Single-Session Therapy and Its Future

What SST Leaders Think

Windy Dryden

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000262544
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Single-Session Therapy and Its Future provides an introduction to the major principles of single-session therapy and what currently constitutes good practice in the field.

The book is a timely reflection on where SST is at, and where it might be heading. It is comprised of interviews with well-known leaders and experts in this field, outlining what they think will happen, hope will happen and fear might happen as the future of SST unfolds. The book further notes the growth and development of SST in many different contexts internationally in the past 30 years.

The book will be of interest to practitioners with little knowledge/experience of the SST "mindset" or mode of service delivery, as well as seasoned SST practitioners. It will also appeal to practitioners working with many client groups around the world.

Chapter 1

Single-session therapy (SST)

An introduction

Overview

In this chapter, I provide an introduction to the major principles of single-session therapy and what constitutes good practice in this field.¹ In particular, I show how SST can be used to help meet client need where the demand for services outstrips supply.

I begin by providing some relevant definitions before considering the foundations of SST. I then compare the features of help provided at the point of need and the features of help provided at the point of availability. It is clear from this comparison that SST is consistent with the former. I go on to consider the question of whether SST is a mindset, a mode of service delivery or a discrete therapeutic approach, arguing that it is the first two and not the latter. I then discuss the goals of SST, before considering the issue of indications and contraindications for SST. There follows a comprehensive discussion of the Dos and Don’ts of good practice in SST, before I provide an example of an effective single-session structure. I end the chapter by considering and responding to common misconceptions of SST.

Introduction

Imagine this scenario. Samantha Smith has been struggling with problems of anxiety for several months and, after prompting from her family, she decides to see her GP. When she telephones for an appointment, she is given one seven days hence. At the consultation, her GP agrees that Samantha could benefit from ‘talking therapy’ and gives her details of the local IAPT² service and asks her to make contact. She telephones the IAPT service the same day, and a receptionist arranges for a psychological wellbeing practitioner (PWP) to carry out a telephone assessment with Samantha which will take place in ten days.

This assessment takes place, and the PWP concludes that Samantha is suffering from mild to moderate generalised anxiety disorder (GAD) and refers her for low-intensity CBT which will either take the form of guided self-help or occur in a psychoeducational group. There will be a four-week wait for such help. If Samantha’s GAD was assessed to be in the severe range, then she would have been referred for high-intensity CBT which would occur in a one-to-one setting and for which there would be an eight-week wait. Samantha was reluctant to opt for guided self-help and did not want to join a group. She preferred to see a therapist one-to-one. The PWP told Samantha that he would have to make a special case for this to his supervisor and that he would contact her in one week. He did so and told Samantha that her request for one-to-one therapy was granted and she was offered an appointment in eight weeks. The time it took for Samantha to have her first therapy session after seeing her GP was eleven and a half weeks.

Contrast this with what would happen if Samantha went to an agency that offers a walk-in option. She would decide that she wanted to talk to a mental health professional, she would ‘walk in’ to the service, complete a brief one-to-two page intake form and then have a session, usually less than an hour after arrival.

This chapter is based on the second approach to service delivery rather than the first.

Some definitions

Let me begin by defining some important terms.

Single-session therapy

There are three main approaches to defining single-session therapy. I will deal with them one at a time.

The ‘Ronseal’ definition

It may be thought that it is clear what single-session therapy (SST) is. It is therapy that lasts for a single session. This is what I call the ‘Ronseal’ definition of SST.³ Using the ‘Ronseal’ definition we can distinguish between two types of SST. First, there is therapy that is designed to last for a single session which is known in the SST literature as single-session therapy ‘by design’. Then there is therapy that lasts for a single session because the client unilaterally decides to attend for only one session. This is known as single-session therapy ‘by default’ in the SST literature.

Moshe Talmon’s definition

Single-session therapy is not a new concept in the psychotherapy literature. Indeed, Sigmund Freud published details of two single-session therapies that he carried out, one with Aurelia Öhm-Kronich – better known as ‘Katharina’ (Freud & Breuer, 1895) and the other with Gustav Mahler (Kuehn, 1965). However, the recent interest in SST can be traced to the publication of a book by the Israeli clinical psychologist Moshe Talmon (1990), based on research he conducted whilst working in northern California, entitled Single Session Therapy: Maximizing the Effect of the First (and Often Only) Therapeutic Encounter.

