Why Therapists Do The Things They Do

Personal quirks or professional best practices? Ian Kerns, A Licensed Marriage and Family Therapist, explains.

I’m a strong believer in therapy, and I suppose I should be given that I’m a therapist. But I’ve also been on the other side of it. In fact, I was a therapy client when I was in college, and that experience was so impactful that I decided to study therapy instead of landscaping and horticulture. While I still love plants, I don’t regret my decision at all.

In my sessions, there were things my therapist did that I noticed and wondered about from the client perspective. And today, I’ve been asked about those same things by my own clients and others who have experience with therapy. Unresolved curiosity can be unpleasant. Without proper context, the habits of therapists could even lead to misconceptions about therapy — creating yet another barrier to getting the support someone needs.

So, let’s address them head on. At the very least, I hope it helps someone to feel more comfortable in therapy and their greater mental health journey. Here are my answers to some of the most common questions I’m asked.

“Why does my therapist look at the clock during my session? Am I that hard to talk to?”

No. I’ve been doing therapy for many years and I can honestly say I’ve never had a session where I was counting the minutes.

Your therapist most likely enjoys talking to you, as evidenced by their job choice. When you spend so much time talking to people, it can be easy to lose track of time. Most therapists learn to keep an eye on the clock to avoid running over and taking time from the next session.

Personally, I also look at the clock a lot to pace the session and keep my client on track. I am being paid to address things in a client’s life that are causing them to feel something significant enough to talk to a therapist about. I feel I owe them the proper structure to make progress each time they come and talk to me. The challenge with this is, as much as they want to address the issues, they may be embarrassing or unpleasant to discuss. As humans, sometimes we stall for time in these instances. Which is understandable, but also counterproductive when we only have 53 minutes to begin with. Because of this, I am always aware of how many minutes I have left to help my clients do what they came to do.

Which leads into the second question.

“I thought therapy sessions were one hour. Why were we done before that?”

This is a valid question. If I paid for a milkshake and it was served less full than I expected, I might ask questions. The short answer is: insurance codes and billing.

It’s important to note that therapy sessions are coded and billed in 18–38, 38–53, and 53–67 minute sessions. For the most part, billing structure is determined by Current Procedural Terminology (CPT) codes based on a therapist’s credentials. We can bill longer sessions for things like crises, but only if there is a documented crisis. If a session runs late and it is not the result of a safety issue, then it does not qualify for an extended therapy code and the therapist would have to bill it as two 38-minute sessions. This isn’t typically covered by insurance, so most therapists don’t want to risk that for their clients.

This matters for two reasons. First, because it’s not realistic for therapists to book sessions that are back to back down to the exact minute. The time in between is necessary for personal things, like bathroom breaks or refilling coffee or water. It’s also necessary for professional things, like checking and responding to messages and greeting the next client. Personally, I always check my phone and email between sessions in case a client needs important information or documents by the end of the day.

So, if a 60-minute session ends early due to the client wanting or needing to leave, then it would be billed accordingly for the time it takes. For instance, if they end at 40 minutes, it will be billed within the 38–53 minute code. If a 60-minute session runs over and lasts 62 minutes, it’s already accounted for in the 53–67 minute billing code.

Either way, the seven extra minutes we build into the schedule between sessions become increasingly important as the day progresses!

“Why didn’t my therapist say hi to me at the store? Is it because they don’t like me?”

Not at all. This one is pretty straightforward. Your therapist cannot ethically acknowledge you in public due to confidentiality.

Even a simple greeting in public could make others aware of a relationship which would violate confidentiality. However, if you’re not concerned about privacy and wish to say hello to your therapist first, they can respond.

“Why won’t my therapist just keep talking to me past the end of the session? I’m pretty sure I’m the last appointment.”

Ethics. Spending time with clients beyond an established session constitutes a dual relationship, which is a serious ethical violation.

Therapists are not allowed to engage in a relationship with their clients beyond the therapeutic relationship. If they do, it violates ethics and is even grounds for citing or removing a therapist’s license to practice.

So, your therapist is likely to avoid spending time with you outside of a therapy context unless it’s something that improves outcomes AND can be justified to their professional board. This is another reason therapists may watch the clock during your session.

“Who does my therapist talk to about my sessions?”

Usually nobody. If they do, it would be a matter of safety or only in instances where a release of information has been signed by you.

There are two reasons your therapist would discuss your session with someone else. First, if you have given signed written permission for them to do so. For instance, if you ask your therapist to talk to a parent or doctor on their behalf, they may require you to sign a Release of Information form. Additionally, therapists are mandatory reporters. If your therapist has reason to believe that you are going to harm yourself or someone else, or that you may be in some sort of physical danger, then they will always put safety and life before anything else and get more help.

“What if I don’t like my therapist?  Will it hurt their feelings if I don’t come back?”

No. If you feel like your therapist isn’t a good fit, or you aren’t benefitting from your sessions, tell them.

I would rather have a client tell me that I am not a good fit for them than have them come to even one session that is not helping them — and every good therapist will feel the same. We would rather have you tell us so we can help you find a better fit, whether that’s another member of our team or a referral to another practice.

I have never taken it personally when finding out my approach wasn’t on a wavelength that a client found helpful or relatable. Most importantly, I don’t want any client to suffer through additional sessions that aren’t working for them and wind up thinking that therapy is not worth it. Sometimes you have to find the right therapist first, and you can’t do that if you aren’t transparent with the wrong ones.

Sometimes the unique things you notice about your therapist are just their personal quirks. If you ever notice something that makes you feel uncomfortable or distracted during a session, just ask. Because above all else, we want you to feel comfortable and secure.

If you would like to me to answers any additional questions about therapy or the things that therapists do, feel free to send your questions to:

generalmailbox@meadowlarkpsych.com with the subject line: Attn Ian Kerns.