Sometimes it happens that some people suffer from ailments and symptoms related to their personal history, their way of constructing reality, the dynamics in which they are inserted, etc. Other times it is external events that get a grip on us and create such an upheaval as to bring even the most balanced and equipped personalities to their knees.
We recently had dramatic proof of this with the earthquake that hit central Italy. There have been other natural disasters in the past that have questioned wellness professionals on the most effective and appropriate ways to intervene in similar circumstances.
A clear devastating example of this was Hurricane Katrina, the coldest hurricane in the history of the United States, which in August 2005 crossed Florida and gained strength by crossing the Gulf of Mexico, to subsequently overwhelm Louisiana with a following of damages estimated to be over center billion dollars and more than 1,836 deaths. On that occasion, the Red Cross had sent hundreds of mental health professionals to provide relief, and the way in which the aid took shape was mainly in the form of Single Session Therapy.
The experience of Hurricane Katrina
John K. Miller (2010) says that he was at first very skeptical about the possible effectiveness of an intervention set up in Single Session but that he changed his mind very soon. The emergency situation was such that not only were there no office spaces available in which to carry out therapeutic work in the traditional setting, but in many areas there was still a lack of electricity and water. The people affected by the disaster therefore had the most disparate needs: there were those who lacked basic necessities and shelter, those who lacked information, those who needed to get back in touch with their families, those who needed to overcome the trauma of a sudden evacuation, or of the upheaval of their own life as they had always known it, or of overcoming the dramatic and sudden mourning of family members perished in the calamity …
It was therefore an emergency situation in the strict sense, in which all the prerequisites for intervention had to deal with the real availability of physical resources and time both of the operators and of the people who asked for their intervention. In short, the hurricane had also ended up catapulting psychologists out of their studies in the midst of a crisis situation that required by its very nature to be maximally effective and efficient in the space of a single meeting.
In order for this to be possible, some precautions were adopted, both in the initial definition of the work that would be carried out together, and in the questions that would have allowed the problem to be configured in functional terms for a possible change.
The most effective questions
As mentioned, before asking the questions it is good to take some precautions, such as contextualizing the situation with the person. For example, in the context of Single Session Therapy in the context of an emergency, one can say: “Before starting, I would like to take a minute to explain to you how we work. As you know, this is a voluntary support service. You can contact us whenever you want and can, just like you did now, and you can access this service for free and without the obligation to return for a subsequent appointment. My hope today is to work together in the time we have – usually around 50 minutes – to help deal with things better. If you want, you can freely come back for further advice whenever we are there; it may not be me again, but you will still find a colleague from the same service who will be happy to talk to you.
If asking is not asking a harmless question, but also defining a horizon and orienting its direction, what tools can a clinician use to generate change in a single session? Which questions can allow the therapist not only to gather information on the problem, but also on the solutions, in order to co-construct a pragmatically useful dimension of work?
Experience with Hurricane Katrina has allowed us to identify some of these key questions. Here are some of them, by way of example, that allow you to work in this direction not only in crisis situations, but more overall to put order in the priorities of intervention and to focus resources:
- “What’s the first biggest concern you have right now?”
In the confusion generated by an abrupt existential change, the first step is to be able to focus on what are the priority needs for urgency and importance towards which to direct attention and energy, without losing sight of the broader context in which they are inserted.
- “What solutions have you already experimented with?”
Questioning the attempted solutions fulfills two fundamental tasks: on the one hand it allows to avoid the repetition of errors already practiced in bankruptcy in the past (Watzlawick et al., 1975); on the other hand, it allows you to ride responses that the person has instead experienced positively, perhaps in dealing with previous traumas (de Shazer & Dolan, 2007). Both of these aspects are crucial because they allow us to put to good use what the person has already learned about himself through his own resources, and therefore to give him back an image of himself as an integral and active part of his own healing process, of which is the protagonist.
- “What personal resource of yours would it be useful if we knew about you?”
It is essential for change operators to know and make all possible elements of resilience available to common therapeutic work – from a sense of self-efficacy, to humor, to creativity, etc. – on which you can leverage.
- “What would be the smallest change that would show you that things are going in the right direction?”
If a journey of a thousand miles begins with the first step, clearly identifying what it may be is crucial (Hoyt, 2009). Working with the other towards the definition of a clearly identifiable result at the end of each session allows you to recover an operational direction, to restore a sense of personal agency to the person and to identify any problem, even the most enormous, as pragmatically addressable. At the end of the meeting, the results will be evaluated based on the achievement of that first fundamental goal, and not necessarily the entire problem.
The most important resource
There are many lessons that dramatic situations like that of Hurricane Katrina can suggest to us. One for all, he can remember that even in the face of a destructive natural disaster such as that of a hurricane of this magnitude, it is possible to intervene extremely effectively through a single session. Indeed, by its very single intervention configuration, it can confirm what is perhaps the most powerful resource of all, which is to remember that resilience is natural, and people’s abilities are the most important part of the healing process.
Tania Da Ros
Psychologist, Psychotherapist
Trainer of the Italian Center
for Single Session Therapy
If you want to know more about Single Session Therapy and learn more about the method, you can read our link (click here) “Single Session Therapy. Principles and Practices ”.
Bibliography
de Shazer, S. & Dolan, Y. (2007). More Than Miracles: The State of the Art of Solution-Focused Brief Therapy. New York/London: Routledge.
Hoyt, M.H. (2009). Brief psychotherapies. Principles & practices. Phoenix, AZ: Zeig, Tucker & Theisen (Tr. it. Psicoterapie brevi. Principi e pratiche. Roma: CISU, 2016).
Miller, J.K. (2010). Single-Session Intervention in the Wake of Hurricane Katrina: Strategies for Disaster Mental Health Counselling. In A. Slive & M. Bobele (eds.) When One Hour is All You Have: Effective Therapy for Walk-In Clients. Phoenix, AZ: Zeig, Tucker & Theisen.
Watzlawick, P., Weakland, J. & Fisch, R. (1975). Change. Principles of problem formation and problem resolution. New York: Norton & co. (Tr. it. Change. La formazione e la soluzione dei problemi. Roma: Astrolabio, 1975).