Single-Session Integrated CBT

Distinctive features

Windy Dryden

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000528077
• Edition: 2
• Topic: Psicologia
• Subtopic: Consulenza psicoterapeutica

In this book, Windy Dryden takes long-standing research on SSI therapy and transfers it to the field of CBT in a timely and conceptual application.

This thoroughly updated new edition offers brand new chapters on single-session thinking. The book questions the commonpractice of predicating therapist training on the notion that therapy is an ongoing process. Based on his extensive work demonstrating the benefits of single-session CBT to public and professional audiences, Dryden has developed a single-session approach for work in the therapy and coaching fields. Comprising 30 key points, and divided into two parts – Theory and Practice –it concisely covers the key features of SSI-CBT.

This book offers essential guidance for students and practitioners experienced in CBT, as well as practitioners from other theoretical orientations who require an accessible guide to the distinctive theoretical and practical features of this exciting new approach.

Part ITHEORY

DOI: 10.4324/9781003214557-2

1Single-Session Integrated CBT (SSI-CBT): What it is and some basic assumptions

DOI: 10.4324/9781003214557-3

When I developed a cognitive-behavioural approach to single-session therapy, I mainly crystallised my way of working that I had developed from the experiences I outlined in the Introduction. However, I also wanted to outline a framework that other CBT therapists could use who wanted to do single-session therapy in their way. In this book, I will discuss the general framework while illustrating the points with my particular approach. When I discuss the general framework, I will refer to it as SSI-CBT, and when I discuss my specific approach, I will refer to it as SSI-CBT (WD). My main goal is to focus on SSI-CBT, but many of the examples are taken from SSI-CBT (WD).

While CBT therapists who wish to use a single-session approach will no doubt develop their own format, at the moment my format is as follows:

• A person contacts me and requests explicitly single-session therapy, or a person contacts me and, after I have explained the services that I offer, they opt for SST
• Having agreed on a date to meet for the single session, I send the person a pre-session preparation form to complete and return before the session. This is designed to help the person get the most from the session. I used to do this by telephone, but no longer do so because it is not time efficient and adds to the cost of the process
• The session takes place, and
• A follow-up takes place at a time agreed between the client and me

While SST can be one session and one session only (see Introduction), more usually it is seen as:

An intentional endeavour between the therapist and the client where the former helps the latter to take away what they have come for from the session, but where further help is available if needed.

As such, at any point it may become clear that the person may need more therapy, in which case you¹ may offer this. If you offer another single session or series of single sessions, this may be viewed as ‘One-At-A-Time’ Therapy (OAATT) (Hoyt, 2011), which some in the SST field see as synonymous with SST. However, when you and the client agree that they will have a block of therapy sessions or ongoing therapy, at that point the work is no longer considered single-session therapy.

What is SSI-CBT?

How can Single-Session Integrated Cognitive Behaviour Therapy (SSI-CBT) be summed up in a nutshell? I think the approach is characterised by the following:

• It is a perspective on SST that is broadly CBT in its foundations (from all waves). In my view, CBT is a tradition, not an approach, and SSI-CBT draws from a variety of CBT approaches
• SSI-CBT also draws upon relevant work from outside CBT. Thus, in my approach to single-session therapy that I refer to as SSI-CBT (WD), I am influenced by:
  • The work of leading single-session therapists, including Talmon (1990)
  • Solution-focused therapy (e.g. Ratner, George & Iveson, 2012)
  • Pluralistic therapy (Cooper & McLeod, 2011)
  • Transformational chairwork (Kellogg, 2015) and
  • Strengths-based approaches (e.g. Duncan, Miller & Sparks, 2004)
• It recognises the importance of behaviour and putting learning into practice
• It recognises the impact of various cognitions (e.g. inferences, attitudes/beliefs/schemas) expressed in several ways (words and images) at different levels of awareness
• It emphasises the importance of emotional impact
• It highlights the importance of the client taking away new meaning in a memorable form and which can be used in appropriate situations
• It is not a single approach to single-session work and is not protocol-driven. Instead, the therapist is encouraged to view each encounter as an unrepeatable event and respond to the client as a unique individual rather than a person with a diagnosable condition treated in a standard manner

An important note

I want to clarify that there are occasions when a person wants to use a single session of therapy not to solve a particular problem or deal with a specific issue. Instead, they may want to explore an issue or talk to get things off their chest. These are legitimate uses for a single session. Any SST practitioner (including an SSI-CBT therapist) needs to offer a helping stance to facilitate the client in these respects. However, they do not require the therapist to draw upon their skills as an SSI-CBT therapist, and, as such, they fall outside of the scope of this book. This does not mean that helping clients explore an issue or express their feelings is not valuable. Far from it. It is beneficial in that, by doing so, you are helping the client in the way that they want to be helped. Having made this point, this book focuses on situations where the client wants to solve a particular problem, get unstuck, make a decision, resolve a dilemma, or any other situation where there is a specific focus to the work. In such cases, I will discuss how you can use SSI-CBT to help clients with the issues for which they are seeking help.

