Offering Extended Sessions: An Alternative to Twice-Weekly Appointments

Facilitating a therapy session is an art. Though this is true in a lot of ways,  one aspect that might not receive as much recognition and appreciation—but that’s impressive nonetheless—is the ability to begin and end an appointment on-time and with minimal rigidity. 

Each individual appointment is a journey in its own right. We settle our client into a session at the beginning, give space for processing and intervention in the middle, and bring each appointment to its rightful close at the end of the allotted time—all within 50 minutes.  

We know that some variation of this framework is necessary for an effective appointment. I remember learning the importance of this rhythm in my graduate program and experiencing its value as I began clinical work. We’re journeying alongside our client during each appointment—from their respective baseline as they first sit down at the start of a session, up to an emotional elevation where much of the therapeutic intervention and treatment takes place, and back down the other side of the hill, ensuring they return to baseline before we conclude the session. This is the art: journeying seamlessly, all the while being mindful of the clock that’s in view just beyond our client in order to stay within the bounds of a 50-minute appointment. 

More often than not, this rhythm is relatively easy to find and maintain, especially for more seasoned clinicians. And yet, there are times when the constraints of a 50-minute appointment prove challenging. You may have sessions where, in order to successfully help your client from one side of the hill to the next, you’ll be wishing for more time. What can you do in these situations?

Reasons You Might Offer Longer Appointment Times

Our clients will experience different challenges along the journey of a given appointment. For one, it might take too long at the onset of an appointment to settle in and feel comfortable enough to begin gaining any elevation, and by the time you are making your way up the hill with them, you’re required to come down early, minimizing the active therapeutic work. Or a client might remain emotionally elevated, unable to sufficiently journey down the other side of the hill and return to baseline before the session is over. Either scenario can leave your client relatively dysregulated, and leave you feeling the constraints of a time limit. 

Often, these clients are in a season of their lives where they’re prone to higher levels of distress, and it’s not uncommon for clinicians to facilitate twice-weekly appointments, instead of just one weekly. I’ve done this in my practice, and I’ve found that with less time between sessions, the continuity of care is easier to maintain. This is helpful in guiding clients back to a feeling of relative stability, where the therapeutic work falls from crisis management back to a more natural rhythm. 

While twice-weekly appointments benefit some of my clients, I’m discovering another—and maybe even a preferred—way: offering these clients extended, or double, appointments. These sessions are about 110 minutes, and they’re once a week, rather than scheduling two 50 minute sessions in a week. 

With these extended sessions, I’m able to accomplish a similar amount of therapeutic work as I would in two appointments—but we only have to start and end the session once. This provides the opportunity to journey up the hill with my clients more slowly, and maintain elevation longer, accomplishing more therapeutic work and leaving enough time to ensure my client returns to their baseline before concluding the appointment. Extended sessions have granted me a bigger canvas for this artistic, therapeutic rhythm. 

Practical Considerations When Offering Extended Appointments

While extended sessions have worked for my practice and some of my clients, they won’t be the right choice for everyone. Here are some practical things to consider as you determine whether this might be a beneficial form of treatment to offer some clients—both for you as a clinician, and for them as clients. 

Assess your client’s required level of care. 

It’s important to identify with our clients what the most effective form of treatment might be for their current level of need. Part of what makes private practice a beautiful environment for healing is the freedom to be creative in how we tailor treatment to each individual’s specific goals and needs. If a client might benefit from a higher level of care, offering extended appointments for a season might prove to be a helpful avenue of treatment. 

Questions to consider: 

• Do the needs of this client require a higher level of care? 
• Would attending one longer session each week be more beneficial than dividing the time into two weekly appointments? 
• Does this client find the natural rhythm of a therapy appointment challenging or constricting?

Gauge the interest of the client in extended sessions. 

As is the case with a lot of therapeutic work, partnering with your client to develop treatment plans can be just as valuable as the treatment itself. If you and your client determine together that a higher level of care would be helpful, then it’s important you discuss what your options are and the benefits and drawbacks of each. 

One longer session a week might prove more convenient to your client’s schedule than twice-weekly appointments, or they might find it beneficial to see you more frequently (twice a week) with less days in between. These are the kinds of things you and your client can talk through together, so they feel they have some ownership in whatever decision the two of you make. 

Questions to consider: 

• Is the client in agreement with increasing the level of care? 
• Would the client find it more convenient to come to only one long session each week, or would the client prefer to attend more frequently with less days in-between? 

Determine how to bill for extended sessions. 

My practice is cash-pay only, so I have flexibility in how I charge and bill my clients for extended appointments. If you bill insurance, it’d be important for you to determine whether or not extended appointments would be billable before moving forward with offering longer sessions. You can call your clients insurance company and verify their benefits to find this out, and then you and your client can use this information to decide if this is the right path for you. 

Questions to consider: 

• If this client is cash pay, what would be a reasonable fee to charge for an extended appointment? 
• If this client uses insurance, would offering extended appointments be an option? 

Once you begin, check in continually. 

Determining whether or not a higher level of treatment is necessary, gauging your client’s interest, and ensuring you’ll receive proper payment for these appointments are all important factors to consider. And at the same time, we still need to consistently be checking in with our clients about how they’re experiencing the extended sessions. Have conversations with your clients about if they want to continue extended sessions, or if they would rather return to traditional appointments. 

Part of what we do in therapy is teach our clients how to advocate for themselves and participate in their treatment. We give space for their voice and ensure they feel comfortable giving feedback regarding their treatment—and the length of their sessions is no exception.

Questions to consider:

• Is the additional time each session valuable? 
• Is my client able to endure remaining emotionally elevated for an extended amount of time? 
• Does my client feel comfortable communicating their treatment needs and so will advocate for themselves?

Remember the Significance of Journeying With Our Clients

The journey we take with our clients, day in and day out, is rhythmic and it’s artistic. And there’s something beautiful about the individuality of our clients’ needs. In private practice, we have the freedom to creatively consider and tailor our treatment plans for each client. Offering extended appointments as an alternative to twice-weekly to clients in need of a higher level of care is one way of accomplishing this. 

Whether you reflect on what this would look like in your practice, or you decide only to offer twice-weekly appointments when necessary, or you decide that you will always and forever stick to a traditional 50-minute appointment once weekly—the work you do is important and admirable. Traveling up hill after hill with our clients and remaining within time constraints is an art. Keep journeying, keep watching the clock, and keep thinking outside the box for ways to most effectively meet your clients’ needs.