The Structure of The 50-Minute Hour:
   Re-Thinking The Clinical Environment

Therapists handle a variety of interactions--often unexpectedly--about the logistics, context, and meaning of therapy. As we work with clients, we also relate to many other professionals, such as physicians and other therapists.

Whether we're aware of it or not, all of these communications have therapeutic impact. Indeed, how we behave and handle our clients' reactions to us in these various arenas IS the therapy. Mishandling such situations prolongs therapy and can lead to client dropouts. This workshop explores a powerful theoretical perspective with which to see these issues: the therapist's comfort and skills with boundaries and limit-setting.

Using many case examples, we will explore the structure of the therapeutic environment, enhancing the therapist's ability to handle issues such as:

• Missed appointments
• Starting and ending each hour--including "doorknob comments"
• Patients who want to talk on the telephone
• Seeing patients in public
• Patients who resist paying their bills
• Patients' reactions to our media appearances, articles, or lectures
• Patients who send us new patients; which referrals should not be accepted?
• Setting clear therapeutic agreements, and handling patients who break, change, or deny the agreements
• Discussions with patients' physician, previous therapist, children's school counselor, or other professionals