ten deadly sins in failing relationships. Gary maintains a private practice in Dundas Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America.

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In response to this posting on my Facebook page, the following dialogue was generated.

  • Excellent approach!!!….it allows clients to relax during their session which promotes clarity and a more accurate picture of the clients needs.
  • Gary Direnfeld, MSW, RSW Absolutely… and interestingly enough, even with three hours, the time flies!
  •  I feel better just reading this
  • Gary Direnfeld, MSW, RSW Pleased – thanks Nancy for letting me know.
  •  I like the approach! If you are working with FN people, I’d suggest using Reality Therapy approach. Works great for me!
  •  Can we do the same for Lawyers? The Makes Sense part could get complicated…
  • Gary Direnfeld, MSW, RSW Truth is, listening takes time and we need to listen in order to understand what is at issue. Only then can we offer meaningful assistance.
  •  I feel this is a wonderful approach. First time meetings can be difficult for both client and therapist.
  • Gary Direnfeld, MSW, RSW Hopefully not difficult for the therapist, after all, we are there in the client’s interest and should have our house in reasonable order to meet the client’s needs! Typically experience breeds comfort with difficult issues. Experience is key as a therapist.
  • That is an amazing approach. Its nice to see that finally someone else is actually getting it. I am going to be doing something similar when I open my practice. OHIP says that when a patient comes in they can only tell you one problem at a time because you will only get paid for one problem from each visit. I don’t care about what OHIP is going to pay me, it’s about the best and most successful care of the patient, I will hear what the problemS are before the appointment is over. I think it’s a great model Jen. You’re awesome!
  • Gary, what made you decide to do that? I really believe its what this population needs during these times now.
  • At different times throughout the last decade I would survey my clients, asking what was helpful and what was not. Consider this research into my own practice. The result of feedback, I have altered my practice to develop those aspects of service that clients identified as most helpful to the process. Listen to your clients and do what they say helps! This is the cornerstone of evidenced based practice. As a result, there are actually a number of things I do differently than most of my colleagues of which providing 3 hour meetings, is just one. The benefit of being in private practice is not being restricted by convention and providing a flexible service to better meet client needs.
    • Tammy Francoeur   I agree Gary. When I meet with families or individuals… the 1st hour is smoke and mirrors, the 2nd they get real, and the 3rd we do some real work….. 38 seconds ago
      •  I think it is great. The unfortunate part is many evaluate the evidence based practices but few actually implement what the evidence proves. Evaluating your own practice is the best way to obtain the goals for your practice specifically. When you have gathered and analyzed the data from your own practice, a great thought would be to publish your findings. Just think, wouldn’t it be great to pioneer a new practice model? You should be very proud and I’m sure you are impacting lives in such a way that no ones else has.
      •  think your longer session approach, is a refreshing idea, Gary!!!

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8 Comments
  1. I do the same for consultations with clients who may wish to use mediation. I offer a free one hour consultation but most times, the clients may be with me for over two or more hours and this they remember and appreciate.
    When people are in such crisis, whatever the issue, they are not only dealing with the crisis and the potential consequences, but they are needing to know it is safe that the professional listening on the other side will honour and respect what is being shared. Gaining that type of trust is key as we all know and it cannot be rushed.
    I’m sure your clients see your kindness Gary and that is also key in building the necessary professional trust. Great to hear!
    Best wishes,
    Risa

  2. All my sessions are ‘up to two hours’. I occasionally over run a little, but I usually check with the client if that’s OK. My approach to counselling, coaching, supervising, is somewhat unusual, and very challenging, because I do very little archeology; focusing instead on helping people to direct attention toward the future they’d like like to live and the person they’d like to be, mining the past for the lessons, and teaching techniques for creating resiliance and resourceful states, which are then turned into developmental tasks that will move them toward the outcome they want.

    Go well.