The basic assumptions of SSI-CBT

Both the general SSI-CBT approach and my specific SSI-CBT (WD) approach are underpinned by several theoretical assumptions that I need to clarify so that you understand the foundation of this way of working.

This may be it

A vital assumption of all forms of SST is that the time you have with a client may be ‘it’, and therefore both parties need to appreciate this and work determinedly to get the most out of this time.

It’s all here

If SSI-CBT were a play, then you and your client are the two protagonists, and the context plays a vital role in determining the focus of the action. These three ingredients are all that is necessary to help both parties get the most out of the process. Thus, ‘it’s all here’.

Focus on both the ‘here and now’ and the future

What makes CBT an approach that is a good fit with single-session therapy are its present-centred and future-oriented foci. While as an SSI-CBT therapist you might ask questions about a client’s past, this would be to discover what the person has tried that was not effective – in which case you would encourage the client to distance themself from this, going forward – and what the person has done that has been helpful – in which case you might wish to encourage the client to capitalise on this, going forward. Generally, however, you will want to find out what the current issues are that the person wants help with and what the person will accept as a viable and realistic goal, given the single-session nature of the work.

Therapy starts before the first contact, and will continue long after the final contact

It is tempting to think that while SSI-CBT is very brief, all its therapeutic potential is realised through contact between therapist and client. This is not the case and, as an SSI-CBT therapist, it is important that you appreciate the therapeutic value of extra-therapy variables. Thus, just deciding that one wishes to address one’s issues can be a powerful therapeutic force, as can contact with other people once such a decision is made.

Leonard had experienced several losses and, for a while, had felt emotionally ‘stuck’. He sought a single session from me, and, as is my custom, I sent him a pre-session questionnaire (see Table 19.1) to help him prepare for the session. The night before the session, Leonard had a Zoom conversation with some of his friends and told them how he felt after these losses. His friends all said that they had felt similar feelings after experiencing loss, which helped Leonard to ‘normalise’ some of his feelings and so, even before we had the session, Leonard began to feel far less stuck than hitherto.

Therapy occurs over the person’s life cycle – it’s not a one-shot deal

Throughout our lives, when we are physically ill, we will, in the first instance, consult our GP, who will manage our problem unless it appears more serious, in which case we will be referred for further investigation. However, this model of consulting a therapist as and when help is needed over the life cycle is regarded more suspiciously. However, SST therapists are generally comfortable with the idea of such consultations and will endeavour to help the person as quickly as possible within the SST framework.

Build on what’s there, don’t start from scratch

Clients generally come to SSI-CBT with a history of having tried various things to help them solve their problems. Therefore, rather than start from scratch, SST assumes that you can build on what clients have already tried to do to solve their problem, encouraging them to desist from using strategies that have not worked and to employ methods that have yielded some benefit and can be developed.

Clients are helped most by taking away one meaningful thing from the session rather than by being overloaded with too many takeaways

If you are working within a single-session framework, there is a temptation to want clients to go away with as much as possible so that they get the most out of the process. I call this the ‘Jewish mother’ syndrome, which points to the idea that the archetypical Jewish mother is only happy if their prodigal children leave after a visit during which they have eaten everything put in front of them, which is usually a considerable amount, and been given more food ‘for later!’ In the same way as a well-digested meal is more satisfying than leaving fully stuffed, single-session therapy clients who leave the process having digested one important therapeutic point, principle or method will generally get more out of the process than those armed with a plethora of such points, principles or methods, but without having digested any of them. Thus, aim to equip your SSI-CBT clients accordingly and resist the urge to throw everything, including the kitchen sink, at them.

Therapy is client-focused and client-driven

Like other approaches to SST, SSI-CBT is focused on the issue that the client brings to the session and what the client wants to take away from the session concerning this issue....