Back-to-Back Client Sessions in Therapy: An Analysis and Personal Reflection

As a mental health professional, particularly as an Art Therapist, the question of back-to-back client sessions often arises. This article will explore the various perspectives, including the historical context and practical implications, of scheduling clients back-to-back. Additionally, we will delve into the perspectives and practices of different therapists working in various settings, including agencies, private practices, and supervision roles.

Historical Context and Purpose

The notion of back-to-back client sessions, while not inherently advantageous, does serve specific purposes. The origins of back-to-back sessions can be traced back to the early days of psychoanalysis. Freud is infamous for his use of this technique to shield his patients from his own personal discomfort, such as his bad breath caused by cigars and mouth cancer. This tradition has persistently been adopted, albeit without much practical benefit to the therapeutic process.

Standard Sessions in Agency Settings

In a typical agency setting, the norm is to schedule 50-minute sessions with clients, often back-to-back. The standard schedule might include:

50-minute individual therapy sessions arranged every hour Scheduled in a pattern of 3 in the morning and 2 in the afternoon

Such a model presents a substantial workload, with a full-time therapist potentially seeing 25 individual clients each week. While this is intensive, it provides a structured framework that is practical for large-scale mental health agencies.

Flexibility in Private Practice and Agencies

Art Therapists and mental health professionals have the luxury of setting their own schedules in both agencies and private practices. An Art Therapist, for instance, might maintain their own timetable, allowing them to still accumulate statistics for a significantly larger number of clients. This flexibility is crucial for managing diverse client needs and accommodating various therapy techniques, from brief check-ins to longer, more in-depth sessions.

Personal Practice and Supervision

For therapists who work in private practice, flexibility in scheduling is paramount. In my experience, shorter 50-minute sessions are appropriate for initial evaluations and check-ins, but I find that 75-minute sessions are ideal for deeply engaged clients. These longer sessions provide the necessary time to bridge from everyday consciousness to internal exploration and art-making, allowing for a more comprehensive and meaningful therapeutic experience. A 15-minute break between sessions also helps to restore the therapeutic space and ensures that the therapist can prepare for the next client effectively.

Challenges and Considerations

While flexibility is beneficial, it also comes with challenges. For example, in some cases, a 30-minute check-in session may suffice, yet these shorter sessions are less profitable than longer ones. However, they are essential for clients who need quick check-ins to consolidate insights, update the therapist on meaningful personal occurrences, or keep their work on track.

Therapist Supervision and Personal Work

On a related note, my current work involves supervision and personal therapy for other therapists. These clients often come from a background accustomed to the 50-minute session format but may require deeper, more sensory-grounded experiences. I find it useful to encourage them to explore these experiences more fully, recognizing the immense value it can bring to their own therapeutic journeys.

Conclusion

The practice of scheduling clients back-to-back is a necessary but not inherently advantageous strategy in the mental health field. Its historical origins lie in protective measures rather than therapeutic benefits. In the current context, flexibility—whether in private practice or through personal choices—enables therapists to tailor their sessions to meet the specific needs of their clients, rather than adhering strictly to a rigid 50-minute model.

The key takeaway is that while the 50-minute format is widely accepted, therapists should be mindful of the various needs of their clients and the benefits that longer, more flexible sessions can offer. This flexibility allows for a more personalized and effective therapeutic experience.