In this article we address a topic that is of profound interest to both scholars of Single Session Therapy and those who are eager to learn it, namely the existence or otherwise of criteria for establishing its use with clients.
Windy Dryden (2019), one of the most important scholars of Cognitive Behavioral Therapy in the world and a scholar of psychotherapies, maintains that there are two different ways of addressing the issue: the first is the one which provides for the existence of indications and contraindications, the second is the one that does not foresee any at all.
What kind of indications and contraindications do therapists rely on the existence of criteria to decide whether or not a client can receive a TSS intervention?
Let’s see some!
TSS can be indicated with :
People who have daily living problems (non-clinical/emotional) such as non-pathological anxiety, depression, guilt, shame, anger, grief, jealousy and envy, or relationship problems at home and work .
People who experience self-discipline issues on a daily basis .
People predisposed to single intervention and ready to take care of their non-clinical problems , especially to prevent more serious problems.
People predisposed to single intervention and ready to take care of their own clinical problems such as simple phobias (Davis III et al ., 2012) or panic attacks (Reinecke et al ., 2013).
Stuck people who need help to free themselves and move forward.
People who see therapy as intermittent help throughout the life cycle.
People with personal development or coaching goals .
People with clinical problems , but ready to tackle a non-clinical problem, for example, a person with a personality disorder who wants help to overcome the problem of procrastination.
People who are open to therapy, but want to try it before committing.
People who want preventative care .
People with meta-emotional problems (e.g. shame of being anxious).
People who require timely and targeted crisis management.
People with life dilemmas or who have an upcoming decision to make.
People with adjustment problems or looking for advice on managing relationships with others.
People prepared to engage in just one therapy session.
People who are in one place for a short time and need help at that time.
People who are volunteering for a demonstration session in front of an audience (Dryden, 2018a) or who are volunteering for a videotaped demonstration session.
Therapy clients seeking a second opinion or wanting brief help with a problem that their therapist can’t or won’t help them with.
Therapy trainees who want to discover what it’s like to do therapy from a different perspective.
TSS is not indicated with :
People requiring ongoing therapy . If someone wants ongoing therapy, they are not inclined to consider it even though they could benefit from it.
Those who require ongoing therapy . People who have many problems are likely to need much more therapy than can be provided with SST.
Customers who are vague about their problems and cannot be specific.
Where the client finds it difficult to quickly develop a therapeutic relationship or may experience abandonment by the therapist.
Let’s see, instead, what type of approach do therapists adopt who do not believe they need to identify criteria for Single Session Therapy?
According to Dryden (2019) two groups of therapists can be distinguished , the first group is that of integrated SST and the second group is that of walk-in therapists .
The integrated SST group starts from the assumption that by incorporating SST into its service system (offering the client both the possibility of returning whenever he wants and of accessing all the other services provided by the organization after an initial session) it allows the professional and for the organization to avoid the difficult, if not impossible, decision of determining who is eligible or not for a single intervention (Young, 2018).
The walk-in therapy group , made up of therapists who work in services that by their nature offer therapy to those who need it and want to use it at that moment, would always offer their help within the walk-in paradigm of a single session , even in the case of a risk assessment.
But if we looked at the problem from the therapist’s point of view, what indications and contraindications would there be for SST?
Since, as Dryden (2019) states, not all therapists are interested in practicing SST and those who are, not all of them will become professionals capable of using it effectively, let’s look at some criteria present in the literature.
Flexibility and pluralism appear among the indications that allow the therapist to practice effective SST (Dryden, 2017; Hoyt & Talmon, 2014; Talmon, 1990, 1993) .
By flexibility we mean the ability of the SST therapist to use the practices that really help the client and not those preferred by the therapist.
By pluralism we mean that the therapist must be able to maintain and embrace apparently contradictory positions at different times and with different clients. This will mean:
have faith in the power of SST and consider it more broadly in the context of the client’s life;
be open both to the possibility that SST may be the only session for the client, and that the person may request one or more additional sessions;
have the humility to know what you can and cannot do and be optimistic in expecting change to happen;
be able to work quickly on developing the relationship and help the client stay focused on a key issue and take their time without rushing the process;
prioritize the client’s perspective on the problem and what might constitute an appropriate solution, offering their perspective on these matters when appropriate.
In contrast, therapist contraindications for SST appear to fall into two main classes: rigidity and poor skill.
Ineffective TSS therapists are rigid in thinking and practice. The latter tend to think that SST should only involve carrying out a single session, considering it a failure if the client were to ask for more. With this rigid view in mind, therapists push the client too hard, producing resistance. Furthermore, by thinking they are the most important variable in promoting client change, they underestimate and underutilize the client’s strengths and resilience. Finally, ineffective SST therapists do not have the ability to practice, therefore they display poor skill.
Conclusions
In conclusion, to practice SST , even before identifying the criteria to be adopted to choose suitable people for a single session, two aspects are even more important to adopt it effectively: flexibility and the ability to train, keeping an open mind.
Angelica Giannetti
Psychologist, Psychotherapist
Team of the Italian Center
for Single Session Therapy
Bibliography
Cannistrà, F., & Piccirilli, F. (2018). Single Session Therapy: Principles and Practices . Giunti Editore.
Davis III, T. E., Ollendick, T. H. & Öst. L.-G. (2012). Intensive One Session Treatment of Specific Phobias . Springer.
Dryden, W. (2017). Single – Session Integrated CBT (SSI-CBT): Distinctive Features. Routledge.
Dryden, W. (2019). Single – Session Therapy. 100 Key points & techniques. Routledge.
Hoyt, M. F., & Talmon, M. (Eds.). (2014). Capturing the moment: Single session therapy and walk-in services . Crown House.
Reinecke, A., Waldenmaier, L. Cooper, M. J. & Harmer, C. J. (2013). Changes in automatic threat processing precede and predict clinical changes with exposure-based cognitive – behavior therapy
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Young, J. (2018). SST: The Misunderstood gift that keeps on giving. In M. F. Hoyt, M. Bobele, A. Slive, J. Young, & M. Talmon (Eds.), Single-session therapy by walk-in or appointment: Administrative, clinical, and supervisory aspects of one at a time services . Routledge.