In training, we’re taught a whole lot of rules and guidelines for best practice in counselling. Many of these have been created for the safety of all parties involved in the therapy relationship. However, we often take these rules at face value without exploring where they came from and how they can create barriers for some clients. In this post, I’m going to look closely at some therapy rules, how they can create a barrier for some clients and safe ways to address these barriers.
Note for clients: you always have a right to ask for something to change to make it more accessible for you. The therapist might not be able to accommodate and that’s okay too but you are allowed to ask for what you need.
Sessions are 50 minutes long
50 minutes is the ‘therapy hour’ and the length of sessions is something that is taken as standard practice. There doesn’t appear to be a consensus on the origins of the ‘therapy hour’ but some trace it back to Freud. Logistically, it works well for a lot of therapists as it supports scheduling clients with helpful breaks in between sessions.
But what about clients? Some people find that 50 minutes is too long especially if they are discussing heavy, traumatic experiences in therapy. Others might find that 50 minutes isn’t long enough, they might take 40 minutes to settle in fully.
I follow the therapy hour practice for logistical purposes. But, shorter and longer sessions can be just as effective depending on client needs. The safety and ethical considerations are about having an agreement in place about the length of sessions. This agreement sets expectations; the client can learn how to use the time in the most useful way for them and the therapist can facilitate a space that contains the emotional experiences emerging.
Sessions need to be weekly
The frequency of sessions is something that has been increasingly questioned over the past few years. These questions are likely a result of financial challenges and long NHS waiting lists driving people to seek private therapy. “I can only afford bi-weekly sessions” is something that 80% of enquiries I receive start with. Some therapists work in this way and have no issues with it.
My experience of trialling bi-weekly sessions when starting with a new client is that it is more challenging to build the therapy relationship. This is why I work on the basis of the first 4 to 6 sessions being weekly and after that, we can reduce the frequency if the client still wishes to. Where possible, I’ll offer reduced cost sessions to those who need it to enable the initial weekly sessions.
Financial constraints will always be a barrier to accessing therapy. Long-term, systemic issues have led to less availability of support from the NHS. The support that people can access is typically shorter term and directive, the client has little choice about which therapist they work with or the modality. Being flexible in session frequency helps to reduce some barriers to access.
Use of silence is necessary
Another area explored in training is our own responses to and experiences of silence. It’s often taught that silence is valuable and should be utilised in sessions. We might use silence to allow space for reflection and encourage the client to engage in self-exploration. This is a key goal of the person-centred approach, facilitating a space where clients can develop understanding for themselves.
However, for some people, silence is painful, it is unhelpful and does not help with processing of information. Silence can be oppressive and so uncomfortable which means that the time in silence is distressing. If this is the case for you then it’s not a problem with you, you’re not broken in any way. The use of silence might need to be adjusted for you to feel safe in the therapy space.
In some approaches, a therapist will ask how you feel about silence initially and adjust their way of working to suit you. It might be that your response to silence changes over the course of the relationship so it could be reviewed over time to ensure silence as part of the process can be tailored.
Summary
Overall, there are numerous rules and guidelines applied to therapy that are rarely questioned. These rules can be helpful, holding and supportive for some clients and therapists. For others, they can be oppressive and create barriers to engagement. Clients and therapists are entitled to hold their boundaries that are most suitable for them. More knowledge about the processes and guidelines of therapy can support anti-oppressive practice so it’s important that clients feel able to ask questions. If you’re a client that is curious, ask your therapist about the guidelines and explore making therapy work best for you. If you’re a therapist that has never questioned the guidelines, spend some time reflecting on the rules and whether more flexibility might be possible for you whilst maintaining safety.
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