Single Session Thinking and Practice in Global, Cultural, and Familial Contexts

Expanding Applications

Michael F. Hoyt, Jeff Young, Pam Rycroft, Michael F. Hoyt, Jeff Young, Pam Rycroft

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000382280
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

Single Session Thinking and Practice teaches readers how to implement single session approaches by encouraging practitioners and clients to collaborate in making the most of every encounter. Single session/one-at-a-time approaches are applicable in a multitude of settings, including clinics, private offices, medical centers, and student counseling services – and can be used both in person and online.

Leading international figures and those practicing on the front lines provide guidance for conducting SST in a variety of contexts. Chapters feature descriptions of theoretical underpinnings, pragmatic clinical examples, cross-cultural applications, research findings, service delivery models, and implementation tips.

This text will be an instant and essential reference for anyone in the fields of brief therapy, casework, and healthcare, as well as walk-in and by-appointment single session services.

Section IV

Single Session Thinking and Practice in Different Clinical Contexts

13 Introducing Single Session Therapy at a University Counseling Center

Alexandra M. Robinson, Grace Harvey, Molly McDonald, and Turi Honegger

Over the past three decades, student mental health centers have noted an increasing demand on services, due to the severity and complexity of presenting concerns and the increase in the number of students accessing services (Center for Collegiate Mental Health, 2020). The requirement for services often surpasses the availability of clinical resources. Recently, the University of California Santa Barbara (UCSB) incorporated Single Session Therapy (SST) as an option to address clinical, student, and organizational needs. We describe the process of implementing SST at our center and offer an explanation of the clinical and organizational adaptations that contributed to its successful implementation at our campus.

Identifying the Need

The year prior to the introduction of SST at UCSB Counseling and Psychological Services, the center implemented a triage system in response to the increasing demand and severity of problems faced by students requesting services. In this system, students were offered a walk-in Brief Assessment (BA). The goal of the BA was to evaluate presenting concerns and help students connect to the most appropriate treatment option(s) based upon their clinical presentation, needs, and resources (see Bratby & Hull-Styles, 2017). Despite increased efficiency, demand continued to surpass clinical availability. Given the need for innovative responses to the “new normal” of college mental health, the SST model was raised during a triage team meeting as a potential solution. One of the postdoctoral fellows, the first author (AMR), had previous SST experience at the Eastside Family Center (EFC) in Calgary, Canada (see Chapter 11 of this volume), which uses the Five-Part (pre-session, session, inter-session consult, intervention delivery, post-session) Milan Model for sessions. She, along with the Clinical Director, Turi Honegger, and the Clinical Coordinator, Grace Harvey, began to identify ways to adapt and implement the EFC SST model for the UCSB counseling center.

Integrating SST with Existing Structures and Organizational Culture

As we considered how to integrate SST with services already offered at our center, it became clear that the BA appointment would serve as the primary referral source. Unlike a typical walk-in model, single sessions are scheduled following a referral from the walk-in BA. To ensure appropriate referrals, we provided training on SST to the whole agency. To our surprise, the training and explanation of SST services was met with significant resistance. Worries were expressed that this model, which was being implemented by primarily white, female therapists, may not be culturally sensitive for traditionally underrepresented and underserved populations (Van Loon, van Schaik, Dekker, & Beekman, 2013). Staff raised concerns that the fairly directive recommendations and inter-session consult, which involves pausing the session for the clinician to meet with a consultation team, could increase the sense of vulnerability, especially amongst Latinx and African American students who had experienced generations of systemic discrimination and betrayal by people in authority. In response to the thoughtful concerns raised, the authors adapted the explanation of SST to be culturally responsive: extra time was devoted at the introduction of each session to explaining confidentiality, the benefit of the consultation was explained, and the therapist spent additional time to answer any other questions or concerns. We also incorporated a multicultural lens in which the therapist makes a conscious effort to understand and respect both cultural and experiential differences (Brown, 2018).

Difficulty in adopting the model due to other unspecified reservations was demonstrated by a few staff members who seemed confused about the model. This resulted in referrals that were not appropriate and/or where the referred client did not receive an accurate description of the service prior to the session. One of the issues that continues to surface is the misconception that the model is an abbreviated substitute for regular therapy rather than a deliberate therapy intervention developed intentionally and based on worldwide data on the benefits of SST (Slive & Bobele, 2011; Green, Correia, Bobele, & Slive, 2011; Hoyt & Talmon, 2014a; Hoyt, Bobele, Slive, Young, & Talmon, 2018; Stewart et al., 2018; Alfred Health, 2020). Following suit from single session pioneers Hoyt and Talmon (2014b; p. 4, italics added), the implementation team realized the agency needed more information to “view each encounter as a whole, complete in itself.” To increase support and understanding of SST, we continued to engage with staff and leadership about existing research conducted in other agencies and disseminated preliminary data of pre- and post-session outcomes and case examples gathered at our clinic. While some residual skepticism remains, SST has been embraced by the staff as evidenced by a growing SST team and a steady flow of referrals.