  3. I like the momentum you can achieve within sessions with lengthier meetings. Further, my attitude is, I wouldn’t want my surgeon kicking me off the table saying he’ll take the scalpel out next week, so similarly, I don’t want to arbitrarily conclude my session on account of time, when my client is just beginning to have a therapeutic moment or is upset due to distressing content. Statistically, 50% of the folks I see is one time only, not because I couldn’t be helpful, but because that was sufficient. 25% of the folks I see is only a second time. The remaining 25% may be seen a third or fourth time, rarely a fifth and almost never a 6th. I also have an expectation that the client leave the session with a plan of action and strategies to do differently with regard to the matter at hand…. If my client chooses to not do the work, I am quick to terminate service. My view is that I am not here to register their issue, but to help with resolution. If I am not doing so, then ethically, it is inappropriate for me to receive payment for a service not utilized. I know a good many colleagues take the view that maybe the client is still getting some thing from the session. Perhaps, but not me. In those circumstances I am more apt to believe the therapist is getting more from the session than the client. I also worry that some colleagues may be keeping their clients in therapy longer than necessary for the client, based on the therapist business or referral needs when clients return session after session without really changing or working. Please understand, this is assuming that therapy is directed at actively making a cognitive, behavioral, attitudinal or affective change. This does not apply to therapy that is supportive in nature as may be provided for psychiatrically or physically impaired persons on a long term basis.

    • Kelly M. Ciccone permalink

      Hi, Gary, Great post! Once again we meet at the intersection of client needs and best practices! (Long ago you and I had reciprocal links to our websites. My page was about communicating with clients, yours was about emotional aspects of divorce – I may have even been Kelly Donovan back then!) I was shocked when I joined a firm several years ago, and first experienced another attorney’s initial consultation at less than an hour. Mine go at least two, sometimes 21/2, The client leaves my office with a clear sense of direction and a way to get there. Looking forward to finally meeting you at the AFCC conference in LA! Kelly Ciccone~

  4. Laurie Fein permalink

    Gary, thanks for addressing the elephant in the room that just never seems to go away. I find people are just getting warmed up at 45 minutes, and it just makes sense to have longer sessions. I think that there is a major risk of co-optation by the status quo that states a session equals 45 minutes because that is defined by code and insurance reimbursement. Insurance companies are very resistant to paying for more than 45 minutes, and requires that we donate our time if we go beyond that. It’s easy to lose our perspective when we are faced with the corporate forces out there, and not question and not listen. Very refreshing thread and glad you introduced the world to this elephant.

    • Yes – it is profoundly disturbing to me how the payer calls the tune in terms of determining the clinical needs of the client. For that reason and the challenge of at times receiving third party payments, I am available strictly on a direct fee-for service basis. I provide my clients a receipt and leave it to them to seek reimbursement at their discretion.

  5. Other comments to this post:

    Bernard J Baca Ph.D. • I see couples exclusivel. My sessions are 90 minutes long, all are videotaped and they get the dvd to review between sessions. I usually schedule couples every two weeks for therapy. I give them homework from Drs. Harville Hendrix and Helen Hunts book “Getting the love you want: a guide for couples”.

    Chris Trailer • Mine are 60 minutes…a very bad habit I developed early on and never changed. I covet my time with my clients and just like the rest of you, only have 1 hour a week to turn around dynamics that were often years in the making. Still, to do 5 or 6 sessions back to back to back in “nuts”! There are times when I have to ask a client to wait a couple of minutes and they have sometimes challenged me, saying such things as, “…You’ve taken 10 minutes out of my time” or “…we’re getting a late start, will I get my time back?” to which I reply, “…The standard in the field is to conduct a 50-minute session, I give you routinely at full hour, which means that every 6th session you’ve recieved a session ‘free’.” They usually drop the matter. To show what a hypocrit I am, if I had an intern that did 60-minute sessions, I’D FIRE THEM!!

    Deb Felio, M.A., L.P.C • I think the time frame of 50 min hour is artificial to begin with – or at least a bowing to the reimbursement from third parties.My sessions with families and couples can be longer and with children shorter, It seems to be more of a personal rhythm for therapist, and hopefully for the client which would be better explained at the beginning of treatment as to how long sessions will be and how they will be charged. It is not fair for the client to expect something and then be held over or under because they got something more ( from the therapist’s perspective) If I had a supervisor expecting something they could not model and teach, I would fire them, since apparently they would be ‘practicing outside their area of expertise’
    Bernard J Baca Ph.D. • I do 90 minutes and don’t get reimbursement from insurance. My couples pay me and I give them a superbill so they can file for their insurance reimbursement. I am not on any panels either. I am much cheaper than a divorce and couples don’t have to marry someone a lot like just divorced!