In his book, Talmon (1990: xv) defined single-session therapy ‘as one face-to-face meeting between a therapist and a patient with no previous or subsequent sessions within one year’ (Talmon, 1990: xv). According to this definition, telephone intake and follow-up are deemed to be part of SST as they do not take place face-to-face. Twenty-eight years later, Hoyt, Bobele, Slive, Young and Talmon (2018a: 18) reported that this ‘SST definition of no other sessions in the year before or after is, of course, arbitrary and was used for research purposes’.

One session, possibly more

Perhaps the most accepted view of single-session therapy has been concisely put forward by Weir, Wills, Young and Perlesz (2008: 12), who said SST ‘is not a “one-off” therapy but rather a structured first session which attempts to maximise the client’s first therapeutic encounter, understanding that it may be the only appointment the client chooses to attend, while entertaining the possibility of ongoing work’. The elements that are important here are that i) both therapist and client will try to get the work done in the first session and ii) there is agreement that more therapy is available if the client needs it. This definition emphasises the deliberate nature of SST. It is something that is agreed in advance by the therapist and the client. As Hymmen, Stalker and Cait (2013: 61) have written: ‘SST refers to a conscious approach to make the most of the first session knowing it may be the only session the client decides to attend—not to the situation where there is an expectation that the client will attend multiple sessions but chooses to attend just one.’ Regardless of definition, it is clear that the practice of SST is growing internationally and that it is being applied to a wider range of problems (Hoyt & Dryden, 2018).

One-at-a-time therapy (OAATT)

One-at-a-time therapy (OAATT) is a term that was coined by Michael Hoyt (2011) and elaborated by Slive and Bobele (2011, 2014) to describe the situation where therapy takes place one contact at a time, and one contact may be all the time that is needed. While additional sessions may be available if needed, OAATT precludes the possibility of clients booking a block of sessions in advance. I have stressed that to help the client get the most out of the first session in OAATT the therapist needs to encourage them to go away and reflect on what they got from the session, digest it as fully as possible, act on what was learned and let time pass before deciding whether or not to book a further session of therapy. In my view, this ‘reflection–digestion–action–let time pass’ process is key to OAATT (Dryden, 2019a).

The foundations of SST

Every approach to therapy and service provision is founded on a set of assumptions and/or principles. In this section, I will outline a number of such foundations of single-session therapy.

Jeff Young’s ‘three findings’ foundations

Jeff Young (2018), a major developer of SST in Australia, notes that the term ‘single-session therapy’ (SST) is an inaccurate one, but one that should be retained because of its ability to shock and stimulate discussion. Thus, SST challenges generally held beliefs about therapy such as i) ‘more is better’, ii) real change happens slowly and gradually and iii) effective therapy is built upon the therapeutic relationship, which takes time to develop.

However, rather than define SST, Young (2018) outlines three findings that serve as some of its foundations. These findings are:

Finding #1: the most common number of service contacts that clients attend is one, followed by two, followed by three…irrespective of diagnosis, complexity, or the severity of their problem (Talmon, 1990).

Finding #2: the majority (often about 70–80%) of those people who attend only one session, across a range of therapies, report that the single session was adequate given their current circumstance (Talmon, 1990; Bloom, 2001; Campbell, 2012).

Finding #3: it seems impossible to accurately predict who will attend only one session and who will attend more, a proposition that has significant clinical and organizational ramifications. If it cannot be predicted who will attend only one session and who will attend more, it follows that both possibilities need to be embraced simultaneously by both the worker and by their service system. That is, the first s...

Table of contents

• Cover
• Half Title
• Series Information
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Preface
• Chapter 1 Single-session therapy (SST): An introduction
• Chapter 2 The future of single-session therapy: An interview with Moshe Talmon
• Chapter 3 Toward the future of single-session therapy: An interview with Michael F. Hoyt
• Chapter 4 Single-session therapy – past and future: An interview with Jeff Young
• Chapter 5 The future of single-session therapy: A synthesis
• Index