A random discovery
It was 1986 and Moshe Talmon was working as psychotherapist in the psychiatric department of the Kaiser Permanente Medical Center, Hayward, California; one of the biggest healthcare organisations of the United States.
While he was in Norman Weinstein’s (the chief) office, Talmon noticed a pile of papers reporting the writing “number of sessions for each patient for the last 12 months”.
Talmon set out to study them, and Weinstein approved.
The included data referred to the past activity of about thirty between psychiatrics, psychologists and social workers working in the clinic. In all cases, the most frequent length of the therapies was of one single session.
The context does not matter
Subsequently, the author studied more than 100.000 encounters over a period of 5 years (1983-1988) and the results he found were always the same. Further studies measured that a single session occurs in 20-50% of cases, and that, when SST is intentionally delivered by the therapist, the percentage of therapies of a single encounter increase up to 80% (Talmon, 1990; Hoyt & Talmon, 2014).
Bloom (1975) examined the frequency of single sessions within both the public and private systems in the United States, which resulted nearly the same. These findings were confirmed by Koss (1979), who noticed that in a sample of patients turning to the private system, the rate of drop-outs after a single session was equal to the one of patients asking for help to the public system. Same results were also retrieved in family services (Kogan, 1957a, 1957b, 1957c), private psychiatric clinics (Spoerl, 1975), private and public mental health services (Bloom, 1975).
A conscious choice
Why did the 20-50% of patients choose to attend one single session?
Some people could say that the clinicians were not able to build a therapeutic relationship, that the reason is the lack in motivation, that the cost of the service was too high, or that the kind of disorder was overly disabling.
All true. But this is not all.
Talmon showed that 30% of the patients receiving a first session of therapy at the Kaiser Permanente Medical Center, deliberately chose to attend only a single session, even if they were offered to continue the therapy (Talmon, 1990).
The author – together with an external researcher that helped to minimize his influence – also contacted on the phone 200 of the patients he met on a single occasion, asking why they chose not to continue the therapy: he found out that 78% of them considered a single session to be sufficient, as feeling “improved” or “very improved” – while only 10% declared that they did not like the therapist or the therapy.
Further, when Hoyt, Rosenbaum and Talmon conducted their first pilot study in Single Session Therapy (1992), 58% of the patients considered a single session to be enough to feel better.
Similarly, Weir, Wills, Young & Perlesz (2008) observed that more than 40’000 out of 100’000 patients evaluated one single session to be sufficient to solve their problem, even if they were given the choice to continue the therapy.
Silverman and Beech (1979), after finding that 80% of the individuals that attended a SST to be satisfied, affirmed that “the idea that drop-outs represent failures of the clients or of the intervention system”, rather than a conscious choice, “is clearly unsustainable”.
It’s for every disorder
Another question is: “which patients benefit the most from a SST?”
Finding from the first study of Hoyt, Rosenbaum and Talmon (1992) revealed that, although SST is not suitable for everyone (not everyone can benefit from one single session of therapy, and this is indisputable), it can suites everything (almost the totality of problems, even the most severe and disabling). Specifically, the main problems considered by the authors were:
- depression
- insomnia
- panic attacks
- normal reactions to anxiety for which subjects seek assurances
- reaction to divorce adaptation
- domestic violence
The study considered subjects of different gender, age and ethnicity, and the therapeutic encounters were organised for individuals, couples or families.
Notably, no success was obtained in persons presenting neurological problems.
Conclusions
- The most frequent number of sessions in psychotherapy is 1.
- This is valid for every context of care.
- 20% to 50% of patients do not need a second therapeutic encounter.
- 80% of the patients attending a single session declared to have solved or very improved their problem.
- SST may be suitable to treat every problem, but not every person.
Flavio Cannistrà
Psychologist, Psychotherapist
Founder Italian Center for
Single Session Therapy
Bibliographical references
Bloom, B. L. (1975). Changing patterns of psychiatric care. New York: Guilford Press.
Hoyt, M. F., Rosenbaum, R. L. & Talmon, M. (1992). Planned single-session psychotherapy. In S.H. Budman, M.F. Hoyt & S. Friedman (eds.), The First Session in Brief Therapy (pp. 59-86). New York: Guilford Press.
Hoyt, M. F. & Talmon, M. (2014). Capturing the Moment. Bancyfelin, UK: Crown House (Tr. it. in pubblicazione).
Kogan, L. S. (1957a). The short-term case in a family agency. Part I. The study plan. In Social Casework, vol. 38, 231-238.
Kogan, L. S. (1957b). The short-term case in a family agency. Part II. Results of study. In Social Casework, vol. 38, 296-302.
Kogan, L. S. (1957a). The short-term case in a family agency. Part III. Further results and conclusions. In Social Casework, vol. 38, 366-374.
Koss, M. P. (1979). Lenght of psychotherapy for clients seen in private practice. In Journal of Consulting and Clinical Psychology, vol. 47, 210-212.
Silverman, W. H. & Beech, R. P. (1979). Are dropouts, dropouts? In Journal of Community Psychology, vol. 7, 236-242.
Spoerl, O. H. (1975). Single session psychotherapy. In Diseases of the Nervous System, vol. 36, 283-285.
Talmon, M. (1990). Single-Session Therapy. San Francisco: Jossey Bass (Tr. it. Psicoterapia a seduta singola. Trento: Erickson, 1996).
Weir, S., Wills, M., Young, J. & Perlesz, A. (2008). The implementation of Single Session Work in community healt. Brunswick, Australia: The Bouverie Centre, La Trobe University.