Single-Session Therapy

Responses to Frequently Asked Questions

Windy Dryden

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000511321
• Edition: 1
• Topic: Psicología
• Subtopic: Asesoramiento psicoterapéutico

In Single-Session Therapy: Responses to Frequently Asked Questions, Windy Dryden takes the questions raised by participants from his workshops and training events on SST and provides answers in a fresh and accessible format.

The book focuses on 50 FAQsand is divided into five parts:

• Part 1: The Nature of Single-Session Therapy

• Part 2: The Foundations of Single-Session Therapy Practice

• Part 3: The Practice of SST

• Part 4: Critical Questions about SST

• Part 5: Miscellaneous Questions

Aimed at counsellors and psychotherapists of all orientations in training and practice, Single-Session Therapy: Responses to Frequently Asked Questions is a concise and readable source of therapeutic knowledge.

PART 1THE NATURE OF SINGLE-SESSION THERAPY

DOI: 10.4324/9781003245490-2

1WHAT IS SINGLE-SESSION THERAPY?

DOI: 10.4324/9781003245490-3

At first glance, the answer to this question is simple. Single-session therapy (SST) is therapy that lasts for one session. And indeed, there are times when therapy does last for a single session. For example, there are occasions when the therapist and the client contract for a ‘block’ of therapy sessions, but the client only attends the first session. This is known as ‘single-session therapy by default’. There are also occasions when, for whatever reason, the client only wants to come for one session and only attends that session. Here, the therapist and the client both contract for that one session. This is known as ‘single-session therapy by design’ when it occurs. Also, when I do a demonstration of single-session therapy at a training workshop, for example, then the volunteer knows that that session will be the only session that they will have with me.

However, the SST community’s majority opinion is that single-session therapy is ‘an intentional endeavour where the client and therapist agree to meet to help the client deal with their nominated concern in one session knowing that more help is available if needed’. In this definition, several important points are made:

1. The work has a purpose. The intention is ideally to help the person in one session.
2. The client will get the help needed. Further therapy sessions are available if the client needs such help.
3. The work is consensual. The therapist and client agree to work together on the basis of the first two points.

There is also a view in the SST community that the client can be encouraged to prepare for this session and that this preparation counts as a therapeutic contact. Let’s also consider that most agencies which offer SST will follow up with the client to see how they are doing after the session. We are faced with the interesting conundrum that single-session therapy may involve three points of contact between the client and the therapist (or the agency where the therapist works) and may involve the client having further sessions.

Thus, what has started as a simple situation – SST is therapy that lasts for one session - has ended with the complicated situation where SST may comprise several therapeutic contacts and the possibility of further treatment following the ‘single session’ if the client needs it.

Given this complexity, why continue to use the term ‘single-session therapy’? Jeff Young (2018), an Australian SST therapist, argues for its retention because of its ‘shock value’ despite its ambiguities. The term fascinates professionals, challenges their assumptions and stimulates them to think through several issues concerning therapy length, client preferences and related points.

I agree with Young that the term ‘single-session therapy’ should be retained as it reflects the following:

1. It is a way of practising therapy based on a way of thinking about therapy known as ‘single-session thinking’ or the ‘single-session mindset’ which emphasises the intent of the work: to help the client in one session.
2. It is a way of organising therapy services that cater to many clients who choose to attend one therapy session. Thus, numerous reports show that the modal¹ number of sessions clients have across settings and countries is ‘one’, followed by ‘two’, followed by ‘three’, etc. (e.g. Brown & Jones, 2005; Hoyt & Talmon, 2014a).

In conclusion, when using the phrase ‘single-session therapy’, it is vital that advocates of this way of working clarify how the term is being used and appreciate that it can be easily misunderstood.

Note

1. The ‘mode’ is the most frequently occurring number in a series.

2WHY IS IT CALLED SINGLE-SESSION THERAPY IF FURTHER SESSIONS ARE AVAILABLE?

DOI: 10.4324/9781003245490-4

Single-session therapy is a way of thinking about therapy and is also a way of delivering therapy services. While it can mean that the client has one session, it can also mean that the client can have further sessions to meet their therapeutic needs.

Modern-day single-session therapy developed from Moshe Talmon’s (1990) work. Talmon, an Israeli psychologist, while working at Kaiser Permanente in northern California, followed up 200 clients who only had one session with him when he expected them to have more. Fearing that he would discover that he had not helped these clients, Talmon (1990) found, to his surprise, that 78% of the clients did not return for a second session because they had got what they wanted from the first. However, and this is the point, they could have returned for a second session if they wanted to, and if they had, Talmon would have seen them.

Talmon (2008) has said of his 1990 book: ‘I wanted to call it Once Upon a Therapy because I wanted mostly to deal with the fact that what happens in therapy is different than what you plan or you think, or you say will happen in therapy.’ However, Talmon’s publishers did not consider it sufficiently catchy and used the title Single Session Therapy: Maximizing the Effect of the First (and Often Only) Therapeutic Encounter instead. As this title shows, Talmon’s purpose was not to establish something called ‘single-session therapy’, but to organise therapy so that the client may not need further therapy sessions after their first session rather than exclude them from having additional sessions.

