In today’s article, the method of Single Session Therapy (SST) in practice will be illustrated through a clinical case. The SST interview presented was conducted by Dr. Valeria Campinoti, psychologist, psychotherapist, and member of the Italian Center for Single Session Therapy. The case does not depict a real story but is an example inspired by several situations, modified and made unrecognizable.
Case Presentation
- contacted me by phone to schedule an online appointment. On the phone, she told me that she had completed her university exams and that she was just missing the final step of writing her thesis to finish her studies. The problem, however, is that she is completely blocked when it comes to writing the thesis, and every time she tries, she can’t do it. We scheduled the appointment and met a few days later.
V: Good morning, F.! Nice to meet you. If it’s okay with you, we can use first names, right?
F: Yes, of course!
V: Great! Before we begin our session, I’d like to explain a bit about how I work and, especially, to give you a bit of background. My door (even virtually) is always open for my clients. However, some clients find that a single session is all they need, and they don’t feel the need for further appointments. Others, on the other hand, feel that they need more sessions. Both solutions are fine because each person and each difficulty is different. I’m telling you this because when we finish our session today, you will be the one to tell me if you feel you need another meeting or if today was enough for you. As I said before, my door is always open for you. (openness and dissemination)
F: Okay, Valeria! I really hope to resolve this block as quickly as possible because this situation is really frustrating me.
V: Of course, I can imagine! Let’s try our best to work through this block. Would you mind telling me more about what you mean? (request for a clearer definition of the problem)
F: Well, I’ve finished all my exams, and I have a really high average—my GPA is 29.5… I chose my thesis supervisor, and I’m happy with the topic of my thesis. Over the past few months, I’ve worked hard to gather the material and select the most suitable books, but every time I think about starting to write the thesis, I feel awful.
V: What do you mean when you say you feel awful? (request for more details to clarify the problem)
F: I get anxious, I start thinking I don’t know where to begin, then my heart races… and I try not to think about it, postponing the task to the next day.
V: But the same thing happens the next day, right?
F: Yes, exactly… and just feeling the time passing makes the frustration worse. I’ve been stuck like this for 2 months! And 2 months is a long time for me since I’ve always done everything on time, by the deadlines. Then it makes me angry because I really can’t wait to graduate, start working, and put into practice everything I’ve studied!
V: So, F., if I understand correctly, you have everything ready to write your thesis, which would allow you to achieve the goal you desire so much, but what happens when you think about it and try to write it is a feeling of anxiety, tachycardia, thoughts, and the passing of time, which for you, someone who has always been on track, increases the frustration. (paraphrasing and reformulating)
F: Yes, exactly… I don’t recognize myself anymore, and that really bothers me.
V: Could you explain a bit more about what happens when you try to write the thesis?
F: Usually, I take my laptop and books and sit at my usual spot, in my room at my desk. Even while I’m gathering everything, I start thinking about the last time I tried the same thing. So, when I sit down and open my laptop, I already think, “You won’t be able to write.” And when I open Word and see that blank page… I freeze. (raises hands and extends arms forward as if blocking something)
V: (mirroring F.’s gesture) When you see that blank page, you freeze… (mirroring)
F: I freeze. It’s like my brain is both empty and full at the same time. I can’t even move a finger! As soon as my hand goes over the keyboard… blackout!
V: And then what happens?
F: Then I force myself to wait… but this waiting period is getting shorter and shorter. Yesterday, after 5 minutes, I slammed the laptop shut and cried. Not being able to do this is making me feel terrible.
V: I can imagine… F. Listen… what needs to happen today so that when we finish, you’ll feel that it was a useful session for you? (defining the session’s goal)
F: I want to break through this block, start writing. I know the problem is all in the beginning, in my inability to start. I don’t know why… but I know that once I start, the rest will be downhill.
V: Okay! So today’s session should focus on helping you start writing your thesis, right? (feedback and agreement on the goal)
F: That’s definitely the thing I want the most!
V: Great! What have you tried doing, F., to break through this situation? (exploring previous attempts to solve the problem)
F: Well… I’ve tried everything, Valeria. But I haven’t made any progress! I started going to the library, even though I’ve never felt comfortable studying there over the years. Still, nothing worked. I went a couple of times, but with no results. Then I involved my coursemates, asking if we could meet and write our theses together, since we’re supposed to graduate in the same session…
V: But it seems like that didn’t work…
F: No, actually, I think it made things worse… especially because my friends were writing quickly, and I wasn’t. I was stuck, motionless like a statue! It was humiliating…
V: I can imagine! Do you remember other things you’ve tried to solve your difficulty?
F: Hmm… Sometimes I searched online for articles, maybe even on blogs or student forums, to see if others had the same problem and if they had overcome it in some way. But I only did that 2 or 3 times over these months. Then it just confused me more, and I gave up.
V: Yes, I agree that it’s best to let go of that solution. Sometimes we use the internet like the book of answers, but not all answers are right for every situation and every person. And I’ll also tell you that we often engage in behaviors trying to solve the problem, but they not only don’t solve it, they often make it worse! Do you think the things you mentioned earlier were good solutions for you? (restructuring paraphrase)
F: I’d say no… actually, as you said, they just made me freeze even more, to the point where I felt like I could only stay still… and the thing that frustrates me the most is the waste of time!
