Extended trauma sessions in Seattle

What this actually is

A trauma processing session at standard length is 50 to 55 minutes. That's enough time for most of what trauma therapy needs to do, most of the time. Occasionally it isn't — there's a specific piece of material that can't reasonably get opened, worked through, and closed back down inside that window, and trying to do it in a normal session means the closing-down part either gets rushed or gets skipped.

For those situations, I offer extended-length sessions: 90 minutes, two hours, or three hours, billed at $175 per hour. Three hours is the ceiling, and the ceiling is clinical, not commercial. Three hours is roughly the upper edge of what most nervous systems can do as active processing in a single day. Beyond that, the processing degrades; what you're paying for stops being therapy and starts being attendance. I won't book past it.

“At the end of my suffering / there was a door.”— Louise Glück, “The Wild Iris”

When this is the right tool

Honestly, not often. Most trauma work happens in regular weekly sessions. The cases where an extended session adds something specific that weekly work can't are narrow, and worth naming:

A piece of material that won't fit in 50 minutes. Some single-incident traumas — the accident, the assault, the medical event — have a contained structure that wants to be processed end-to-end. Opening it at the start of a weekly session means closing it before the processing is complete. A longer session lets the arc finish.

Material that consistently shuts down right when it starts to open. If you and your therapist have noticed that the same kind of content keeps getting accessed and then walled off within the same session, an extended block can sometimes get past that pattern — there's more room for the shut-down to pass and the processing to continue.

A concentrated arc with a specific scope. Sometimes a client wants to address a specific cluster of memories over the span of a week or two, in two or three extended sessions rather than across two or three months of weekly work. This is usually for clients who already have a therapy relationship in place and want to do focused work on something defined.

These cases share a pattern: the work has a shape that benefits from more time in a sitting. The cases where extended sessions don't add anything specific — and there are more of these — are situations where the issue is diffuse, where stabilization is the actual need, or where weekly pacing is itself part of the work.

What it isn't

Extended sessions are not a faster version of trauma therapy. The processing happens at the same rate it would in weekly work — what you get is more time per sitting, not accelerated change. The research on intensive EMDR shows it can produce outcomes comparable to weekly EMDR for specific PTSD presentations; it does not show that intensive formats compress months of treatment into a weekend, and that framing overstates what the evidence supports.

For complex trauma — multiple traumatic experiences, developmental trauma, longstanding attachment wounds — concentrated processing in a private-practice setting isn't usually the right fit. The research on intensive EMDR for complex presentations comes mostly from inpatient or partial-hospital programs with significant wraparound support; translating those results to a single-clinician outpatient office is an extrapolation I'm not comfortable making. For complex trauma I do regular weekly work, with the pacing and stabilization built into the arc. An extended session may have a role in that arc; extended sessions are not the treatment.

And they're not a workaround for clients who haven't been able to get started in weekly work. If accessing material has been the obstacle, more time in one sitting doesn't solve that — usually the obstacle is something we need to address inside the regular treatment relationship first.

How a session is structured

An extended session is not three hours of bilateral stimulation. The active processing portion is the middle. The shape of a three-hour session is roughly:

Orientation and grounding at the start. We're not jumping in cold. Even with the target identified in advance, the first portion of the session is checking in, settling, and orienting your nervous system to the work. This may be brief or substantial depending on how you arrive.

The processing block in the middle. This is where the EMDR or Brainspotting or Flash work happens. Sets are timed to your nervous system, not to a clock. Breaks are built in — not as a formality, but because the processing capacity benefits from rest within the session, not just at the end of it.

Closure and integration at the end. Active processing stops well before the session ends. We close the target, return to baseline, and spend the final stretch of the session orienting back to ordinary life — discussing what shifted, what's still active, what your nervous system might do over the next 48 hours as the processing continues outside the session. Skipping this closing portion is the single most common way trauma intensives fail; I won't skip it.

Shorter extended sessions — 90 minutes or two hours — compress this structure but keep the same shape. The proportion of active processing time to orientation and closure stays roughly similar.

If you're considering a series

Some clients do well with two or three extended sessions across a week or two, focused on a defined arc of work. This isn't a packaged offering — there's no series rate, no commitment in advance — but it is a structure that often makes sense for specific kinds of work.

If we go this direction, the spacing matters. Most nervous systems do better with at least a day between three-hour sessions for the processing to continue and the system to come back to baseline. Two extended sessions in the same week, with a recovery day or two between them, is more typical than three in a row.

Whether a series is the right structure is a clinical question we'd work out together based on what you're bringing and how the first session lands.

Pricing

$175 per hour. Three-hour maximum per day.

Extended sessions are not covered by insurance and are paid at the time of service. If you're currently a weekly client of mine using insurance, those weekly sessions remain in-network at the contracted rate; extended sessions are separate and out-of-pocket.

If you're not sure whether an extended session is the right tool for what you're working on, the regular consultation conversation is where we figure that out. There's no premium consultation fee.

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