The financial cost of couple therapy

We’ve had a great telephone consultation and we feel like you are a good fit to be our therapist, but we are having second thoughts because of the cost. Couldn’t we save money by doing the less expensive 50-minute appointments for couple therapy instead of 80-minute appointments?

Therapy is expensive, and it makes sense to carefully weigh the financial cost. While the short-term cost savings of shorter sessions may be attractive, in the long run, research shows that longer appointments outperform shorter appointments for Couple Therapy.

In graduate school I participated in a Couple Therapy study that used 90-minute sessions as part of the treatment protocol. Couple Therapy sessions that were not a part of this study defaulted to the “standard” session length of 50 minutes. I was immediately drawn to the longer session format, finding that this greatly facilitated the complex process of eliciting two quite different perspectives, then weaving them into a narrative of mutual understanding. Couples who completed the study and were switched to 50-minute follow-up appointments were, without fail, even more enthusiastically supportive of the longer sessions than I was.

After graduate school I missed what I thought of as the “luxury” of these longer appointments, and pushed myself to refine my approach to fit into a “standard” 50-minute block. Over and over I and my clients experienced the frustration of having to end sessions just as we were beginning to reach the “synthesis” stage where mutual understanding emerges. When we tried to “pick up where we left off” a week later, it was as if all the threads of meaning we had gathered were scattered by the winds of everyday life. The words and phrases we had written down and pledged to remember were intact, but they had become abstractions, and did not come alive again until we spent much of the next session rebuilding the connections we had lost. A few years later I had the opportunity to again use longer session times, and immediately experienced the satisfaction of being able draw out two perspectives and effectively weave them together during the same appointment. I was reminded of how this created an anchor point to return to that was meaningful, not a mere abstraction. I concluded that a single, longer session had as much value as two shorter sessions, perhaps even more.

During a couple therapy training through the Gottman Institute, which recommends longer appointments with couples, a fellow participant wondered if longer appointments really are necessary with couples. He pointed out the logistical difficulties of scheduling a mix of shorter, individual therapy appointments, and longer, couple therapy appointments. In his response, Dr. John Gottman — one of the foremost researchers in the field of Couple Therapy — cited research showing that clients given the same total number of minutes of therapy showed greater gains (which lasted longer!) when they had fewer, but longer appointments. He concluded that longer appointments facilitate depth in a way that shorter appointments do not, leading to deeper, more lasting change. Since then, I have ceased to regard longer appointments for Couple Therapy as a “luxury,” and now regard them as standard.

As you weigh the costs and benefits of Couple Therapy, remember that fewer, longer appointments produce greater gains, despite costing the same amount as shorter, more numerous appointments.

This post was written by Brian Livelsberger, a marriage therapist at Emily Cook Therapy in Bethesda, MD with more than 10 years experience working with couples in counseling.