Have you ever wondered why your therapist is strict about session length? There are many ethical, clinical, and business reasons to maintain time boundaries.
Therapy session lengths are often a mystery to non therapists. Unlike traditional medical practices in the United States, therapists can’t double book clients and the sessions must be a specific length for billing purposes. While your PCP or allergist may meet with you for 5 minutes and bill their full fee, therapist cannot do this. I’ll try to explain more in this post about why this practice exists, and why therapists safeguard the session length so carefully.
Please make an appointment through the patient portal or call 443-300-6094 if you’re interested in pursuing therapy in Howard County, Maryland through Happy Honeysuckle Healing Center. If you have a psychiatric or medical emergency, please contact 911 or go to your nearest emergency room.
This blog is for educational purposes only. This information is best case scenario, at least within the scope of my knowledge and experience at the time I write the post. Not only does everyone have different approaches to parenting and life- and my way may not be your cup of tea, but also- I am not perfect, nor do I want anyone to imagine that I am. Despite being a therapist and having a whole host of really cool techniques for all the mental health related things, I am constantly learning and trying to do better.
I’m hoping that this blog can help you. When we share what works for us, we can help others develop their own toolkit for improving their mental health. As an affiliate with Amazon and other affiliate networks, I may earn from qualifying purchases made with product links on this site. If you’re a current client of this practice, you have access to therapist-created resources free of charge.
How Long are Therapy Sessions?
The answer is really- it depends. Personally, I offer 45 minute and 60 minute individual sessions. I work with children and find that 45 minutes might be better for some kids while 60 minutes is better for others. These are the MOST TYPICAL options. There’s a 30 minute option, but I don’t know many clinicians who use that code frequently.
These are the codes for individual therapy… there is the official time, and then there’s the time range that the session is supposed to be according to the insurance company. If you have a 45 minute session, the therapist may conclude it at 38 minutes and spend the last 6 minutes writing a note, or they may conclude at 52 minutes.
Individual Psychotherapy
| CPT Code | “Official” Time | Actual Time Range |
| 90832 | 30 Minutes | 16 – 37 minutes |
| 90834 | 45 Minutes | 38 – 52 minutes |
| 90837 | 60 Minutes | 53+ minutes |
Most therapists would probably say that they try to end at a natural closing point.
Therapy isn’t something we want to force and try to fit as much in as possible. We need time to digest and process. We need time to self regulate. We can’t trauma dump and complete therapy work in a session. Take a big deep breath and don’t try to ‘win’ therapy. It’s all about the process and it’s not a race.
Insurance Factors with Session Timing
Every practice is a little different with how they handle this, but for billing purposes, the insurance company wants to know EXACTLY how long you met with the therapist. As clinicians, we are supposed to be very clear about what time the client came into session and left session.
This means that if the client is late to session or leaves session early, the insurance company may not want to cover the session or pay for the whole fee. I’m really not clear on how this impacts paneled therapists vs. out of network therapists, or how this plays out in the insurance world.
Insurance is confusing and I am not going to pretend to understand it completely. But I like our model better than the normal medical model because it is very frustrating when doctors don’t listen to you and yeet you out of their office after 5 minutes when you have questions or concerns. In my opinion, this leads to mistakes and malpractice issues that therapists don’t necessarily deal with as much. We can make mistakes- we have more time to make mistakes… but we generally get a very detailed picture of what is going on, provided the client gives us the necessary information.
Ending Sessions “Early“
Play therapy and animal assisted therapy, particularly on a farm, impact session timing a bit differently than a virtual or traditional office setting.
These are five reasons I end the formal part of session ‘early’… some specific to my niche and some that are more general:
- The client needs emergency mental health care and I’m advising the parent to bring them to the hospital immediately. If possible, I maintain the session length to review safety, hospital choice, and the plan, but sometimes it might be more appropriate for the session to end immediately for transport to the hospital.
- If a child absolutely cannot follow rules and we’re having safety issues, play therapists sometimes will set the boundary that the session needs to end early if that behavior continues. This gives children a chance to correct the behavior, but we try to maintain boundaries around safety. We might end session if they continue to test boundaries, then state that we can try again next session. This can be quite therapeutic when done properly.
I have not needed to do this- I usually set the boundary as, “if we can’t act nicely around the animals, we need to relocate to the play therapy room so we don’t endanger ourselves or the animals.”
I have needed to make this transition and I’ve had children successfully manage this transition. This seems to set the boundary and expectation pretty nicely, and I can tolerate more behaviors in the play therapy room than I can with the animals/nature. - I occasionally save time to speak with the grownups. Technically the session is still occurring, but it definitely feels like it ended early to the child. I generally prefer have parent sessions separately for this reason.
- I sometimes need to plan to finish ‘early’ for some kids to make the transition smoother… if kids have a tendency to refuse to leave, I plan in time for refusal.
Weird Session Lengths
There are occasions when sessions are weird lengths.
- Family therapy is generally at least 60 minutes.
- Group therapy is generally 60-90 minutes.
- Some therapists offer longer sessions for clients who need it or for modalities that require it.
When you see longer sessions, it’s typically for a higher level of care or it may incorporate more niche types of treatment.
