How Long Should a Therapy Session Be? Is Longer Actually Better?
Updated: 22 hours ago
How Long Should a Therapy Session Be?
Fifty minutes is the standard almost everywhere, and most of us never think to ask why. I didn't for a long time.
The answer turns out to be fairly ordinary. The fifty-minute hour became the unit of psychotherapy because it divides a working day cleanly and lets a clinician see a predictable number of people with a few minutes in between to write a note. Insurance billing codes were built on top of it later, which is what made it permanent. Even the Freud story that gets told about its origins doesn't quite hold: there is little evidence he worked in fifty-minute blocks, and he once spent four hours walking around Leiden with Gustav Mahler.
None of that makes fifty minutes a bad length. It works well for a great deal of good therapy, and most of my colleagues do excellent work inside it. It just means the number came from the shape of a workday rather than from anything we learned about how people change.
To be clear, I am not arguing that longer is always better. A longer appointment is not automatically deeper, more effective, or a better fit. Some people work best in fifty minutes. Some treatments are designed around shorter, measured exposure periods. My claim is narrower: for some couples, especially when the work is emotionally complex, a longer session can make it possible to reach the work without having to stop just as it begins. The right length depends on the people, the treatment, and what the session is trying to accomplish.
We Have Spent a Century Counting Sessions
For decades, research on how much therapy a person needs has asked the question in terms of appointments: how many sessions before symptoms shift, how many before most people improve, and where the gains start to level off. That literature is genuinely large and useful. Session length was mostly left alone.
The dose-response literature in psychotherapy has focused largely on number of sessions rather than session length, and the weekly fifty-minute session has rested more on tradition than direct evidence.
So we know a fair amount about how many times to come, and until recently almost nothing about how long to stay. That is beginning to change.
The First Direct Evidence Is Interesting
A 2026 preregistered meta-analysis of individual psychotherapy for generalized anxiety disorder drew on 41 randomized controlled trials and 1,607 participants. The number of sessions, overall treatment duration, and total therapist contact time showed little relationship with outcome. Session length was different: sessions longer than 60 minutes were associated with larger effects than sessions under 60 minutes. That is an association, not proof that longer sessions caused better outcomes.
A 2024 meta-analysis of psychological treatment for body dysmorphic disorder found the same direction. Longer sessions were associated with larger effects for body-dysmorphic symptoms and depression at the end of treatment, and for depression at follow-up. The authors also noted that further research is needed.
Two studies do not make a literature, and neither study involved couples therapy. But they are the first direct looks at this question, and both point toward longer sessions being worth studying.
There Is Good Evidence on the Other Side Too
The strongest counterweight comes from prolonged exposure therapy for PTSD, and it deserves a fair hearing.
Van Minnen and Foa compared 60 minutes of imaginal exposure with 30. The shorter sessions produced less within-session habituation, but outcomes were not different at the end of treatment or at one-month follow-up. Nacasch and colleagues later ran a randomized noninferiority trial comparing 60- and 90-minute prolonged-exposure sessions. The shorter format held up at post-treatment and six-month follow-up.
Those studies answer a somewhat different question. In prolonged exposure, the exposure itself is the active ingredient, delivered in a measured dose. Asking how many minutes of trauma reliving a person needs before returns diminish is valuable. It is not quite the same as asking how long a conversation needs.
Attention is another legitimate objection. Some clinicians find that people cannot hold focus much past fifty minutes, and that a longer session buys thinner engagement rather than deeper work. That may be true for some people and some kinds of therapy. It has not been what I have seen with couples, but I do not have data to settle it.
Nobody Has Studied This in Couples Work
Here is the gap I cannot fill for you: as far as I can find, there is no randomized trial comparing session lengths in couples therapy.
What exists is convention. Couples and family sessions usually run 60 to 90 minutes, and the reason given is always the same: more people in the room, more to hold. EFT efficacy trials also tend to use sessions of about 75 minutes rather than 50. The field seems to have concluded that couples work needs more room and then never got around to testing it.
So when I say longer sessions serve couples better, I am carrying a finding from individual therapy across a gap. I think that is a reasonable inference. It is still an inference, not a result.
What I Have Found in My Own Work
I see couples for 90 minutes, and it is the only length I offer. I did not get there from reading studies. I got there because fifty minutes kept coming up short in the same place every time.
With two people, the early part of a session goes to getting both accounts on the table. That time is not wasted, but it is not the work yet either. By the time I can see the cycle moving between them clearly enough to say something genuinely useful, a good chunk of the hour is behind us.
And when a couple finally softens, when they start speaking to each other instead of to me, that is not a moment I want to close down because the clock says so. In my experience it tends to arrive late in a session, after the guard has come down, rather than in the first twenty minutes.
The longer session is not really about talking more. It is about not having to stop partway through.
I would rather be careful with you about what the evidence does and does not show. The direct research on session length is thin, it is new, and none of it was done with couples. What there is supports longer sessions. Beyond that, this is what I have found helpful over years of trying it one way and then another. I offer it as clinical experience rather than proof.
If you are wondering whether this format fits what you and your partner are working through, call or email me and we can talk it through.
If you are considering couples therapy in Joplin, MO, you can read more about Emotionally Focused Therapy.
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If you are ready to get started, Schedule a Couples Therapy Appointment.
Call or text me at 417-768-9089, or email me at shira@radicalrelationshiptransformation.com.