V: It seems that wasting time is a big issue for you. You know, if you have time, you can waste it. But you, no. You don’t have the time, nor the desire, to waste it. And the more aware you are of the value of time, the more frustrated you feel when you waste it. Has this ever happened to you before? I imagine you wrote your thesis for your bachelor’s as well. How did that go?
F: What you said about time really struck a chord with me… and it even made me a bit angry at myself. Anyway… for my bachelor’s thesis, it was a completely different story. I wrote it quickly, without any problems! In fact, one day I forgot to save the file, and I lost 10 pages. Ten long pages of work. I cried, but then I rolled up my sleeves and rewrote them. Maybe even better than before, you know.
V: How did you manage to write your thesis quickly without any problems in that case? (exploring resources and exceptions to the problem in a similar situation)
F: Well, you know, I didn’t do anything special… I went to the library to get books, read them, highlighted, and then processed everything.
V: So, it seems like you know how to write a thesis! (smiles)
F: Well, yes… you know, in these two months, I never thought about the fact that I wrote my bachelor’s thesis! (laughs)
(We stay silent for a moment)
F: I just realized that for my bachelor’s thesis, I set specific times during the day. Back then, I worked as a waitress, so my whole week was organized around shifts, and everything had to fit in.
V: How about now, how is your day organized?
F: Now I wake up, go for a walk, then I come home and start thinking I should dedicate at least 4 or 5 hours to the thesis, either the whole morning or afternoon. But then this thought just kills me because I know I won’t do anything. I sit down, take the books, and waste time, getting lost in thoughts. I think I can’t do it, I think I’ll do a mediocre job, and I keep catastrophizing. The day goes by like that, with attempts to write and a thousand distractions.
V: You know… dedicating a lot of time to something doesn’t always mean you’re giving it quality time. (restructuring)
F: Hmm… (sighs)
V: So, F., do you think organizing your day into slots dedicated to the thesis could help? (feedback and exploring solutions in session)
F: Actually, that’s something I haven’t tried these past months. I should give it a go.
V: Great, it seems like you’ve found a path.
F: Yes… maybe, partly.
V: To make this solution work even better, we need to add a little piece. But before I tell you, there’s something I want to say: sometimes I ask people to do certain exercises, even though they might seem “impossible” to carry out, and the person may feel like they’re “doing it wrong” or doing something strange. In these cases, I ask you to continue with the agreed exercises, despite any feelings or thoughts about the exercises themselves. Some therapeutic techniques can only be explained later, so initially, it’s important to just follow through with what was agreed, even if you don’t fully understand it. If it feels absurd, if you’re bored, if it’s difficult, if it seems like you’re wasting time, or if it feels like you’re doing the exercise wrong, I still ask you to continue. Okay?
F: Yes, sure.
V: F., I want you to set a daily appointment with your books, at the same time every day, in the same place, with everything you need to write your thesis. Clear your desk of unnecessary things and things that could distract you, like your phone or anything else. Set a timer for 45 minutes. For example, if you decide to start at 10:00, set the alarm for 10:45. What you need to do in those 45 minutes is NOT write your thesis. So, I want you to stay there, sitting in front of your laptop, your books, your notes, but you’re absolutely prohibited from writing your thesis. During those 45 minutes, I’m only asking you to NOT write your thesis. (paradoxical prescription)
F: Hmm… this is all very strange, but I’m curious. I’ll give it a try…
V: Great, F.! It seems like a lot of things have come up in this session, right? And it seems like you really have a lot of resources. What would you like to do now? Since my door is always open for you, do you think you want to make another appointment, or would you prefer to check in with me in 2-3 weeks, see how things go, and then decide?
F: I want to start putting this new strategy into action tomorrow, see if it works, so I think I’ll stop here for now.
V: Perfect. We’ll check in anyway in 3 weeks to see how things are going, and you’ll update me. Thank you.
F: Thank you, too.
Three weeks later, as agreed with F., I call her for an update on the work we did together. F. answers the phone with a bright voice and immediately exclaims, “I wrote it!” I immediately congratulate her and ask her to tell me how the past weeks have gone. F. shares that the first 3 days were a real struggle: she sat down with her books, and although the initial moments were filled with thoughts and worries about the thesis, she then became annoyed because she felt like she was wasting time. She admits that she stuck with it for 3 days, and by the third day, she had opened one of the books to read the index and highlight the relevant chapters for the thesis. By the fourth day, she says, “I couldn’t take it anymore! Those 45 minutes seemed like the worst thing that could happen to me, and rather than staying there frozen, I started writing.” She tells me that she initially drafted a provisional outline of the thesis, along with the introduction, and spent the rest of the time organizing the material she had. By the fifth day, she says, “I exploded, in a good way, haha… I started writing and didn’t stop until the timer went off!”
I congratulate F. on the great work she’s managed to do in such a short time and ask her about the next steps. She says she’s finished writing the first chapter of the thesis and is waiting for feedback from her supervisor. She also feels much better emotionally; the worries are gone, and she has resumed studying with her classmates, both in the library and elsewhere. She’s very happy that she’ll graduate in the session she had planned and has even started looking into internship opportunities for when she graduates.
At the end of the call, after reminding F. that my door is always open, she thanks me emotionally and says that she’ll continue on her own towards graduation, adding that it would be nice for her to send me a photo of that day.
Indeed, 4 months later, F. smiles in a photo holding her thesis in her hands, wearing a laurel crown.
Valeria Campinoti
Psychologist, Psychotherapist
Team of the Italian Center for Single Session Therapy