Letter: The 45-Minute Therapy â€˜Hourâ€™: A Sign of the Times?

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Richard A. Friedman laments the fact that a therapy "hour" is typically less than 60 minutes, suggesting that this is an ominous sign of our times ("Shrinking Hours," Sunday Review, Oct. 13).

What is remarkable is that a typical psychotherapy session has changed little, if at all, for so long. As a practicing psychiatrist and psychoanalyst for 25 years, I have always kept my psychotherapy sessions at 45 minutes, a time that is by and large typical of most practitioners.

In other words, despite the hyper-focus on efficiency in our culture and the devaluation of intimate conversation, given the intrusion of modern technology, psychotherapy remains an invaluable modality precisely because its practitioners value time.

What is ominous is that giving patients adequate time — within psychiatry and other branches of medicine — is increasingly rare.

LARRY S. SANDBERG
New York, Oct. 13, 2013

The writer is a clinical associate professor of psychiatry at Weill Cornell Medical College.

To the Editor:

Richard A. Friedman's commentary on the fascinating and sometimes ignoble history of the "therapy hour" didn't mention the most important factor: economics.

When I began practicing psychotherapy 36 years ago, 50 minutes was a standard hour. The 10-minute break allowed for writing a progress note and catching one's breath. In the ensuing three decades, reimbursement rates remained flat or were actually reduced, first falling behind inflation and in recent years falling in current dollars.

Psychotherapy costs remain a tiny and shrinking percentage of our overall health care spending. Therapists now need the 45-minute hour to bill enough hours to make up for reduced compensation. Sadly, the needs of the patients are not the primary driving force.