The Ten-Minute Gap

Every morning, I unlock the door to my consulting room at 6:45 a.m. I do so for several reasons. First of all, I need to ensure that I arrive well before my first patient, whose sessions begin at 7:00 a.m. Additionally, I must switch on the lights, turn on the heating on winter days, and place two large tissues over the pillow on the couch so that each patient will have a hygienic coverlet on which to rest the head. I also scan through my appointment diary, refresh myself about the previous day's work, and prepare myself for the day ahead.

Now that I have been in practice for years, my patients tend to arrive with utter precision, and the bell will ring promptly at 7:00 a.m. I then undertake my work with the patient in question for the requisite fifty-minute hour, and at 7:50 a.m., precisely, I shift in my seat behind the couch and uncross my legs, thus indicating in a subtle yet clear manner that the session must now end. The patient sits up from the couch, retrieves coat, umbrella, and briefcase, and heads for the door. I now have a ten-minute gap before my 8:00 a.m. analysand arrives.

The psychoanalytic and psychotherapeutic literatures contain an entire library full of books and articles about what happens during the fifty-minute hour, but virtually nothing at all about what happens between fifty-minute hours, in that much practiced, much needed, but little theorized ten-minute gap. At various points during my day, during my working week, and throughout my clinical career, I have utilized the ten-minute gaps in different ways and for different purposes; and I hope that colleagues will permit me to reflect about this seemingly trivial, but, I would suggest, quite vital transitional space in which one bids goodbye to patient "A" before greeting patient "B."

I do appreciate, of course, that not all of us schedule our appointments on the hour, and that not all of us work for fifty minutes; in fact, some may see clients or analysands for as few as forty-five minutes or indeed as many as sixty minutes. Those who practice in the Lacanian vein might rely upon the so-called "short session" or the "variable hour," and I have met at least one Lacanian psychoanalyst who will, from time to time, stop sessions after only twenty minutes! But in Great Britain, at least, fifty minutes remains the gold standard for session length among most of my colleagues within the psychotherapeutic milieu.

However, not all of us allow ourselves a ten-minute gap. I know many people who schedule patients with a mere five-minute breather at 7:00 a.m., 7:55 a.m., 8:50 a.m., 9:45 a.m., and so on, throughout the day. Others allow no break whatsoever between patients and operate something more akin to a conveyor belt system. As one of my colleagues explained, "I don't really need a break. I would rather bunch patients up without a break. This way, I get to see more patients, and go home earlier." Indeed, if one works with, for instance, eight patients per day, and honors the ten-minute gap, this will keep one in the office for, at minimum, a good seven hours and fifty minutes. But by shaving away the gap to five minutes, eight patients would therefore consume only seven-and-a-quarter hours of time. And by eliminating the break completely, treating eight patients without any pauses would necessitate a mere six hours and forty minutes in the consulting room. Thus, preserving one's ten-minute break adds, automatically, one hour and twenty extra minutes per day—enough time in which one could treat at least one more patient, or start one hour later, or go home one hour earlier. Keeping the ten-minute gap adds not only a supplementary eighty minutes to the working day, but another 400 minutes to the ordinary working week, and more than 18,000 minutes—in other words, 300 hours...