Time is a source of therapeutic energy so I pay close attention to it. I'm punctual, starting sessions and I don't tend to flex the end time to accommodate late arrivals. I even like, when possible, for my patients to have a regularity to the hour of their visit, same day of the week, same time of the day.
Here are the associated ideas. By beginning a session on time I allow myself to observe this aspect of my patient's behavior. Does she arrive on time, or is she habitually late, or rarely, is she habitually early. Each of these behaviors can give me clues, especially in the context of the themes present in the therapeutic conversation, as to what these behavior might be signaling, if anything.
I end sessions at the designated time even if the patient arrives late. This creates a gentle, almost subliminal pressure for the patient to get down to business knowing that the session time is about to expire. It's not unusual for patients to have something on their mind they are reluctant to talk about, often unbeknownst to the therapist, and a consistent ending time to the session can energize the patient to disclose that which might be important.
The idea of having scheduled appointments for an individual on the same day of the week at the time is to take advantage of rhythm. It encourages the patient, often unconsciously, to work through ideas and feelings pertinent to the therapy. In essence, it encourages the patient to be mindful. Rhythm is a great way to build up energy. Picture pushing a child on a swing. By timing one's push to the rhythm of the swing, energy is added. Get out of synch and energy is lost.
Paying attention to time in this way may sound rigid to some. I see it rather as something gentle.
Maintaining a consistent frame to the treatment setting is like building a sturdy frame to a cradle, rather than being unforgiving, a study frame provides support and safety.