For example, I’d eventually like to offer mini summer ‘camps’ for neurodivergent children. The plan is to have (5) 3-hour ‘camp’ days that can be billed as a group therapy session each day so families can be reimbursed for a portion of the cost, assuming their insurance includes out of network coverage. I love the idea of these groups as it allows kids to really get to know other kids with similar reasons for coming to therapy and similar interests (animals!). It also allows me to incorporate some teaching of social skills, to complete experiential activities that are best with groups, and to also get five straight days in a row to work with the same people. It’s a more intensive approach. The directive ‘therapeutic activity’ can be condensed into 1.5 hours of the day (a fairly typical group therapy length), and the rest of the day would be more free play, following the non directive play therapy model. That’s not to say that clinical work isn’t being done, but non directive play therapy is more letting kids play out what’s going on in their lives and providing therapeutic support via reflection on the play.
Why are Therapists “in a Rush” to End Session?
Generally we try to stay at the time limit so we are on time to all of our sessions and we have time to use the restroom, make notes, meditate, or generally find a way to start fresh with our next client.
Think of how you feel when you accidentally schedule back to back meetings- you end up flustered and maybe a little anxious.
We are therapists. That’s not a great way to show up in session. We don’t want to be still processing what our first client said when we meet with our next client. We want to be present.
Here are some other reasons we end session on time…
- We are the Time Keeper: We are the time keeper so you don’t need to be. Many clients will stress about the time… by honoring the time, we help reduce client anxiety about it. I find this is particularly true with AuDHD clients. We have a complicated relationship with time, particularly if we have time blindness. If we feel like we need to keep time for the therapist, we are taking on a role that isn’t appropriate for the setting (the idea being that the client isn’t responsible for taking care of the clinician).
- Healthy Boundaries: This is supposed to be a setting where you have a healthy relationship with another human (the therapist). This means that the therapist role models healthy boundaries. Time is a boundary.
- To Prevent Everyone from Being Late: We don’t want to make you (or someone who is driving you) late for something. We don’t want to be late for other sessions.
- Financial reasons: Realistically, we need to offer a certain number of sessions to be financially okay-ish. If we plan huge gaps between sessions, we have a loss of income and may not be able to continue to practice.
Most of my clients (kids and teens) need after school hours so I try to plan three sessions close together so kids don’t need to miss a ton of school to see a therapist. If I space everyone too far apart to account for going over our time, I don’t have enough openings for everyone without running sessions very late at night. - Creating a Sense of Safety: Therapy isn’t always unicorns and butterflies… it can be stressful. The time is there as a boundary and a safe space… people often drop therapy ‘bombs’ at the end of sessions. They know the session is ending. They are, either consciously or subconsciously, suggesting with their timing that they don’t feel safe addressing it as a full-length session yet. If they felt safe starting with that, they would have.
If I ignore that time boundary and dive in, I might be pushing them into discussing something they aren’t ready for… it might feel good for a moment to have your therapist ‘care’, but it’s not a healthy ‘feel good.’ It’s really not reading the real cue: I want to talk about this, but I am super nervous to talk about it right this moment.
The therapist bringing up next session shows that they remember and care. The therapist may also tell you that it’s okay if you aren’t ready to fully dive in too. - Creating Healthy Transitions: The transition is healthier when therapists make children (or adults) aware of time. This gives the client time to mentally prepare themselves for the end of session and not feel rushed out of session. I like to provide a 10 minute warning. Right now, it’s an alarm on my phone that we all hate… but I’m trying to find something a little more calming. I haven’t found the right thing yet.
I’m neurodivergent myself and transitioning out of activities is hard, so I love knowing when time is coming to an end so I can mentally prepare myself.
Adults can generally just eyeball the time occasionally, but kids frequently don’t have that skill (or a watch) yet so it’s our job to do it. I knew a therapist many years ago who had a chime that went off 10-15 minutes before the end of session… I haven’t been able to find something like that, but I thought it was lovely.
With young clients with extreme transitioning issues, I will sometimes need to set multiple timers, i.e.. 5 min, 10 min, 15 min. - To Prevent Clients from Running Into Each Other: My practice is small and I only have one client here at a time. Ending on time means that clients don’t see each other. It’s a bit awkward to run into a classmate in the therapy office waiting room. I have “cool farm vibes” so it might feel a little differently here, but I still like to avoid this. It DOES happen occasionally and I find kids are often curious about other kids who come here. Kids don’t have a great grasp on confidentiality so it’s a great opportunity to discuss it, but I still think that it’s a difficult concept, particularly when you’re 12 and you’re dealing with situations such as your best friend yelling across the playground who you have a crush on.
It’s important for therapists to understand the ethical, as well as the business-related, reasons for carefully managing therapy session length.
We can often forget the WHY of session length, particularly when we get lost in our own time blindness, enjoyment of our job, guilt over ‘cutting off’ a client who has something important to say, and- let’s be honest- the guilt over accepting money and wanting people to ‘get their money’s worth’ from a therapy session. As much as we treatment plan and check-in regarding goal completion, we may never know if we were truly effective as clinicians. And we (generally) can’t solve that by tacking on another 5 minutes to session lengths. Sometimes extra time can even do harm.