Research has shown that many people come to therapy and stay for only one session (e.g. Brown & Jones, 2005). It would be nice if we, as therapists, could predict the clients who would have one session and those who would return for more. However, the reality is that we are not good at making such predictions (Young, 2018). Given this, Talmon and others have argued that we should organise the first session to maximise the possibility that a client gets what they want from the session and if they require no further help, that is fine. However, if they need further help, that is fine too, and they can have it. It follows from this that, in single-session therapy, the therapist aims to get therapy off the ground immediately rather than begin the session with the more usual practices of taking a case history, carrying out a full assessment or doing a case formulation.

When therapy services are organised so that all incoming clients are offered and accept single-session therapy, it transpires that about 50% require no further help. The remaining 50% who need additional help are offered this even though they have received single-session therapy. If single-session therapy truly meant that clients were offered and could have only one session, then half of those requesting help would be denied the help that they need. Single-session therapy, then, is a way of delivering therapy that seeks to help clients in one session but allows them access to further help. It thus aims to help all clients, not just 50% of them.

My view is that the therapy’s name is less important than what it offers in practice. If people are not happy with the term ‘single-session therapy’, they should be free to use a different name. Whatever term they use, it is vital for them to precisely describe what is on offer and what is not offered.

3WHAT ARE THE DIFFERENCES, IF ANY, BETWEEN SINGLE-SESSION THERAPY (SST) AND ONE-AT-A-TIME (OAAT) THERAPY?

DOI: 10.4324/9781003245490-5

In this response, I will outline several ways of answering this question. As you will see, the question has no definitive answer.

SINGLE-SESSION THERAPY AND ONE-AT-A-TIME (OAAT) THERAPY ARE SYNONYMOUS

Hoyt (2011) introduced the term ‘one-at-a-time’ into the SST literature, and some have used it as a term that is synonymous with single-session therapy. These terms both describe the practice where the therapist and client set out to help the client in a single session on the understanding that the client can have more sessions if they elect to do so.

SINGLE-SESSION THERAPY AND ONE-AT-A-TIME (OAAT) THERAPY ARE DIFFERENT

Some therapists see SST and OAAT therapy as different. Of these, some prefer the term ‘one-at-a-time’ therapy to the term single-session therapy. When asked why, these therapists argue that the term ‘SST’ stresses the work’s single-session nature. In contrast, the term ‘OAAT therapy’ emphasises that more therapy is available even if this involves one session at a time. Services based on OAAT therapy principles allow clients to have further sessions but only, as the name implies, one session at a time.

SERVICES BASED ON OAAT THERAPY

In some agencies, OAAT therapy is introduced to offer clients help at the point of need and reduce the time it takes for clients to access counselling. Usually, this is in response to the common practice of offering clients a block of sessions, most often six, a practice which neither reduces waiting lists nor brings down waiting time appreciably. In these agencies, the term ‘one-at-a-time’ is interpreted literally, and clients can only book one session at a time. However, there is no cap on the number of sessions a client may have in these agencies, although, as noted above, these can only be booked one at a time. Indeed, some clients may have more than six sessions if they choose to do so.

In OAAT services, clients are encouraged to reflect on what they learned from a session, digest this learning, take appropriate action, and let time pass before deciding whether or not to have another therapy session. In this way, clients can get the most from every session that they elect to have.

SERVICES BASED ON SST

In agencies that offer SST services, in my view, there is more flexibility. As we have seen, in OAAT therapy agencies, clients can have more sessions, but these can only be booked one session at a time. In SST, by contrast, if clients elect to have further therapy, they can choose from the agency’s services. Thus, they may elect to have a) another single session after the first, b) a block of counselling sessions if these are available and clinically indicated, c) ongoing therapy if offered, and even d) specialist services if the agency provides them itself or has an arrangement with an agency that does. What is important here is that the therapist is transparent with the client concerning what help is available to the client after the first session and what is not.

THERAPISTS’ PREFERENCES

At the beginning of this response, I argued that SST and OAAT therapy could be regarded as synonymous terms. They both describe the practice that the therapist and client set out to help the client in that session, knowing that more sessions are available. In my experience, therapists who prefer the term ‘SST’ emphasise the first part of this sentence, i.e. helping the client in one session. By contrast, therapists who prefer the term ‘OAAT therapy’ emphasise the second part of the sentence, i.e. further help is available. OAAT therapy is, therefore, a term acceptable to counsellors who have doubts, reservations and objections to the single-session intention of ‘single-session therapy’.

Whether SST and OAAT therapy are the same or different, what is important is for the person employing the term ‘SST’ or the term ‘OAAT therapy’ to clarify how they are using these terms rather than rely on generic definitions.

4IS SINGLE-SESSION THERAPY PSYCHOTHERAPY? IS IT COUNSELLING?

DOI: 10.4324/9781003245490-6

People who enrol on professional traini...