Who Told Us Therapy Was Supposed to Be an Hour a Week?

A friend asked me this question a while back, and honestly? It stumped me.

We were discussing my work with "Focused Sessions"—intensive therapy over larger blocks of time instead of the traditional weekly hour. I was excited about this new approach and the freedom it gave me to dig deeper. It felt more organic and natural. Yet, I had been practicing like most therapists do: the therapy hour, once a week, for years.

It hadn't occurred to me that we could do it differently.

Therapy Against the Clock

The primary reason to do it differently? The clock.

It's practically a cliché at this point—a running joke you see on TV. You know the scene. A character shares something deep, and then suddenly, in that moment of vulnerability, the therapist looks at the clock and says, "Our time is up! See you next week."

It's funny. But it's also painful, because it highlights a painful truth. And painful truths often lead to comedy.

In my couple work, it often felt like a bomb dropped with just 5 or 10 minutes left in the session. Many therapists share this experience. It’s like an unwanted cliffhanger we all have to walk away from until next week. More often than not, we're working through a difficult situation, but the pressure of the clock prevents us from pushing through.

Sometimes it's hard on clients. I remember reporting to my supervisor years ago: "I took them apart but couldn't put them back together again." It's an awful feeling to leave a session when people are upset. You have to land the plane.

How Did We Get Here?

It seems like a self-imposed obstacle, doesn't it? But my best guess to the answer of "who told us" is: insurance companies.

Simply put, it's the billable hour.

The mental health industry has long been tied to the medical profession, using the medical model. Something is wrong inside, and you go to a doctor to fix it. This model still dominates not only our industry but also our way of thinking about mental health. Insurance accounts for the primary way most people pay for mental health services, and it's all rooted in diagnostic codes to guide treatment and CPT codes to pay for it.

And yet therapy is fundamentally different from a medical visit.

The process is more similar to physical therapy or surgery than a consultation with a doctor. The focus is on the work rather than the diagnostic information or the prescription. And the work always requires vulnerability. It has steps and stages. It has stuck points that you work through.

You can't always do that in 50 minutes.

The Beauty of Focused Sessions

That's what I discovered in Focused Sessions: room to work.

I often liken it to surgery, where you have a specific goal and you go in until you get it done. Imagine a surgeon saying, "Oh, looks like our time is up! Sew them up and we'll pick it up next week."

Couples have stuck points. You have to work through them to achieve breakthroughs. They need to experience each other going through it together.

Often, the best moments come when we find that deeper place that we as human beings spend so much time avoiding or panicking in—and then we slow it down. We sit in it to understand what's really happening and what we really need. Those are the places we need to be seen, to experience acceptance, care, or help.

That takes time.

What This Looks Like in Practice

In a Focused Session—whether it's a 3-hour block, a full day, or a weekend retreat—we have the space to:

• Actually finish what we start. When something tender comes up, we can stay with it. Work through it. Come out the other side. No artificial stopping points.

• Build real momentum. Change happens when you can build on insights in real-time, through experiences in vulnerability, not after they've had a week to cool off and get rationalized away. In EFT talk, when the protections come down, you can do the work, not wait a week for them to go up again.

• Go deeper without rushing. We can explore what's underneath the surface patterns without constantly checking the clock.

• Create lasting change. When couples have enough time to move through their stuck patterns and into new ways of connecting, those changes stick. We're not just touching the surface each week—we're actually creating new experiences together.

  
  

The Either/Or Trap

Can we achieve meaningful change with weekly, hour-long sessions? Sure. We can also watch a movie with multiple breaks over the course of a week.

This isn't an either/or conversation. Sometimes people really do need to process a therapeutic experience over time. Weekly sessions have their place. But we should explore ways to do things more effectively. Sometimes that comes from asking simple questions about long-held assumptions.

Like: Who told us therapy was supposed to be an hour every week?

Who This Works For

Focused Sessions aren't for everyone. But they're particularly powerful for:

• Couples who are stuck. If you keep having the same fights, hitting the same walls, and feeling like you're going in circles—intensive work gives you the space to actually break through instead of just managing symptoms.

• Busy professionals. If you value efficiency and getting things done well, this model makes sense. Why spread months of weekly therapy over half a year when you could make comparable progress in concentrated time?

• People who've tried traditional therapy and plateaued. Sometimes the weekly format just doesn't generate enough momentum. A different approach might be what you need.

• Anyone serious about change. If you're ready to do the work—really do it—intensive sessions create the container for transformation to happen.

  
  

The Bottom Line

I'm not saying the traditional model is wrong. I practiced it for years, and it helps a lot of people.

But when my friend asked that simple question—"Who told us therapy was supposed to be an hour every week?"—it opened something up for me.

Maybe we've been following a model designed more for billing convenience than therapeutic effectiveness. Maybe there are better ways to create the conditions for real change. Maybe it's worth asking the simple questions about our long-held assumptions.

For me, Focused Sessions answered a question I didn't know I was asking: What becomes possible when we take the clock out of the equation?

The answer? A lot more than I expected.

---

If you're curious whether Focused Sessions might be right for your situation, I offer free consultations. Let's talk about what you're dealing with and whether this approach makes sense for you. You can reach out through email, *mark@pacificagroup.org, or phone at (619) 664-4606