Try thinking about an event that changes your life.
Done?
Now write it down and remember what happened. define the time for the event that changed and re-oriented your life. In most cases, the duration of significant events isn’t that long, isn’t it?
Taking a cue from daily life, you will have realized that often a corrective emotional experience (Alexander, 1946) is something that in a short time generates unexpected changes and progress.
Duncan and Miller (2000) present the data of a research in which there are significant changes at the beginning of the psychotherapy session, reinforcing the idea that the first interview has great potential, as we pointed out in the article “What is the correct term : Single Session Therapy or Psychotherapy? “
Searches
Long Duration, Short Duration or Single Session?
That is the question!
it is certain (Baldwin et al., 2009; Feaster, Newman & Rice, 2003; Harnett , O’Donovan & Lambert 2010) that substantial improvements in the early stages of therapy are followed by less progress in the continuation of the process. Along this line, McGarry and colleagues (2008) argue that a short intervention (1 to 3 sessions) was as effective as, and in some cases even more, long-term treatment.
Lebow (1997) argues that therapies in which no (or minimal) change occurs in the early stages risk leading to a null or even negative outcome of the process, worsening the initial situation.
A whole series of researches (so-called dose-effect studies, which in psychotherapy study precisely the “dose”, the number of sessions necessary to obtain significant changes – and the one beyond there are no longer – go in this direction: in first sessions, often in just one, you get the maximum results, if not everything you need.
The long life and the construction of a myth
The most popular theories learned in the training process have greatly influenced the private practice of numerous psychologists and psychotherapists.
The idea that for the success of a psychotherapeutic process it is necessary, almost mandatory, to search for deep roots, digging a lot and almost for a long time, allow me the provocation, opting for a self-flagellation aimed at expiating sins to return to live peacefully, was powered. The underlying matrix, linked to the need for a long duration, derives from the assumption that it takes a long time to change psychological beliefs, precisely because these beliefs prove to be resistant and therefore require time and sacrifice.
From here the “certainty” that to eliminate the malaise it is appropriate to act not so much on the symptom – with consequent criticism of the Short Psychotherapies – as on the underlying pathology, and to do this it is believed (or at least it was believed) that the main path was therapy long lasting.
Much researches, some already mentioned in our articles, shows that there is no direct correlation between duration and improvement.Barkham and colleagues (2006) establish that the change in a therapeutic process shows a progressive improvement over time until the person reaches a satisfactory level, after which the therapist and client move towards new goals.And a “satisfactory level”, as shown by field research, can also be obtained in a Single Session: it was a psychoanalyst, David Malan, who said that before a long or even short therapy it is necessary to propose a Single Session to the patient.
The myth of relapse
Other criticisms leveled at Short Psychotherapies derive from the possibility that people who have taken advantage of short therapy courses may, after a period of time, months or years, experience relapses with the accusation of a positive response to treatment that is only superficial.
Beyond the now countless studies that have shown the maintenance of the results of Single Sessions and short therapies over the years, it is precisely the assumption that is misleading.For example: an antibiotic treatment for an “X” problem done today, will solve the problem forever, avoiding that this, or others, may arise in the course of life? Or, as Watzlawick (2007) said, if the dentist solves the problem for us today, does that mean we will never have to go back?
From theory to practice: everyday life
O’Hanlon & Weiner-Davis (1989) list a series of assumptions that support and reinforce the meaning and motivation of a Single Session Therapy:
1 – Rapid changes are not only possible but extremely common in people’s lives,
2 – The therapist’s expectations regarding the change in the “time necessary for the change” are sent back, through verbal and non-verbal language, to the person with whom he is speaking, thus influencing the therapeutic process
3 – There is no direct correlation between the duration and severity of the problem and the duration of the treatment.
4 – There is much less need, than is believed, to have knowledge of the history of the disease and of the person.
5 – Clients are much less interested in psychotherapy than therapists: what they care about is feeling good.
6 – The biggest changes always occur in the first moments of a therapeutic process
“More” is not necessarily “better”
Drawing from these assumptions, the authors conceptualize some key points on why “more is not necessarily better”:
1 – A single work session is often the number preferred by clients: determining the time affects both the professional’s performance and the client’s collaboration.
2 – By communicating to the client that a single session may be sufficient, we restore power to the person and his or her resources, and consequently to the possibility of change.
3 – When a therapeutic process takes long-term drifts, people can introject the meaning of being in a serious condition.
4 – The shorter time guarantees the person more time for himself and is financially sustainable.
Conclusions
From the above it seems appropriate, if not mandatory as professionals of the helping relationship, to ask ourselves if the goal, which I remember is the well-being of the person, is not to achieve the result in the shortest possible time, also in consideration that many studies lead to the conclusion of as long-term psychotherapy is not the elective choice of treatments.
Years ago during a training I greatly appreciated the statement of the trainer that characterized the Vision of the help work: “Aiming for the self-extinction of the therapist”. Already reducing an intervention to a Single Session I believe is a step towards this goal on which, then as now, I fully agree.
Federico Piccirilli
Psychologist, Psychotherapist
Co-founder dell’Italian Center
for Single Session Therapy Bibliography
Alexander, F., French, T.M. (1946). Psychoanalytic Therapy: Principles and Application. New York: Ronald Press.
Baldwin, S.A., Berkeljon, A., Atkins, D.C. , Olsen, J.A. & Nielsen, S.L. (2009). Rates of change in naturalistic psychotherapy: Contrasting
dose-effect and good-enough level models of change. Journal of Consulting & Clinical Psychology, 77, 203–211.
Barkham, M., Mellor-Clark, J., Connell J. & Cahill J. (2006). A core approach to practice-based evidence: A brief history of the origins and
application of the CORE-OM and CORE System. Counselling and Psychotherapy Research, 6(1): 3-15.
Bobele, M. & Slive, A. (2011). When One Hour is All You Have. Phoenix: Zeig, Tucker & Theisen.
Cutler, D.M., Finkelstein, M. & McGarry, K. (2008). Preference Heterogeneity and Insurance Markets: Explaining a Puzzle of
Insurance. National Bureau of Economic Research (working paper).
Fester, D.J., Newman, F.L. & Rice, C. (2003). Longitudinal analysis when the experimenters does not determine when treatments end: What
is does response? Clinical Psychology and Psychotherapy, 10(6), 352-360.
Harnett, P., O’Donovan, A. & Lambert, M.J. (2010). The dose response relationship in psychotherapy: Implications for social policy. Clinical
Psychologist, 14 (2), 39-44.
Lebow, J. (1997). The Integrative Revolution in Couple and Family Therapy. Family Process, Volume 36, Issue 1, 23–24.
Miller, S. & Duncan, B.L. (2000). The Outcome Rating Scale. Chicago, IL: Authors.
O’Hanlon, W., Deiner-Davis, M. (1989). In search of solutions: a new direction in psychotherapy. W.W. Norton & Company, Inc: New York.
Watzlawick, P. (2007). Guardarsi dentro rende ciechi. Scritti scelti. Milano: Ponte alle Grazie.