    The 50 minute hour was a book written in the 50s by an old analytic trained psychiatrist (who’s name now escapes me–perhaps Alexander Lowenthal). That seems to be the notion for the 50 minute “hour” of psychotherapy.

    Deb Felio, M.A., L.P.C • I also am private pay and offer families a superbill. I do inform them as of Jan 1 of the changes in reimbursement, as insurance codes are for a 45 min! session and now may require preauth for a longer session to be reimbursed to the client at the slightly higher rate. It is up to them to decide, but in true informed consent, I think we need to let them know. Also re the hx of 50 min hour – guess that had more meaning if one was seeing the client 4-5 times a week
    Terrance Trites • I really like the practice of a longer first session in establishing rapport, connections or threads (patterns) in the client’s history. This is particularly useful, I think, with couples or families. As I am in private practice, with eap/insurance as well, I will experiment a bit to find both a therapeutic and financial balance.
    I also tend to use shorter sessions with children.
    Thanks for this discussion.

    Denise Kirsop, M.A., LMHC • I ask couples to commit to minimum 2 hour sessions. 50-60 minutes just isn’t enough time to make any progress. I have had longer sessions and they seem to be the most productive.

    Jodi Behn • Many couples I see ask for two hour first sessions, and that’s what I generally do. Then it’s weekly, and I will go the full 60 minutes. It’s been a habit I developed as an intern and I can’t seem to shake it! I do extend time when needed.

    Gary Direnfeld • Just to add to my initial post, here are some further comments on the topic of the 3-hour session:
    https://garydirenfeld.wordpress.com/2013/01/29/longer-sessions-real-work-better-results/

    Bernard J Baca Ph.D. • I was trained over 20 years ago by Dr. Harville Hendrix, the co-author of the book “Getting the love you want: a guide for couples”. His stuff encorporates almost all the developmental, therapeutic, theories and techniques for couples therapy. That intrigued me so that all I see now are couples (straight or gay). They tend to move quicker therapeutically than individuals due to their intrinsic balance. One member has shame at his core and the other has abondonment at his core. Each actives this core in their “power struggle”. Dr. Hendrix urged me to start every couples session with the notion of “what have you done to help your partner feel loved and safe?” This avoids the pitfall of the outspoken one to dominate the session and gets the other to have an opportunity to speak. Finally, before I see a couple, I ask them to purchase two copies of the book above, read it, and complete the first exercise in the book. While I ask this we also set up the first session. BTW, the person who calls to schedule the first session is the overtly emotional one and should not be allowed to dominated the first session. That’s why my sessions are 90 minutes–it allows the couple to have relatively equal opportunity to be heard by their partner who must dialogue everything their partner says in session. Sorry about my ramblings. Regards to all.

    Gary Direnfeld • I particularly keyed into the preparation your clients must do before even entering the room. This must pre-establish an expectation of working together towards a mutual goal.

    Bernard J Baca Ph.D. • Thanks Gary,

    It makes the process much easier. Rather than spending a couple of sessions getting them to understand “why” they are together (since they picked each other), it helps them have a “head start”. Furthermore, having them read the book and do the assignment before coming in is a clear indicator of their commitment to working out their relationship (diagnostically relevant to determine the process and the stumbling blocks. Most couples (I suspect all) are frightened about their relationship; frightened about it working and they’ll be with this person the rest of their lives, and equally frightened about losing this person because they are either unworthy or deficient in their ability to be “loved”. This is the pervasive theme with couples including myself. I wrote about this in a article published in a book on Imago Couples therapy: perspectives on theory. My article addressed the notion of self/other destruction based on comparison and resulting envy. Regards to all of you who are contributing to this discussion.

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