Gradual Implementation

Single session services were gradually introduced over a six-month period with only two of the coauthors (AMR and GH) initially offering direct services. This allowed the team to refine the referral process, train other staff through direct observation and debriefing of sessions, and collect outcome data to demonstrate that the SST services were meeting clinical needs. Gradual introduction was also effective in addressing a number of issues: lack of staff trained in SST; uncertainty about how the students would respond; concern over human resource support to administer the service; determining how best to refer students and how best to fit this model into the current system; responding to student diversity; identifying the best way to collect pre- and post-session surveys; scheduling; and gathering of initial data. Once these details were resolved, the agency was ready to launch SST on a larger scale. Leadership further incentivized therapists concerned about their caseload by offering a novel “trade-off” of a routine intake for a single session, so that therapists who joined the SST team would have one fewer intake on their schedule for every single session they offered.

Due to our decision to offer the single session option using the Five-Part Milan Model used at EFC and elsewhere (see Slive & Bobele, 2011), which includes team consultation, one of the most challenging aspects of implementing SST was scheduling. With great effort, we were able to identify times in therapists’ schedules that would best adapt to a 90-minute block, allowing for a buffer time in our packed schedules. We sought to group at least two sessions at a time, offset by approximately 15 minutes, to optimize the consult team availability for both sessions. (The SST process is described in the next section.)

Refining the Referral Process

To place the student in a position of authority regarding their service options, SST is offered as an option that students can self-select during their BA appointment. Similar to the Stepped Care 2.0 model (Cornish et al., 2017), this empowers students to be engaged in planning their treatment. In presenting SST as a treatment option during the referral portion of the BA, the therapist might say:

A lot of people find that just one session is enough for them. You could choose to work on your concern with a Single Session appointment, which is a stand-alone meeting with a therapist focused solely on your goal, and it would be scheduled within the week. If you’re interested in this option, I can tell you more.

For interested students, we further describe the format of the session and support them with identifying their goal for the session:

The first 30 minutes of the session is the time when you and the therapist discuss what has been going on and what you are hoping to get help with. Then, there is a break in the session for 10–15 minutes during which time the therapist will consult with a team of therapists and brainstorm recommendations for you based on your goals. The remainder of the time is used to review the team’s ideas with you and hopefully you will find some of the team’s ideas helpful!

A small SST information sheet (see Table 13.1), which briefly explains Single Session Therapy, what to expect, and how to make the most of their session, is also provided at the time of referral. Students looking for concrete, immediate steps to address their mental health needs tend to be most interested in SST.

Table 13.1 SST Information Sheet

What is Single Session Therapy?

A goal-oriented therapy session intended to provide you with strategies and solutions to help improve your overall mental health and wellness.

What is this service most helpful for?

Students find it useful to help manage a range of concerns such as stress, anxiety, depression, situational crisis, grief, difficulty adjusting to college, lifestyle concerns, etc.

What should I do to prepare for my appointment?

Come to your appointment with a goal in mind! Arrive at CAPS 15 minutes early to allow time for paperwork. Please allow for 90 minutes, including paperwork.

What can I expect during the session?

You will spend the first ~30 minutes discussing the nature of why you are here and what you are hoping to get help with. Then, the clinician takes 10–15 minutes to meet with a consultation team to brainstorm ideas based on your goals for the session (believing two heads are better than one!). After this, the clinician will return to share the team’s thoughts and ideas with you, which concludes the session.

Students unfamiliar with the single session approach often ask questions, such as: “What if I need more than one session?” to which we reply:

Often, one session is enough. If at the end of the session, you and the therapist determine that ongoing therapy would be beneficial, that will be one of the interventions discussed.

To a similar question: “Can I see that therapist more than once?” our reply is:

Each session is one-at-a-time, and after each session it is best to try implementing the strategies for a period of time before returning for more help. If you do return, often you will be working with a different therapist due to the stand-alone nature of the service.

To increase consistency in the referral process and to ensure student-client understanding, we engage in ongoing conversations with the referring therapists. As we have a limited number of sessions to offer, we decided that it was important to iden...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Figures
• List of Tables
• About the Contributors
• Acknowledgments
• Foreword
• Section I: Editors’ Introduction
• Section II: Orientations: Single Session Thinking
• Section III: Implementation: Single Session Practice
• Section IV: Single Session Thinking and Practice in Different Clinical Contexts
• Section V: Applications in Cross-Cultural/Non-Western Contexts
• Section VI: Single Session Thinking and Practice with Families
• Section VII: Editors’ Conclusion
• Index